Bacterial Meningitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

BACTERIAL MENINGITIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Bacterial Meningitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84345-7 1. Bacterial Meningitis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on bacterial meningitis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BACTERIAL MENINGITIS ........................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Bacterial Meningitis ..................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 17 The National Library of Medicine: PubMed ................................................................................ 21 CHAPTER 2. NUTRITION AND BACTERIAL MENINGITIS ................................................................. 65 Overview...................................................................................................................................... 65 Finding Nutrition Studies on Bacterial Meningitis .................................................................... 65 Federal Resources on Nutrition ................................................................................................... 68 Additional Web Resources ........................................................................................................... 69 CHAPTER 3. ALTERNATIVE MEDICINE AND BACTERIAL MENINGITIS ........................................... 71 Overview...................................................................................................................................... 71 National Center for Complementary and Alternative Medicine.................................................. 71 Additional Web Resources ........................................................................................................... 76 General References ....................................................................................................................... 77 CHAPTER 4. PATENTS ON BACTERIAL MENINGITIS........................................................................ 79 Overview...................................................................................................................................... 79 Patents on Bacterial Meningitis .................................................................................................. 79 Patent Applications on Bacterial Meningitis............................................................................... 86 Keeping Current .......................................................................................................................... 91 CHAPTER 5. BOOKS ON BACTERIAL MENINGITIS ........................................................................... 93 Overview...................................................................................................................................... 93 Book Summaries: Online Booksellers........................................................................................... 93 Chapters on Bacterial Meningitis ................................................................................................ 94 CHAPTER 6. PERIODICALS AND NEWS ON BACTERIAL MENINGITIS ............................................. 97 Overview...................................................................................................................................... 97 News Services and Press Releases................................................................................................ 97 Academic Periodicals covering Bacterial Meningitis................................................................. 100 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 103 Overview.................................................................................................................................... 103 NIH Guidelines.......................................................................................................................... 103 NIH Databases........................................................................................................................... 105 Other Commercial Databases..................................................................................................... 107 APPENDIX B. PATIENT RESOURCES ............................................................................................... 109 Overview.................................................................................................................................... 109 Patient Guideline Sources.......................................................................................................... 109 Finding Associations.................................................................................................................. 111 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 113 Overview.................................................................................................................................... 113 Preparation................................................................................................................................. 113 Finding a Local Medical Library................................................................................................ 113 Medical Libraries in the U.S. and Canada ................................................................................. 113 ONLINE GLOSSARIES................................................................................................................ 119 Online Dictionary Directories ................................................................................................... 119 BACTERIAL MENINGITIS DICTIONARY............................................................................. 121 INDEX .............................................................................................................................................. 173

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with bacterial meningitis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about bacterial meningitis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to bacterial meningitis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on bacterial meningitis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to bacterial meningitis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on bacterial meningitis. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON BACTERIAL MENINGITIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on bacterial meningitis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and bacterial meningitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “bacterial meningitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Hearing Impairment After Bacterial Meningitis: A Review Source: Archives of Disease in Childhood. 67(9): 1128-1133. 1992. Summary: This journal article, intended for health professionals, reviews the recent literature on the incidence of hearing impairment following bacterial meningitis. The article discusses the rate of hearing impairment following bacterial meningitis, possible predictive factors, the permanence of hearing loss following bacterial meningitis, and possible means of reducing the risks of postmeningitic sensorineural hearing loss. It recommends that all children recovering from bacterial meningitis be referred for audiological assessment before discharge from the hospital. Bibliographic references are included.

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Federally Funded Research on Bacterial Meningitis The U.S. Government supports a variety of research studies relating to bacterial meningitis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to bacterial meningitis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore bacterial meningitis. The following is typical of the type of information found when searching the CRISP database for bacterial meningitis: •

Project Title: A MENINGOCOCCAL LOS VACCINE Principal Investigator & Institution: Griffiss, John M.; Associate Professor; Northern California Institute Res & Educ 4150 Clement Street (151-Nc) San Francisco, Ca 941211545 Timing: Fiscal Year 2003; Project Start 15-JUN-2003; Project End 30-NOV-2005 Summary: (provided by applicant): Meningococcal disease primarily affects infants and very young children. The group B capsule is not immunogenic, and outer membrane protein vaccines provide only short-lived protection, in older children, that is restricted to serotypes in the vaccine. Protection is mediated by bactericidal antibodies that are induced by asymptomatic colonization by organisms that share lipooligosaccharides (LOS). By adolescence most children have LOS IgG that are bactericidal for most meningococcal strains. These antibodies prevent meningococcal disease, regardless of protein serotype. LOS are immunogenic at birth, and LOS antibodies can be induced by vaccination. During disease, infants make bactericidal antibodies against their infecting strains. These antibodies bind to a conserved LOS structure that is expressed well by 126E (L1,8), other L1 strains, and by L3,7 and L4,6 strains. This structure has not been definitively identified. LOS antibodies induced during infancy can prevent the monoclonal antibody (mAb), D6A, from binding to 126E LOS, and we have used this mAb, which binds to meningococci of all groups and types, as a surrogate for the LOS structure. MAb D6A binds the deeply truncated LOS of deltagalE mutants that have only a conserved basal structure, but it is not clear that this truncated LOS is the optimal immunogen. We now propose to affinity purify human IgG that binds the conserved LOS structure by 1) passage of IVIG over deltagalE LOS, and 2) by sequential passage of IVIG over L1, L1,8, L3,7 and L4,6 LOS, each coupled to Sepharose. We will assess how well each IgG kills 34 consecutive and unique endemic meningococcal case strains, and whether they can opsonize these meningococci for PMN killing. We will compare the binding of this pauciclonal IgG (pclgG) to that of mAb D6A and use Mass Spectrometry combined with chemical and enzymatic degradations to confirm the LOS structure recognized by mAb D6A and pclgG. We will immunize transgenic mice that have

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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human immmunoglobulin loci (XenoMouse) with a deltagalE mutant to insure that this LOS structure is immunogenic for the human immune system, and characterize the functional activity of the induced IgG, as for the IVIG IgG. We will use enrichment of a coliphage display library with mAb D6A to identify a peptide mimic of the mAb D6A LOS antigen, use this peptide to immunize XenoMouse mice and functionally charaterize the induced IgG. We also will try to identify a peptide mimic that binds the human pclgG. The resulting data should confirm the suitability of a conserved LOS structure as a vaccine for the prevention of endemic group B disease in infants and young children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BACTERIAL PHOSPHORYLCHOLINE AND PATHOGENESIS Principal Investigator & Institution: Weiser, Jeffrey N.; Associate Professor; Microbiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 30-JUN-2004 Summary: Description (Adapted from Applicant's Abstract): The bacterial cell surface is generally considered to be highly divergent from species to species. An exception to this rule is the expression of phosphorylcholine (ChoP). This unusual prokaryotic structure is now known to be exposed on the surface of the most common pathogens infecting the human respiratory tract; Haemophilus influenzae, mycoplasma, and Streptococcus pneumoniae. In addition, based on cross-reactivity to a MAb recognizing this structure, ChoP may be present on diverse phase-variable structures on N. meningitidis, N. gonorrhoeae, P. aeruginosa, and A. actinomycetemcomitans. We have defined the genetic basis of ChoP expression and the molecular mechanism controlling its phase variation in H. influenzae. This has allowed direct genetic analysis of clinical samples to show that the ChoP+ phase variants predominate on the mucosal surface of humans. The structure, however, is the target of innate immunity mediated by binding of C-reactive protein (CRP), which is bactericidal in the presence of complement. The focus of this proposal is to define the biological role of variants both with and without ChoP using H. influenzae as a prototype human respiratory tract pathogen. In Aim 1, we will determine whether switching to the ChoP- phenotype is required in natural H. influenzae infection (otitis media, pneumonia, bacteremia, and meningitis) to evade clearance by CRP and bactericidal anti-ChoP IgG. The ChoP phenotype in vivo will be determined by direct genetic analysis and compared to the local concentration of CRP and anti-ChoP antibody during infection. The local expression and concentration of CRP in the upper respiratory tract will be investigated. In Aim 2, we will determine how ChoP contributes to persistence on the mucosal surface. Genetically defined H. influenzae mutants with constitutive ChoP-on and ChoP-off phenotypes will be used to determine whether this host membrane-like structure contributes to (a) resistance to respiratory tract antibacterial peptides including LL-37 and tracheal antimicrobial peptide (TAP), and (b) colonization by functioning as a bacterial adhesin to host epithelial cells via putative ChoP ligands including GalNAcb 14Gal on the asialo-GM1 glycolipid and the platelet activating factor receptor. The blocking of complement mediated killing by naturally acquired secretory IgA recognizing ChoP will be explored as an explanation for the selection of the ChoP+ phenotype on the mucosal surface, despite the increased susceptibility of this phenotype to CRP and complement. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BACTERIAL VACCINE ANTIGEN DISCOVERY Principal Investigator & Institution: Paoletti, Lawrence C.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): New directions in bacterial vaccine discovery may arise from studies of host-microbe interactions, particularly through the use of a newly described technology: the dynamic in vitro attachment and invasion system (DIVAS). DIVAS was developed to study bacterial attachment and invasion with cells held at specific and controlled conditions of growth, metabolism, and nutrient levels. Results from experiments performed with DIVAS and group B Streptococcus (GBS) type III strains substantiated earlier findings that capsular polysaccharide is not critical for invasion of respiratory epithelial cells. Moreover, GBS invaded these cells only when held at a fast as opposed to a relatively slower rate of growth and they expressed several proteins solely under growth conditions conducive for invasion. In this proposal, we seek to test the hypothesis that GBS proteins involved with invasion of eukaryotic cells are new and important targets of protective immunity. GBS is a major cause of neonatal sepsis and meningitis, and is increasingly prevalent among nonpregnant adults and the elderly with underlying illnesses. Preclinical and clinical trials have been successfully performed with protein conjugate vaccines prepared with polysaccharides from most of the nine currently known GBS serotypes. GBS protein antigens with virulence properties have been described and some with vaccine potential have been tested preclinically. In this proposal, we seek to use DIVAS to identify physiological conditions conducive for bacterial attachment/invasion of eukaryotic cells using GBS as a model pathogen. We plan to isolate and identify GBS membrane proteins expressed solely under invasive conditions (Specific Aim 1). Several of these newly expressed proteins will be purified directly from GBS, or cloned and recombinantly expressed, and tested as vaccine candidates in mice (Specific Aim 2). Findings from these studies utilizing this unique approach to vaccine antigen discovery could be directly applied to other bacterial pathogens including those on the category A bioterrorism list. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MENINGITIS

BIOACTIVITIES

OF

PNEUMOCOCCAL

CELL

WALL

IN

Principal Investigator & Institution: Tuomanen, Elaine I.; Chair, Professor; St. Jude Children's Research Hospital Memphis, Tn 381052794 Timing: Fiscal Year 2002; Project Start 01-JUN-1989; Project End 31-JAN-2005 Summary: The pneumococcus remains the cause of meningitis with the greatest morbidity and mortality in children and older adults. This pattern persists despite the use of antibiotics of exceptionally rapid bactericidal activity. Over the past 10 years of this proposal we have sought to understand the biochemical basis of the inflammatory response to pneumococci in the subarachnoid space. We established that the pneumococcal cell wall is a library of inflammatory components which incites the cytokine, coagulation and arachidonate cascades and directly injures endothelial cells of the blood brain barrier. Further, we established that the release of cell wall during antibiotic-induced death engenders a dramatic host response that is responsible for serious injury to host tissues. This provided a rationale for use of agents like dexamethasone that can act as partner drugs with antibiotics to selectively control the injurious components of the host defense response. The current proposal seeks to determine the molecular details of the mechanism of pneumococcal invasion into brain

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and how neuronal cells are killed during meningitis. Blocking information decreases some sequelae of infection but does not appear to be sufficient in controlling neuronal loss, particularly for pneumococcal disease. Over half of the current survivors of this injection still have major permanent sequelae. Understanding this process will allow design of agents to specifically attenuate these ongoing losses. We propose to apply our expertise in the identification and characterization of pneumococcal surface components, to map the process of transcytosis across the blood brain barrier. We will identify the pneumococcal components involved, specifically focusing on CbpA. This protein is required for pneumococcal invasion. Secondly, we will characterize the process of pneumococcal translocation in terms of the intracellular vesicle and the signaling process. Involvement of the PAF receptor that binds pneumococci and sIgA that ligates CbpA in actual translocation will be determined. Finally, we will investigate preliminary evidence that upon inhibition of apoptosis suggest this is an important contributor to sequelae. The detailed mechanism appears to be novel and will potentially instruct cell biology as well as pathogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOMARKER OF NEUROPROTECTANT EFFICACY IN ALS Principal Investigator & Institution: Gabbita, Somasundar P.; Phase 2 Discovery, Inc. 3130 Highland Ave, 3Rd Fl Cincinnati, Oh 45219 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): The objective of this Phase I feasibility study is to develop a reliable biomarker of neuronal damage in a validated mouse model of amyotrophic lateral sclerosis (ALS). Currently, there is no widely accepted biomarker to quantify ALS-induced motor neuron injury. Previously, we have shown that neuronal degeneration in rodents and humans results in cleavage of the cytoskeletal protein MAP-tau. Our laboratory has developed a sensitive ELISA that specifically measures cleaved MAP-tau (C-tau) in rodent models of traumatic brain injury and bacterial meningitis. Using this C-tau ELISA assay, our preliminary studies demonstrate that spinal cord C-tau levels are tenfold higher in late stage symptomatic ALS (G93A-SOD1 mutation) mice as compared to control mice. Using a rotorod motor performance assay, Hensley et al. have recently demonstrated that administration of Nor-dihydroguaiaretic acid (NDGA) to ALS mice delays onset of neurologic deficits. We hypothesize that 1) Ctau is a reliable biomarker of motor neuron injury in ALS mice and 2) C-tau can serve as a screening tool to identify neuroprotectant drags for treating ALS. We will test these hypotheses by determining the relationship between C-tau levels and progression of neurologic deficits in ALS mice. Furthermore, we will test whether the demonstrated neuroprotectant effect of NDGA that delays onset of neurologic deficits in ALS mice also exerts expected effects on C-tau levels. Our Specific Aims are: Specific Aim 1: Compare spinal cord C-tau levels in ALS mice and control mice at 120 days. Specific Aim 2: Determine the relationship between C-tau levels and neurologic deficits in ALS mice as compared to controls. Neurologic deficits and spinal cord C-tau levels will be determined in ALS and age-matched control mice and statistically compared from the presymptomatic stages to late symptomatic stages of disease progression. Specific Aim 3: Determine if C-tau levels reliably quantify the effect of a demonstrated neuroprotectant drag intervention in ALS mice. C-tau levels and rotorod performance will be determined and compared as a function of NDGA treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BRAIN ENDOTHELIAL RECEPTOR FOR E. COLI Principal Investigator & Institution: Nemani, Prasadarao V.; Children's Hospital Los Angeles 4650 Sunset Blvd Los Angeles, Ca 90027 Timing: Fiscal Year 2002; Project Start 01-JAN-1997; Project End 30-APR-2006 Summary: (provided by applicant): Neonatal Escherichia coil meningitis continues to be a diagnostic and treatment challenge despite the availability of active antibiotics. Investigations on the understanding of the pathogenesis and pathophysiology are needed to develop novel strategies to prevent the high morbidity and mortality associated with this disease. OmpA of E. coil is one of the major factors responsible for E. coil traversal across the blood-brain barrier that constitutes a lining of brain microvascular endothelial cells (BMEC). Ecgp, a novel blood-brain barrier specific glycoprotein interacts with OmpA to induce actin rearrangement for subsequent penetration into the central nervous system, has been identified and characterized. Recombinant Ecgp significantly blocked the E. coli traversal across the blood-brain barrier indicating the biological relevance of OmpA-Ecgp interaction in the development of this disease. Ecgp itself is phosphorylated to interact with two BMEC cytoplasmic signaling proteins, FAK and Vav2. in response to E coli infection. The identification of ligand binding and signaling domains of Ecgp will help elucidate the molecular mechanisms of OmpA-Ecgp interaction and its importance in the pathogenesis and pathophysiology of E. coli meningitis. Hypothesis: OmpA-Ecgp interaction is a key step that signals BMEC for E. coil traversal across the blood-brain barrier to cause meningitis. The following are the specific aims to test this hypothesis: 1. Characterize the antigenic structure of Ecgp using monoclonal antibodies against Ecgp that block E. coli invasion of HBMEC both in vitro and in the newborn rat model of hematogenous meningitis. 2. Identify the minimum structures of the Ecgp extracellular domains that interact with OmpA responsible for E. coli invasion of HBMEC by molecular modeling and site directed mutagenesis of Ecgp. 3. Identify the intracellular motifs of Ecgp that interact with the HBMEC cytoplasmic proteins, FAK and Vav2. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEAFNESS AND OSSIFICATION IN LABYRINTHITIS OSSIFICANS Principal Investigator & Institution: Brodie, Hilary A.; Otolaryngology; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 01-JAN-2000; Project End 31-DEC-2004 Summary: (Adapted from the Investigator's Abstract) Labyrinthitis ossificans (LO) is the growth of pathologic new bone within the lumen of the cochlea. It is multifactorial in origin and may result in deafness. Profound hearing loss and LO in children are most commonly associated with meningogenic labyrinthitis. The relationship of LO to meningogenic cochlear pathology and its mechanism of induction have not been clearly defined. Cochlear implants are a significant treatment option for improving hearing and quality of life in these patients. However, LO can reduce the efficacy of cochlear implantation. The long-term objective of this research program is to understand the mechanisms which lead to the development, progression, and destructive aspects of LO. Such an understanding may lead to new strategies to prevent the devastating effects of hearing loss associated with this disease. The specific aims of this application are: (1) to correlate hearing loss with the temporal and spatial progression of bacterial meningitis from the subarachnoid space to the cochlea; (2) to correlate hearing loss with the temporal and spatial sequence for both labyrinthine fibrosis and ossification and the histopathology of cochlear tissues: spiral ganglion, organ of Corti, Reissner's membrane,

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stria vascularis, and spiral ligament; (3) to determine the relationship of bone lining cells to osteoblast formation and recruitment during labyrinthine neo-ossification; and (4) to determine the effects of decomplementation, non-steroidal anti-inflammatory compounds, and bacteriostatic vs. bactericidal antibiotics on neo-ossification and hearing loss. There are four hypotheses/specific aims outlined and they are as follows: Bacterial invasion of the cochlear labyrinth from the subarachnoid space correlates with hearing loss and occurs principally via the cochlear aqueduct and not the internal auditory canal; The destruction of cochlear tissue occurs subsequent to the arrival of inflammatory cells and not with the appearance of bacteria within the cochlea. Hearing loss may occur prior to observable pathology and reflect central auditory damage related to meningitis; Bone lining cells of the endosteum are activated and become mature osteoblasts and are the principal source of neo-ossification in labyrinthitis ossificans; and The inflammatory response to suppurative labyrinthitis includes fibrosis and neo-ossification formation and causes cochlear tissue destruction. Inhibition of this process will result in a reduction in both hearing loss and bone deposition. Methods used: The investigators propose to use an experimental gerbilline model of LO, histomorphometry, fluorescent bone histomorphometry, transmission and scanning electron microscopy, autoradiography, and auditory brainstem evoked response. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: E COLI INVASION OF BRAIN ENDOTHELIAL CELLS Principal Investigator & Institution: Kim, Kwang S.; Professor and Director; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-MAR-1988; Project End 31-AUG-2004 Summary: Description (Adapted from the applicant's abstract): The mortality and morbidity associated with neonatal bacterial meningitis have remained significant despite advances in antimicrobial chemotherapy and supportive care. Inadequate knowledge of the pathogenesis and pathophysiology has contributed to this high mortality and morbidity. E. coli is the most common gram-negative organism that causes meningitis during the neonatal period. Most cases of E. coli meningitis in newborns develop as a result of hematogenous spread, but it is not clear how circulating E. coli cross the blood-brain barrier. We have established an infant rat model of experimental hematogenous meningitis which mimics human E. coli meningitis (e.g. hematogenous infection of meninges). We have also established an in vitro model of the blood-brain barrier with brain microvascular endothelial cells (BMEC). Using these in vitro and in vivo systems, we have shown that invasion of BMEC is a requirement for E. coli K1 crossing of the blood-brain barrier in vivo. During the previous funding period, we have shown that several E. coli K1 determinants contribute to invasion of BMEC in vitro and crossing of the blood-brain barrier in vivo (i.e., OmpA, IbeA, IbeB, IbeC, CNF1). We also showed that E. coli K1 invasion of endothelial cells is specific to BMEC, and no such invasion was observed for endothelial cells of non-brain origin. We have so far shown that some of the E. coli proteins (e.g., OmpA, IbeA) interact with specific receptors present on BMEC, not on systemic vascular endothelial cells. In addition, we showed that actin cytoskeleton rearrangements are involved in E. coli K1 invasion of BMEC, as shown by invasive E. coli K1-associated F-actin condensation and blockade of invasion by cytochalasin D. Based on the resources and findings derived from the past funding period, we would like to examine the following specific aims. 1. To continue to identify and characterize microbial determinants contributing to E. coli K1 invasion of BMEC in vitro and in vivo 2. To examine the mechanisms involved in E. coli K1 invasion of BMEC, including structure-function analysis of E. coli proteins, and identification and

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characterization of BMEC receptors. 3. To determine host cell signal transduction pathways involved in E. coli K1 invasion of BMEC, including focal adhesion kinase (FAK), Rho and phosphatidylinositol (PI)3-kinase. Further understanding and characterization of these E. coli K1-BMEC interactions should allow us to develop novel strategies to prevent this serious infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EMERGING INFECTIOUS DISEASES AND URBANIZATION Principal Investigator & Institution: Ko, Albert I.; Medicine; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2003; Project Start 20-SEP-1997; Project End 31-MAR-2008 Summary: (provided by applicant): The Division of International Medicine and Infectious Disease, Weill Medical College of Cornell University (Cornell) has had a joint training and research program on endemic tropical diseases with Brazilian institutions in the city of Salvador since the 1964. More recently, the investigations of Cornell and its Brazilian collaborators have brought to attention infectious diseases, such as epidemic leptospirosis, which have emerged in the urban setting due to rapid urbanization and increasing social inequality. Through the Fogarty-sponsored International Training in Emerging Infectious Diseases (ITREID) Program, we have been established at the Oswaldo Cruz Foundation (Fiocruz), Brazilian Ministry of Health in Salvador: 1) a multidisciplinary team of epidemiologists, clinicians, microbiologists and basic researchers, 2) on-going population-based surveillance for leptospirosis and bacterial meningitis; 2) a diagnostic laboratory that is now the national reference center for leptospirosis surveillance; 3) a molecular strain typing center, and 4) field sites to perform community-based longitudinal studies designed to identify determinants of transmission for leptospirosis and the etiologic pathogens for bacterial meningitis. Moreover, ITREID projects have convinced the Brazilian government to prioritize emerging infectious diseases such as leptospirosis, and in turn have led to national projects to sequence the Leptospira genome and develop a vaccine against leptospirosis. The infrastructure created at Fiocruz since 1996 provides a vehicle to pursue multidisciplinary training approaches for emerging infectious diseases. In this proposal, we will use leptospirosis and bacterial meningitis as disease models to address the following specific objectives: 1) Expand training opportunities that will provide Brazilian trainees at Fiocruz the capacity to develop treatment, control and prevention strategies for emerging infectious diseases; and 2) Work jointly with the Brazilian Ministry of Health to disseminate expertise already established at Fiocruz in laboratorybased surveillance, outbreak investigations and molecular epidemiology to other regions of Brazil. The proposal emphasizes the use of in-country expertise and resources to provide training. For the first aim, we propose long-term training to 6 predoctoral and 2 postdoctoral fellows each year to address specific needs in expertise within the areas of clinical and field epidemiology, molecular epidemiology, pathogenesis and biotechnology application to develop public health interventions. In-country training provided by outstanding Brazilian mentors will be augmented with short training experiences in the institutions of long-standing US collaborators. For the second aim, Fiocruz will work with the National Center of Epidemiology, Brazilian Ministry of Health in providing short-term training opportunities and a yearly course, the National Course in Molecular Epidemiology in Emerging Infectious Diseases, which are designed to enhance the capacity of local public health epidemiologists and reference laboratory staff to perform laboratory-based surveillance and apply molecular strain typing tools to epidemiological investigations.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ESCHERICHIA COLI INVASION OF BRAIN ENDOTHELIAL CELLS Principal Investigator & Institution: Huang, Sheng-He; Children's Hospital Los Angeles 4650 Sunset Blvd Los Angeles, Ca 90027 Timing: Fiscal Year 2003; Project Start 01-JUL-1997; Project End 31-DEC-2007 Summary: (provided by applicant): E. coli K1 is the most common gram-negative organism causing neonatal meningitis. One of the least understood issues in the pathogenesis of this disease is how circulating E. coli K1 crosses the blood-brain barrier (BBB) to cause brain injury. We have demonstrated in the in vitro and in vivo models of the BBB that E. coli K1 invasion is a complex process mediated by multiple E. coli invasion determinants, among which the 50-kDa protein encoded by ibeA is unique to E. coli K1. A bovine IbeA-binding protein (IbeABP) has been isolated by IbeA-affinity chromatography from brain microvascular endothelial cells (BMEC). The ibeA locus is a genetic island of meningitic E. coli (GimA) containing 15 genes, which consist of four operons, ptnlPKC, cglDTEC, gcxKRCI and ibeRAT. IbeA is an important virulence factor contributing to E. coli K1-mediated invasion in BMEC and the 14 other genes may involve in energy metabolism. The regulatory protein IbeR carrying an as4-interaction domain belongs to the NtrC/NifA family of transcriptional activators. It has been shown that anaerobic growth and glucose greatly enhanced E. coli K1 invasion of BMEC. Based on these results, we have hypothesized that the ibeA locus-mediated invasion and energy metabolism are coordinate events in pathogenesis of E. coli K1 meningitis. Interactions between IbeA and its receptor induce cellular responses that are required for E. coli entry of BMECs. Invasion gene expression is regulated by the genetic island GimA including IbeR and environmental signals. Our hypothesis will be tested through the following Specific Aims. (1). To examine how IbeA contributes to E. coil K1 entry of human BMECs. (2). To further characterize the role of IbeABP in E. coil K1 invasion of human BMEC. (3). To determine how E. coil K1 invasion gene expression is regulated by the ibeA locus (GimA) including IbeR and environmental signals (glucose and oxygen tension). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FORMATION OF CORTICAL PLAQUES BY NEISSERIA Principal Investigator & Institution: So, Magdalene Y.; Chair; Molecular Microbiology and Immunology; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-MAY-2006 Summary: (provided by the applicant): The Neisseria type IV pilus modulates bacterial infectivity by mediating adhesion and inducing cell signaling pathways. Upon binding its receptor, CD46, the pilus causes a transient increase in cytosolic free Ca2+ levels, triggering endosome and lysosome exocytosis. Piliated bacteria next trigger elongation of microvilli and formation of cortical plaques at the plasma membrane beneath the site of contact. Cortical plaques contain clusters of Opa receptors, transmembrane signaling proteins, actin microfilaments and ezrin, a protein that tethers the membrane to the actin cytoskeleton. These plaques serve multiple signaling functions that promote bacterial infection. Unlike the Ca2+ response, which can be induced with purified pill, cortical plaque formation requires live diplococci and PilT, a protein that functions in pilus assembly and DNA transformation. PilT also controls pilus retraction, a process that drives twitching motility and the ability of diplococci to aggregate into microcolonies. Retraction generates substantial force on the substrate to which the pilus is attached.

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External forces placed on the membranes of eucaryotic cells result in the induction of kinase cascades, cytoskeleton reorganization and alterations in translation. The tension generated on the plasma membrane by retraction of pili during infection may therefore act as a signal to promote the formation of cortical plaques and subsequent bacterial invasion. Based on these and other observations, we propose a model for early events in pilus-induced cortical plaque formation. In this proposal, we describe experiments to test key predictions of this model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC MUTATIONS THAT PREDOPOSE TO INFECTIOUS DISEASE Principal Investigator & Institution: Butler, Bruce; Scripps Research Institute Tpc7 La Jolla, Ca 92037 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2007 Summary: The innate immune response is dependent upon a discrete collection of proteins that mediate the detection of microbial invaders and their elimination. Only a handful of these proteins are known at present, and among them, the Toll-like receptors and associated signaling proteins play a prominent role as sensors. The program of which this Bridging proposal is a part will permit the identification of many critical genes involved in the innate immune response. We propose to examine each of these genes in turn, starting with the Toll-like receptors and moving to new genes as they are discovered. Our ultimate goal is to determine whether mutations at these loci contribute to susceptibility to sepsis in humans, or influence the outcome of sepsis once it is established. The approach taken is one in which modem techniques for mutation detection will be used to assay genetic load within the coding region at each locus, in disease populations and in ethnically matched control populations. In particular, we will emphasize the use of advanced methods for mutation detection, coupled with highthroughput sequencing to achieve this end. In accordance with the emerging principle that most complex human diseases may be ascribed to low-frequency codominant mutations affecting multiple loci, it is expected that mutations will be over-represented in specific loci within a disease population, given that those loci encode genes that are important in fighting infection. Preliminary work has supported this principle as it applies to the TLR4 locus in meningococcal disease: there is a significant excess ofmissense mutations at this locus in the disease population, compared with controls. We intend to generalize the principle, seeking to establish the importance of rare mutations at multiple loci in the pathogenesis of diverse infections. This proposal will entail extensive interactions between the Forward Genetics Core, the Genomics Core, and the Sequencing Core. Mutational data bearing on the involvement of specific genes in sepsis will quickly be disseminated to the scientific community at large through a webbased information system. Ultimately, these studies may foretell susceptibility to infection, and explain the strong heritability of infectious diseases in molecular terms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENOME ANALYSIS OF STREPTOCOCCUS AGALACTIAE Principal Investigator & Institution: Tettelin, Herve S.; Associate Investigator; Institute for Genomic Research Rockville, Md 20850 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 29-SEP-2004 Summary: (provided by applicant): Group B streptococci (GBS) or Streptococcus agalactiae are weakly beta-hemolytic, facultatively anaerobic Gram-positive cocci, which

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have emerged over the past 50 years as the most significant bacterial cause of neonatal sepsis, pneumonia, and meningitis. GBS account for 30-50 percent of neonatal bacterial infections and increases in adult GBS infections have also been noted. This demonstrates that GBS infections remain an important public health problem. We propose to sequence the 2.1 Mb genome of S. agalactiae serotype Ia strain A909 using a genome-wide random shotgun approach. We will then use the final assembled sequence and its complete annotation to perform detailed comparative genomics analyses between serotype Ia and other organisms causing pneumonia and meningitis. These analyses will allow to identify virulence determinants shared by all organisms or specific to individual ones. These determinants will be related to Drs. Jones and Rubens? experiments on signature tagged mutagenesis and TnphoZ translational fusion (identification of secreted proteins) mutant libraries constructed through transposon insertions in strain A909. Regions where transposons inserted will be aligned to the genome sequence to identify the genes affected. A subset of the mutants conserved across serotypes will be analyzed in the rat sepsis model to evaluate their virulence. This collaborative effort will provide extensive preliminary data for future proposals relevant to understanding the pathogenesis of S. agalactiae infections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GROUP B. STREPTOCOCCI AND TOLL-LIKE RECEPTORS Principal Investigator & Institution: Golenbock, Douglas T.; Chief, Division of Infectious Diseases a; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Group B streptococci (GBS) are the leading cause of neonatal sepsis, the third most frequent cause of bacterial meningitis and an increasingly important cause of bacteremia and sepsis in adults in the United States today. Preliminary studies have identified a novel proinflammatory component of GBS, which we have designated GBS-factor (GBS-F). Based on experiments in mice with targeted genetic deletions in Toll-like receptor (TLR) expression and on experiments with engineered cell lines, we have determined that responses to GBS-F require expression of CD14, TLRs 2 and 6, and the Toll-adapter protein, MyD88. Activation of this receptor complex by GBS-F initiates important signaling events such as the activation of NF-kB, the phosphorylation of MAP kinases, the formation of proinflammatory cytokines, and the intracellular production of the toxic oxidant peroxynitrate. In contrast, although other components of GBS appear to engage TLRs, the exact identity of contributing TLRs is entirely unknown. The overall goal of this proposal is to identify and define components of GBS, focusing first on GBS-F, and their cognate Toll-like receptors (TLRs). We propose to characterize the structure of GBS-F and assess its function in vitro and in vivo. Furthermore, we will determine if TLR2, and related downstream signal transduction molecules, mediate a variety of important innate immune responses to GBS, including leukocyte chemotaxis and the intracellular killing of bacteria. Finally, we intend to determine what other TLRs, and associated signal transduction molecules, are involved in GBS recognition and response. The data learned from these studies should help in the development of rational therapeutic strategies to interfere with the deleterious hyperinflammation triggered by GBS and similar microbial organisms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HIPPOCAMPAL DENTATE GYRUS INJURY IN NEONATAL BACTERIAL Principal Investigator & Institution: Pleasure, Samuel Jeremy.; Assistant Professor; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 25-SEP-2002; Project End 31-AUG-2007 Summary: Bacterial meningitis in newborns leads to brain damage and subsequent neurologic sequelae including learning and memory deficits. In an infant rat model of neonatal bacterial meningitis, damage to the dentate gyrus of the hippocampal formation occurred regularly and showed two fundamentally distinct forms: (1) Scattered apoptotic injury confined to cells in the subgranular zone and (2) injury of the lower blade of the dentate gyrus with clusters of pyknotic appearing cells. Since the hippocampus is critical for learning and memory function, damage to it may be the basis for the learning deficits in survivors of bacterial meningitis. Indeed, damage to the dentate gyrus was associated with learning deficits in experimental meningitis. The dentate gyrus of the hippocampus is unique in two respects. First, the morphogenesis occurs very late in development in both rodents and humans, perhaps making it more vulnerable to pathologic insult at later developmental stages than other brain regions. Second, the dentate gyrus is a continuously developing system throughout life, containing progenitor cells able to multiply and give rise to new neurons. This has been implicated in the ability to form new memories and learn new tasks later in life. In meningitis, the progenitor cells appear to be selectively damaged. We will test the hypothesis that bacterial meningitis in young animals leads to selective damage within the dentate gyrus, including the progenitors or their immediate progeny, giving rise to neuroanatomical and functional abnormalities that underlie some of the permanent neurologic deficits affecting survivors of bacterial meningitis. Specifically, we will determine the nature of cell death in the dentate gyrus (apoptosis or necrosis); we will identify the cells damaged by the meningitic process )progenitor cells, immature or mature granule cell neurons, interneurons, glia); we will identify pathophysiologic factors leading to cell death (e.g., ischemia, excitatory amino acids, oxygen radicals, cytokines); and we will define in adult animals the neuroanatomical and functional consequences of damage to the immature dentate gyrus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF CAPSULE BIOSYNTHESIS IN N. MENINGITIDIS Principal Investigator & Institution: Stephens, David S.; Director; Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-JUL-1997; Project End 28-FEB-2007 Summary: (provided by applicant): Capsular polysaccharides of serogroups A, B, C, Y and W-135 are major virulence factors of the important human pathogen Neisseria meningitidis. Despite the essential role of capsule in meningococcal disease, the genetic basis for expression of meningococcal capsules is not fully defined. In this continuation application, we propose to determine the pathways regulating meningococcal capsular polysaccharide assembly and transport to the cell surface. In Specific Aim 1, we will define the genetic basis for formation of the meningococcal capsule polymer. New genes to be studied include the unique genes sacA-D of the serogroup A capsule biosynthesis locus, and two genes, kpsF and pglB2, located outside the capsule locus, that when mutated reduce meningococcal capsule expression in all serogroups and increase sensitivity to killing by human sera. Preliminary data indicate that kpsF- and pglB2encoded proteins influence Kdo and undecaprenol phosphate production and that these

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intermediates are required for capsule polymer assembly. In Specific Aim 2, the genetic and biochemical basis for the novel lipid modifications (1,2 diacylglycerol C16:0 or C18:0) of meningococcal capsule polymers will be determined and the role of lipA and lipB in lipidation of the capsule polymer, capsule assembly, transport and function will be defined. In Specific Aim 3, the function of the ctrA, ctrB, ctrC and ctrD capsule transport operon genes and their encoded proteins will be determined. Very limited information is available regarding the mechanisms of meningococcal capsule translocation across the two cellular membranes and about the recognition and interaction between the transport apparatus and the assembled capsule polymers. The proposed studies have direct application to the development of new meningococcal vaccine strategies. CtrA, for example, is a surface-exposed protein, appears conserved, is essential for capsule expression and is a candidate for conjugate or other meningococcal vaccines that prevent disease due to all invasive serogroups. Antibiotic resistance is also increasing in meningococci. These studies also can identify novel pathways that interfere with meningococcal capsule expression, which, when blocked, would increase meningococcal susceptibility to killing by host defenses and decrease meningococcal transmission to new human hosts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STUDY OF S PNEUMONIAE VIRULENCE GENE REGULATION Principal Investigator & Institution: Camilli, Andrew; Associate Professor; Molecular Biol & Microbiology; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 14-SEP-2004 Summary: (provided by applicant): The overall goal of our research is to understand the pathogenicity of Streptococcus pneumoniae, the most common cause of bacteremia, bacterial meningitis, otitis media and community-acquired pneumonia in the U.S.A. Current capsule-based vaccines, which only contain a subset of the capsular types in circulation, do not provide adequate protection from pneumonia and otitis media, which account for the majority of S. pneumoniae morbidity. Despite more than a century of research, understanding of S. pneumoniae virulence factors is limited. Furthermore, almost nothing is known concerning the regulation of S. pneumoniae virulence factors during infection. These limitations, plus an increasing incidence of antibiotic-resistance mandate increased study of the pathogenicity of this organism. We have completed a large-scale screen that resulted in the identification of 233 genes that are essential in a murine model of pneumonia. Additionally, we tested the importance of each of these genes in murine models of bacteremia and nasopharygeal carriage. Included among these novel virulence factors are 21 surface proteins, and 20 putative regulators that we hypothesize coordinate tissue-specific virulence gene expression. The first goal of the proposed work is to gain an understanding of both the regulation and mechanisms of action of two factors hypothesized to localize to the bacterial surface and interact with host components. Mutational analyses and virulence assays will be combined to define their interacting domains. The second goal is to identify major virulence gene regulons and their modes of coordination during infection. Five putative transcription factors identified in our screen will be placed under inducible expression, and the subset of genes regulated by each will be determined by transcriptional profiling on microarrays. For selected genes, the level of expression during nasopharyngeal carriage in mice and humans will be determined using quantitative RTPCR. The requirement for each cognate regulator for expression of these virulence genes during infection of mice will be confirmed. These studies will enhance our knowledge and understanding of S. pneumoniae-host interactions and virulence mechanisms, and

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will constitute the first broad study of S. pneumoniae virulence gene regulation. These studies will aid in the development of novel vaccines, and will suggest new targets for antimicrobial drug development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUBSTANCE P, NO & MICROGLIA IN CNS INFLAMMATION Principal Investigator & Institution: Nathan, Barnett R.; Neurology; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-MAY-2004 Summary: In the next 5 years I plan to study in vitro and in vivo the interactions of microglia, macrophages, substance P and nitric oxide as well as the effect of these substances on mitochondrial function. Substance P (SP) has effects as a pain mediator in the spinal cord and has vasoactive properties. It also plays a significant role in the pathogenesis of neurogenic inflammation, being released from peripheral nerve terminals and causing precapillary vasodilatation, postcapillary plasma extravasation and histamine release. Nitric oxide (NO) is known to play a role in bacterial meningitis and also has immunomodulatory and vasoactive properties. Peripheral blood macrophages and central nervous system (CNS) microglia share similar immunogenic properties and may be derived from the same cell line. Microglia are suspected to play a role in the pathophysiology of a wide variety of inflammatory CNS diseases and the mediators for this microglial induced injury may be modulators such as substance P and nitric oxide. The underlying hypothesis which provides the framework for all of the proposed studies is that substance P (SP), nitric oxide(NO) and microglia play a central role in the pathophysiology of bacterial meningitis (BM) and other acute CNS inflammatory conditions. The overall goal of this application is to investigate the effects of SP and NO on macrophage and microglia functions in in vitro and in vivo systems. This overall goal will be approached by addressing the following specific hypotheses. Hypothesis 1: Substance P plays a central role in bacterial meningitis, both through its direct immunomodulatory effects and through its effects on nitric oxide. In stimulated phagocytic cells there is an upregulation of preprotachykinin and SP receptor message. Hypothesis 2: Nitric oxide plays a central role in the pathophysiology of bacterial meningitis. There is upregulation of inducible nitric oxide synthase (iNOS) message resulting in increased production of NO. SP modulates iNOS via inhibition of iNOS message. Hypothesis 3: Both the resident and transient phagocytic cells in the CNS (microglia and macrophages) participate in the pathophysiology of bacterial meningitis. SP and NO modulate their effects in CNS inflammation via these cells. Hypothesis 4: The ultimate site for the effects of SP and NO may be the mitochondrial respiratory chain enzymes of these phagocytic cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATING SEPSIS WITH PAF ACETYLHYDROLASE Principal Investigator & Institution: Prescott, Stephen M.; H.A. & Edna Benning Presidential Profess; Intermountain Reg Cancer Netwk; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2004 Summary: In this application we propose to test if removal of PAF and related phospholipids reduces the mortality associated with certain forms of sepsis. To test this hypothesis, we will examine the effect of administration of recombinant PAF acetylhydrolase, the enzyme that inactivates PAF and related phospholipids, to animals

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undergoing sepsis. We will use survival as the endpoint but will also characterize the response to enzyme administration by comparing cytokine levels in animals treated with placebo or with the recombinant protein. We will utilize two experimental models of sepsis: cecal ligation and puncture and sepsis induced by injection of Neisseria meningitidis. As a clinical corollary, we will determine the levels of PAF acetylhydrolase activity and cytokine levels in the plasma of patients undergoing sepsis and meningococcemia. An important goal of these studies, in addition to testing the potential of PAF acetylhydrolase as a therapeutic agent, is to identify patient groups that are likely to benefit the most from PAF acetylhydrolase administration. Recent clinical studies have failed to demonstrate that anti-inflammatory or immunomodulatory agents have beneficial effects in the treatment of sepsis. A possible explanation for this observation is that the patient population studied included subjects in whom a variety of different mechanisms resulted in sepsis. This may have precluded the ability of the agent(s) tested to show a beneficial effect in a limited group of patients because such effects would be lost in the analysis of the entire patient group. Our hypothesis is that the definition of sub-populations with similar etiologies will be a key factor in our understanding of sepsis. This approach will facilitate identification of markers to characterize the evolution and outcome of the disease as well as identify novel therapies. For example, patients suffering from meningococcemia-related sepsis can be identified as a homogeneous sub-population of septic patients. The studies proposed here may facilitate the molecular identification and treatment of populations that can significantly benefit from PAF acetylhydrolase administration. These studies will be carried out primarily in Brazil, as an extension of NIH SCOR grant P50 HL50153 (Project 5). They constitute an ideal complement to the studies currently being performed by Drs. Prescott and Stafforini, who are the Principal Investigator and Project Director of Project 5 of the SCOR in Acute Lung Injury, respectively. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “bacterial meningitis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for bacterial meningitis in the PubMed Central database: •

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Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis. by Klugman KP, Friedland IR, Bradley JS.; 1995 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=162869 Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Bactericidal activity against intermediately cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with bacterial meningitis treated with high doses of cefotaxime and vancomycin. by Doit C, Barre J, Cohen R, Bonacorsi S, Bourrillon A, Bingen EH.; 1997 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=164066

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Blockade of NMDA receptor subtype NR2B prevents seizures but not apoptosis of dentate gyrus neurons in bacterial meningitis in infant rats. by Kolarova A, Ringer R, Tauber MG, Leib SL.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=212551

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Cefuroxime treatment of bacterial meningitis in infants and children. by Sirinavin S, Chiemchanya S, Visudhipan P, Lolekha S.; 1984 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185488

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Cerebrospinal fluid penetration of amikacin in children with community-acquired bacterial meningitis. by Gaillard JL, Silly C, Le Masne A, Mahut B, Lacaille F, Cheron G, Abadie V, Hubert P, Matha V, Coustere C.; 1995 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=162520

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Comparison of ceftriaxone and ampicillin plus chloramphenicol for the therapy of acute bacterial meningitis. by Bryan JP, Rocha H, da Silva HR, Taveres A, Sande MA, Scheld WM.; 1985 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=180254

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Comparison of ceftriaxone and traditional therapy of bacterial meningitis. by Congeni BL.; 1984 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185431

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Concentrations of cefoperazone in cerebrospinal fluid during bacterial meningitis. by Cable D, Overturf G, Edralin G.; 1983 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=184788

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Concentrations of Cefpirome in Cerebrospinal Fluid of Children with Bacterial Meningitis after a Single Intravenous Dose. by Friedland IR, Sultan E, Lehr KH, Lenfant B.; 1998 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105484

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Correlation of cerebrospinal fluid endotoxinlike activity with clinical and laboratory variables in gram-negative bacterial meningitis in children. by Dwelle TL, Dunkle LM, Blair L.; 1987 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=266103

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Counterimmunoelectrophoresis in the diagnosis of bacterial meningitis. by Colding H, Lind I.; 1977 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=274615

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Decreased cerebrospinal fluid cyclic adenosine 3',5'-monophosphate in bacterial meningitis. by Weitzman S, Palmer LB, Berger SA.; 1979 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=273029

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Determination of bacterial meningitis: a retrospective study of 80 cerebrospinal fluid specimens evaluated by four in vitro methods. by Wasilauskas BL, Hampton KD.; 1982 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=272403

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Dexamethasone in adults with bacterial meningitis. by Suh KN.; 2003 Mar 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154925

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Evaluation of aztreonam in experimental bacterial meningitis and cerebritis. by Scheld WM, Brodeur JP, Gratz JC, Foresman P, Rodeheaver G.; 1983 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185925

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Evaluation of the Phadebact CSF test for detection of the four most common causes of bacterial meningitis. by Drow DL, Welch DF, Hensel D, Eisenach K, Long E, Slifkin M.; 1983 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=272908

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Factitious Bacterial Meningitis Revisited. by Peterson E, Thrupp L, Uchiyama N, Hawkins B, Wolvin B, Greene G.; 1982 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=272465

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Intrathecal production of interleukin-12 and gamma interferon in patients with bacterial meningitis. by Kornelisse RF, Hack CE, Savelkoul HF, van der Pouw Kraan TC, Hop WC, van Mierlo G, Suur MH, Neijens HJ, de Groot R.; 1997 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175063

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Moxalactam penetration into cerebrospinal fluid in patients with bacterial meningitis. by Modai J, Wolff M, Lebas J, Meulemans A, Manuel C.; 1982 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=181939

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Moxalactam Therapy of Bacterial Meningitis in Adults. by Uwaydah M, Tannir N, Kantarjian H, Osseiran M, Bal'a F.; 1983 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=186039

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Neutralization of Macrophage Inflammatory Protein 2 (MIP-2) and MIP-1[alpha] Attenuates Neutrophil Recruitment in the Central Nervous System during Experimental Bacterial Meningitis. by Diab A, Abdalla H, Li HL, Shi FD, Zhu J, Hojberg B, Lindquist L, Wretlind B, Bakhiet M, Link H.; 1999 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116008

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Penetration of aztreonam into cerebrospinal fluid of patients with bacterial meningitis. by Modai J, Vittecoq D, Decazes JM, Wolff M, Meulemans A.; 1986 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=176391

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Penetration of cefoxitin into cerebrospinal fluid of infants and children with bacterial meningitis. by Feldman WE, Moffitt S, Manning NS.; 1982 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=181916

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Penetration of ceftazidime into cerebrospinal fluid of patients with bacterial meningitis. by Modai J, Vittecoq D, Decazes JM, Wolff M, Meulemans A.; 1983 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185115

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Penetration of ciprofloxacin into cerebrospinal fluid of patients with bacterial meningitis. by Wolff M, Boutron L, Singlas E, Clair B, Decazes JM, Regnier B.; 1987 Jun; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=284207

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Pentoxifylline modulates meningeal inflammation in experimental bacterial meningitis. by Saez-Llorens X, Ramilo O, Mustafa MM, Mertsola J, de Alba C, Hansen E, McCracken GH Jr.; 1990 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=171702

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Pharmacokinetics and cerebrospinal fluid bactericidal activity of ceftriaxone in the treatment of pediatric patients with bacterial meningitis. by Del Rio M, McCracken GH Jr, Nelson JD, Chrane D, Shelton S.; 1982 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=183803

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Pharmacokinetics of cefuroxime in infants and children with bacterial meningitis. by del Rio MD, Chrane DF, Shelton S, McCracken GH Jr, Nelson JD.; 1982 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185707

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Potential role of nitric oxide in the pathophysiology of experimental bacterial meningitis in rats. by Buster BL, Weintrob AC, Townsend GC, Scheld WM.; 1995 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173539

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Practical considerations in using counterimmunoelectrophoresis to identify the principal causative agents of bacterial meningitis. by Finch CA, Wilkinson HW.; 1979 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=273207

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Prospective randomized comparison of cefepime and cefotaxime for treatment of bacterial meningitis in infants and children. by Saez-Llorens X, Castano E, Garcia R, Baez C, Perez M, Tejeira F, McCracken GH Jr.; 1995 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=162657

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Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group. by Klugman KP, Dagan R.; 1995 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=162697

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Rapid diagnosis of gram-negative bacterial meningitis by the Limulus endotoxin assay. by Jorgensen JH, Lee JC.; 1978 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=274848

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Rapid differentiation of rocky mountain spotted fever from chickenpox, measles, and enterovirus infections and bacterial meningitis by frequency-pulsed electron capture gas-liquid chromatographic analysis of sera. by Brooks JB, McDade JE, Alley CC.; 1981 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=271928

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Rapid differentiation of the major causative agents of bacterial meningitis by use of frequency-pulsed electron capture gas-liquid chromatograph: analysis of acids. by Brooks JB, Kellogg DS Jr, Shepherd ME, Alley CC.; 1980 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=273314

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Rapid differentiation of the major causative agents of bacterial meningitis by use of frequency-pulsed electron capture gas-liquid chromatography: analysis of amines. by Brooks JB, Kellogg DS Jr, Shepherd ME, Alley CC.; 1980 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=273315

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Roles of proinflammatory and anti-inflammatory cytokines in pathophysiology of bacterial meningitis and effect of adjunctive therapy. by van Furth AM, Roord JJ, van Furth R.; 1996 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=174464

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Treatment of bacterial meningitis with ceftizoxime. by Overturf GD, Cable DC, Forthal DN, Shikuma C.; 1984 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185485

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with bacterial meningitis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “bacterial meningitis” (or synonyms) into the search box, and click “Go.” The following is the type of 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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output you can expect from PubMed for bacterial meningitis (hyperlinks lead to article summaries): •

A revised clinical method for assessment of severity of acute bacterial meningitis. Author(s): Akpede GO, Jalo I, Dawodu SO. Source: Annals of Tropical Paediatrics. 2002 March; 22(1): 33-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926048&dopt=Abstract

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A silkworm larvae plasma test for detecting peptidoglycan in cerebrospinal fluid is useful for the diagnosis of bacterial meningitis. Author(s): Inada K, Takahashi K, Ichinohe S, Suda H, Tsuchiya M, Takahashi J, Matsuura S, Kasai T, Yoshida M, Endo S, Sato S. Source: Microbiology and Immunology. 2003; 47(10): 701-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14605436&dopt=Abstract

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Absolute neutrophil count in aseptic and bacterial meningitis related to time of lumbar puncture. Author(s): Straussberg R, Harel L, Nussinovitch M, Amir J. Source: Pediatric Neurology. 2003 May; 28(5): 365-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878298&dopt=Abstract

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Acute bacterial meningitis as a complication of otitis media and related mortality factors. Author(s): Geyik MF, Kokoglu OF, Hosoglu S, Ayaz C. Source: Yonsei Medical Journal. 2002 October; 43(5): 573-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12402369&dopt=Abstract

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Acute bacterial meningitis in adults. A 12-year review. Author(s): Hussein AS, Shafran SD. Source: Medicine; Analytical Reviews of General Medicine, Neurology, Psychiatry, Dermatology, and Pediatrics. 2000 November; 79(6): 360-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11144034&dopt=Abstract

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Acute bacterial meningitis in children admitted to a rural Kenyan hospital: increasing antibiotic resistance and outcome. Author(s): Mwangi I, Berkley J, Lowe B, Peshu N, Marsh K, Newton CR. Source: The Pediatric Infectious Disease Journal. 2002 November; 21(11): 1042-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442027&dopt=Abstract

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Acute bacterial meningitis. Author(s): Roos KL. Source: Seminars in Neurology. 2000; 20(3): 293-306. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11051294&dopt=Abstract

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Acute bacterial meningitis: time for a better outcome. Author(s): Zimmerli W. Source: Intensive Care Medicine. 2003 November; 29(11): 1868-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14669755&dopt=Abstract

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Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Author(s): Flores-Cordero JM, Amaya-Villar R, Rincon-Ferrari MD, Leal-Noval SR, Garnacho-Montero J, Llanos-Rodriguez AC, Murillo-Cabezas F. Source: Intensive Care Medicine. 2003 November; 29(11): 1967-73. Epub 2003 August 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904848&dopt=Abstract

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Acute severe spinal cord dysfunction in bacterial meningitis in adults: MRI findings suggest extensive myelitis. Author(s): Kastenbauer S, Winkler F, Fesl G, Schiel X, Ostermann H, Yousry TA, Pfister HW. Source: Archives of Neurology. 2001 May; 58(5): 806-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11346376&dopt=Abstract

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Acute severe spinal cord dysfunction in bacterial meningitis in adults: MRI findings suggest extensive myelitis. Author(s): Roos KL. Source: Archives of Neurology. 2001 May; 58(5): 717-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11346365&dopt=Abstract

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Adjunctive dexamethasone treatment in acute bacterial meningitis. Author(s): Chaudhuri A. Source: Lancet. Neurology. 2004 January; 3(1): 54-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14693112&dopt=Abstract

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Adult bacterial meningitis in Southern Taiwan: epidemiologic trend and prognostic factors. Author(s): Lu CH, Chang WN, Chang HW. Source: Journal of the Neurological Sciences. 2000 December 15; 182(1): 36-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11102637&dopt=Abstract

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Adult community acquired bacterial meningitis in a Singaporean teaching hospital. A seven-year overview (1993-2000). Author(s): Chan YC, Wilder-Smith A, Ong BK, Kumarasinghe G, Wilder-Smith E. Source: Singapore Med J. 2002 December; 43(12): 632-6. Erratum In: Singapore Med J. 2003 January; 44(1): 50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693768&dopt=Abstract

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An indigenous leucocyte esterase test along with Pandy's test for the diagnosis of bacterial meningitis. Author(s): Locham KK, Sodhi M, Jindal G. Source: Indian Pediatrics. 2002 June; 39(6): 602-3; Author Reply 603-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12084964&dopt=Abstract

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An indigenous leucocyte esterase test along with Pandy's test for the diagnosis of bacterial meningitis. Author(s): Srivastava RK, Gupta S, Bhargava M, Kumar N, Upadhyay P, Puliyel JM. Source: Indian Pediatrics. 2001 November; 38(11): 1281-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11721069&dopt=Abstract

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An unusual cause of acute bacterial meningitis. Author(s): Stephenson I, Wiselka MJ. Source: Postgraduate Medical Journal. 2001 December; 77(914): 791, 800-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723327&dopt=Abstract

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Antibiotic guidelines and antibiotic use in adult bacterial meningitis in The Netherlands. Author(s): van de Beek D, de Gans J, Spanjaard L, Vermeulen M, Dankert J. Source: The Journal of Antimicrobial Chemotherapy. 2002 April; 49(4): 661-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11909840&dopt=Abstract

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Approach to acute bacterial meningitis. Minireview. Author(s): Tabbarah ZA. Source: J Med Liban. 2001 January-February; 49(1): 18-21. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910960&dopt=Abstract

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Association of tumour necrosis factor alpha & malnutrition with outcome in children with acute bacterial meningitis. Author(s): Hemalatha R, Bhaskaram P, Balakrishna N, Saraswathi I. Source: The Indian Journal of Medical Research. 2002 February; 115: 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138665&dopt=Abstract

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Bacterial and mycobacterial meningitis in HIV-positive compared with HIV-negative patients in an internal medicine ward in Libreville, Gabon. Author(s): Nkoumou MO, Betha G, Kombila M, Clevenbergh P. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 2003 March 1; 32(3): 345-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12626897&dopt=Abstract

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Bacterial meningitis and dorsal spinal epidural abscess caused by Crohn's disease. Author(s): Hefter H, Piontek M, Aulich A. Source: Neurology. 1991 April; 41(4): 606-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2011270&dopt=Abstract

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Bacterial meningitis in aging adults. Author(s): Choi C. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 October 15; 33(8): 1380-5. Epub 2001 September 05. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11550119&dopt=Abstract

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Bacterial meningitis in Angola. Author(s): Bernardino L, Magalhaes J, Simoes MJ, Monteiro L. Source: Lancet. 2003 May 3; 361(9368): 1564-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737901&dopt=Abstract

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Bacterial meningitis in childhood at the Children's Hospital of Pittsburgh: 1988-1998. Author(s): Neuman HB, Wald ER. Source: Clinical Pediatrics. 2001 November; 40(11): 595-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11758958&dopt=Abstract

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Bacterial meningitis in children with cochlear implants. Author(s): Bluestone CD. Source: The New England Journal of Medicine. 2003 October 30; 349(18): 1772-3; Author Reply 1772-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14593995&dopt=Abstract

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Bacterial meningitis in children with cochlear implants. Author(s): Lefrancois RD, Moran LM. Source: The New England Journal of Medicine. 2003 October 30; 349(18): 1772-3; Author Reply 1772-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14585948&dopt=Abstract

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Bacterial meningitis in children. Author(s): Saez-Llorens X, McCracken GH Jr. Source: Lancet. 2003 June 21; 361(9375): 2139-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826449&dopt=Abstract

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Bacterial meningitis in children: critical care needs. Author(s): Singhi S, Singhi P, Baranwal AK. Source: Indian J Pediatr. 2001 August; 68(8): 737-47. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11563252&dopt=Abstract

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Bacterial meningitis in Malawian adults: pneumococcal disease is common, severe, and seasonal. Author(s): Gordon SB, Walsh AL, Chaponda M, Gordon MA, Soko D, Mbwvinji M, Molyneux ME, Read RC. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 July; 31(1): 53-7. Epub 2000 July 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10913396&dopt=Abstract

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Bacterial meningitis in Saudi Arabia: the impact of Haemophilus influenzae type b vaccination. Author(s): Almuneef M, Alshaalan M, Memish Z, Alalola S. Source: J Chemother. 2001 April; 13 Suppl 1: 34-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11434527&dopt=Abstract

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Bacterial meningitis observed in a phase I trial of vinorelbine, cisplatin and thoracic radiotherapy for non-small cell lung cancer: report of a case and discussion on doselimiting toxicity. Author(s): Sekine I, Matsuda T, Saisho T, Watanabe H, Yamamoto N, Kunitoh H, Ohe Y, Tamura T, Kodama T, Saijo N. Source: Japanese Journal of Clinical Oncology. 2000 September; 30(9): 401-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095138&dopt=Abstract

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Bacterial meningitis of an infant with Currarino triad. Author(s): Chou IC, Mak SC, Lin TP, Chi CS, Pen HC. Source: Acta Paediatr Taiwan. 2002 September-October; 43(5): 288-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607487&dopt=Abstract

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Bacterial meningitis secondary to a transethmoidal encephalocele presenting to the emergency department. Author(s): Schwartz MD, Shaw GJ. Source: The Journal of Emergency Medicine. 2002 August; 23(2): 171-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359286&dopt=Abstract

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Bacterial meningitis. Appeal to thwart deadly outbreak. Author(s): Vogel G. Source: Science. 2002 October 11; 298(5592): 339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12376673&dopt=Abstract

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Bacterial meningitis: current controversies in approaches to treatment. Author(s): Williams AJ, Nadel S. Source: Cns Drugs. 2001; 15(12): 909-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11735611&dopt=Abstract

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Bacterial meningitis: diagnosis and treatment. Author(s): Snyder RD. Source: Curr Neurol Neurosci Rep. 2003 November; 3(6): 461-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14565899&dopt=Abstract

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Bacterial meningitis: T cell activation and immunoregulatory CD4+ T cell subset alteration. Author(s): Raziuddin S, el-Awad ME, Mir NA. Source: The Journal of Allergy and Clinical Immunology. 1991 June; 87(6): 1115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1710632&dopt=Abstract

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Bilateral ophthalmoparesis associated with bacterial meningitis. Author(s): Barron TF, Galetta SL, Avner JA, Younkin DP. Source: Clinical Pediatrics. 1991 April; 30(4): 258-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2025989&dopt=Abstract

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Broad-range bacterial polymerase chain reaction for early detection of bacterial meningitis. Author(s): Saravolatz LD, Manzor O, VanderVelde N, Pawlak J, Belian B. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 January 1; 36(1): 40-5. Epub 2002 December 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12491200&dopt=Abstract

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Cerebral blood flow, oxidative metabolism and cerebrovascular carbon dioxide reactivity in patients with acute bacterial meningitis. Author(s): Moller K, Strauss GI, Thomsen G, Larsen FS, Holm S, Sperling BK, Skinhoj P, Knudsen GM. Source: Acta Anaesthesiologica Scandinavica. 2002 May; 46(5): 567-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12027852&dopt=Abstract

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Cerebral infarction in perinatal and childhood bacterial meningitis. Author(s): Chang CJ, Chang WN, Huang LT, Chang YC, Huang SC, Hung PL, Ho HH, Chang CS, Wang KW, Cheng BC, Lui CC, Chang HW, Lu CH. Source: Qjm : Monthly Journal of the Association of Physicians. 2003 October; 96(10): 755-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500862&dopt=Abstract

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Cerebrospinal fluid glucose levels and sensorineural hearing loss in bacterial meningitis. Author(s): Eisenhut M, Meehan T, Batchelor L. Source: Infection. 2003 August; 31(4): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14562950&dopt=Abstract

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Cerebrospinal fluid penetration of levofloxacin in patients with spontaneous acute bacterial meningitis. Author(s): Scotton PG, Pea F, Giobbia M, Baraldo M, Vaglia A, Furlanut M. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 November 1; 33(9): E109-11. Epub 2001 September 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11577376&dopt=Abstract

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Childhood bacterial meningitis in Bulgaria: a population-based retrospective study in six regions during 1992-96. Author(s): Kojouharova M, Gatcheva N, Setchanova L, Mechandjieva V; Bulgarian Hib Study Team. Source: International Journal of Infectious Diseases : Ijid : Official Publication of the International Society for Infectious Diseases. 2003 June; 7(2): 109-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839711&dopt=Abstract

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Childhood bacterial meningitis in Mbarara Hospital, Uganda: antimicrobial susceptibility and outcome of treatment. Author(s): Kiwanuka JP, Mwanga J. Source: Afr Health Sci. 2001 August; 1(1): 9-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789126&dopt=Abstract

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Childhood bacterial meningitis in Pondicherry, South India. Author(s): Sahai S, Mahadevan S, Srinivasan S, Kanungo R. Source: Indian J Pediatr. 2001 September; 68(9): 839-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11669031&dopt=Abstract

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Claims of equivalence in randomized controlled trials of the treatment of bacterial meningitis in children. Author(s): Krysan DJ, Kemper AR. Source: The Pediatric Infectious Disease Journal. 2002 August; 21(8): 753-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12192164&dopt=Abstract

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Clearance of 14-3-3 protein from cerebrospinal fluid heralds the resolution of bacterial meningitis. Author(s): Bonora S, Zanusso G, Raiteri R, Monaco S, Rossati A, Ferrari S, Boffito M, Audagnotto S, Sinicco A, Rizzuto N, Concia E, Di Perri G. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 June 1; 36(11): 1492-5. Epub 2003 May 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766846&dopt=Abstract

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Clinical predictors of bacterial meningitis in infants and young children in The Gambia. Author(s): Weber MW, Herman J, Jaffar S, Usen S, Oparaugo A, Omosigho C, Adegbola RA, Greenwood BM, Mulholland EK. Source: Tropical Medicine & International Health : Tm & Ih. 2002 September; 7(9): 72231. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12225501&dopt=Abstract

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Cognitive impairment in adults with good recovery after bacterial meningitis. Author(s): van de Beek D, Schmand B, de Gans J, Weisfelt M, Vaessen H, Dankert J, Vermeulen M. Source: The Journal of Infectious Diseases. 2002 October 1; 186(7): 1047-52. Epub 2002 September 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12232850&dopt=Abstract

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Community acquired-bacterial meningitis in adults. Author(s): Chotmongkol V, Techoruangwiwat C. Source: Southeast Asian J Trop Med Public Health. 2000 September; 31(3): 506-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289010&dopt=Abstract

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Community-acquired bacterial meningitis in adults: categorization of causes and timing of death. Author(s): McMillan DA, Lin CY, Aronin SI, Quagliarello VJ. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 October 1; 33(7): 969-75. Epub 2001 August 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11528567&dopt=Abstract

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Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors. Author(s): Lu CH, Huang CR, Chang WN, Chang CJ, Cheng BC, Lee PY, Lin MW, Chang HW. Source: Clinical Neurology and Neurosurgery. 2002 September; 104(4): 352-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140104&dopt=Abstract

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Community-acquired spontaneous bacterial meningitis in adult diabetic patients: an analysis of clinical characteristics and prognostic factors. Author(s): Huang CR, Lu CH, Chang HW, Lee PY, Lin MW, Chang WN. Source: Infection. 2002 December; 30(6): 346-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478323&dopt=Abstract

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Community-acquired spontaneous bacterial meningitis in patients with alcoholic liver disease. Author(s): Chang WN, Lu CH, Chang CS, Huang CR. Source: J Formos Med Assoc. 2003 September; 102(9): 653-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14625613&dopt=Abstract

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Conjugates and reverse vaccinology to eliminate bacterial meningitis. Author(s): Rappuoli R. Source: Vaccine. 2001 March 21; 19(17-19): 2319-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11257355&dopt=Abstract

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Corticosteroids in acute bacterial meningitis. Author(s): van de Beek D, de Gans J, McIntyre P, Prasad K. Source: Cochrane Database Syst Rev. 2003; (3): Cd004305. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918010&dopt=Abstract

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Cranial Doppler ultrasonography as a predictor of neurologic sequelae in infants with bacterial meningitis. Author(s): Okten A, Ahmetoglu A, Dilber E, Dinc H, Kalyoncu M, Ciftcibais K, Yaris N. Source: Investigative Radiology. 2002 February; 37(2): 86-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11799332&dopt=Abstract

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C-reactive protein concentrations in cerebral spinal fluid in gram-positive and gramnegative bacterial meningitis. Author(s): Rajs G, Finzi-Yeheskel Z, Rajs A, Mayer M. Source: Clinical Chemistry. 2002 March; 48(3): 591-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11861461&dopt=Abstract

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D- and L-lactate in rabbit and human bacterial meningitis. Author(s): Wellmer A, Prange J, Gerber J, Zysk G, Lange P, Michel U, Eiffert H, Nau R. Source: Scandinavian Journal of Infectious Diseases. 2001; 33(12): 909-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868764&dopt=Abstract

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Dexamethasone in acute bacterial meningitis. Author(s): Principi N, Esposito S. Source: Lancet. 2002 November 16; 360(9345): 1610; Author Reply 1610-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443642&dopt=Abstract

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Dexamethasone in acute bacterial meningitis. Author(s): Obaro SK. Source: Lancet. 2002 November 16; 360(9345): 1609-10; Author Reply 1610-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443641&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): Joffe AR. Source: The New England Journal of Medicine. 2003 March 6; 348(10): 954-7; Author Reply 954-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622128&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): Poshkus M, Obaro S. Source: The New England Journal of Medicine. 2003 March 6; 348(10): 954-7; Author Reply 954-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622127&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): Abril V, Ortega E. Source: The New England Journal of Medicine. 2003 March 6; 348(10): 954-7; Author Reply 954-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622126&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): Tancredi DN, Binder WD. Source: The New England Journal of Medicine. 2003 March 6; 348(10): 954-7; Author Reply 954-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622125&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): Tabas JA, Chambers HF. Source: The New England Journal of Medicine. 2003 March 6; 348(10): 954-7; Author Reply 954-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621141&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): de Gans J, van de Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Source: The New England Journal of Medicine. 2002 November 14; 347(20): 1549-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12432041&dopt=Abstract

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Dexamethasone in adults with bacterial meningitis. Author(s): Gupta A, Singh NK. Source: J Assoc Physicians India. 1996 February; 44(2): 90-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10999057&dopt=Abstract

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Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study. Author(s): Gijwani D, Kumhar MR, Singh VB, Chadda VS, Soni PK, Nayak KC, Gupta BK. Source: Neurology India. 2002 March; 50(1): 63-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11960154&dopt=Abstract

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Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. Author(s): Molyneux EM, Walsh AL, Forsyth H, Tembo M, Mwenechanya J, Kayira K, Bwanaisa L, Njobvu A, Rogerson S, Malenga G. Source: Lancet. 2002 July 20; 360(9328): 211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133656&dopt=Abstract

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Diagnosing bacterial meningitis after the Haemophilus influenzae vaccine: still a challenge. Author(s): Frohna JG, Park SM, Gopal S. Source: Archives of Pediatrics & Adolescent Medicine. 2001 December; 155(12): 1307-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732948&dopt=Abstract

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Diagnosis and outcome of acute bacterial meningitis in early childhood. Author(s): Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A, Niphadkar KB, Dutta A, Leboulleux D. Source: Indian Pediatrics. 2002 October; 39(10): 914-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12428036&dopt=Abstract

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Diagnosis and treatment of bacterial meningitis. Author(s): El Bashir H, Laundy M, Booy R. Source: Archives of Disease in Childhood. 2003 July; 88(7): 615-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818910&dopt=Abstract

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Diagnosis of acute bacterial meningitis in children at a district hospital in subSaharan Africa. Author(s): Berkley JA, Mwangi I, Ngetsa CJ, Mwarumba S, Lowe BS, Marsh K, Newton CR. Source: Lancet. 2001 June 2; 357(9270): 1753-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11403812&dopt=Abstract

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Diagnosis of bacterial meningitis. Author(s): Enwere G, Obaro S. Source: Lancet. 2001 November 3; 358(9292): 1549-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11705597&dopt=Abstract

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Diffusion-weighted imaging in acute bacterial meningitis in infancy. Author(s): Jan W, Zimmerman RA, Bilaniuk LT, Hunter JV, Simon EM, Haselgrove J. Source: Neuroradiology. 2003 September; 45(9): 634-9. Epub 2003 August 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908092&dopt=Abstract

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Distinguishing between chemical and bacterial meningitis in patients who have undergone neurosurgery. Author(s): Brown EM, de Louvois J, Bayston R, Lees PD, Pople IK; British Society for Antimicrobial Chemotherapy Working Party on Neurosurgical Infections. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 February 15; 34(4): 556-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11797188&dopt=Abstract

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Does dexamethasone affect ceftriazone penetration into cerebrospinal fluid in adult bacterial meningitis. Author(s): Buke AC, Cavusoglu C, Karasulu E, Karakartal G. Source: International Journal of Antimicrobial Agents. 2003 May; 21(5): 452-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727079&dopt=Abstract

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Early management of suspected bacterial meningitis and meningococcal septicaemia in adults. Author(s): Heyderman RS, Lambert HP, O'Sullivan I, Stuart JM, Taylor BL, Wall RA. Source: The Journal of Infection. 2003 February; 46(2): 75-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634067&dopt=Abstract

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Early prediction of neurological sequelae or death after bacterial meningitis. Author(s): Oostenbrink R, Moons KG, Derksen-Lubsen G, Grobbee DE, Moll HA. Source: Acta Paediatrica (Oslo, Norway : 1992). 2002; 91(4): 391-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12061353&dopt=Abstract

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Effect of short-term hyperventilation on cerebral blood flow autoregulation in patients with acute bacterial meningitis. Author(s): Moller K, Skinhoj P, Knudsen GM, Larsen FS. Source: Stroke; a Journal of Cerebral Circulation. 2000 May; 31(5): 1116-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10797174&dopt=Abstract

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Elevated cerebrospinal fluid levels of glutamate in children with bacterial meningitis as a predictor of the development of seizures or other adverse outcomes. Author(s): Ma W, Shang-Feaster G, Okada PJ, Kernie SG. Source: Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2003 April; 4(2): 170-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749647&dopt=Abstract

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Emergence of drug resistance. Impact on bacterial meningitis. Author(s): Klugman KP, Madhi SA. Source: Infectious Disease Clinics of North America. 1999 September; 13(3): 637-46, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10470559&dopt=Abstract

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Emergency department stabilization of pediatric patients with bacterial meningitis. Current advances. Author(s): Bushore M, Marante AA. Source: Emergency Medicine Clinics of North America. 1991 May; 9(2): 239-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1893892&dopt=Abstract

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Endogenous or exogenous origin of platelet-activating factor in cerebrospinal fluid of children with bacterial meningitis. Author(s): Denizot Y. Source: The Journal of Infectious Diseases. 1991 May; 163(5): 1164. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2019766&dopt=Abstract

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Epidemiology of bacterial meningitis among children in Brazil, 1997-1998. Author(s): Weiss DP, Coplan P, Guess H. Source: Revista De Saude Publica. 2001 June; 35(3): 249-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11486147&dopt=Abstract

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Epidemiology of bacterial meningitis in Niamey, Niger, 1981-96. Author(s): Campagne G, Schuchat A, Djibo S, Ousseini A, Cisse L, Chippaux JP. Source: Bulletin of the World Health Organization. 1999; 77(6): 499-508. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10427935&dopt=Abstract

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Epidemiology of bacterial meningitis. Author(s): Gold R. Source: Infectious Disease Clinics of North America. 1999 September; 13(3): 515-25, V. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10470553&dopt=Abstract

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Epidemiology of childhood bacterial meningitis in Poland. Incidence of bacterial meningitis with special reference to Haemophilus influenzae type b among children 0-59 months old in the former Kielce and Bydgoszcz districts in Poland in 1998-1999. Author(s): Zielinski A, Tomaszunas-Blaszczyk J, Kuklinska D. Source: European Journal of Epidemiology. 2001; 17(8): 779-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12086097&dopt=Abstract

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Epidemiology of post-neonatal bacterial meningitis in Cape Town children. Author(s): Hussey G, Schaaf H, Hanslo D, Hitchcock J, Coetzee G, Pitout J, Malan H, Donald P. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1997 January; 87(1): 51-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9063315&dopt=Abstract

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Estimating incidence of bacterial meningitis with capture-recapture method, Lazio Region, Italy. Author(s): Faustini A, Fano V, Sangalli M, Ferro S, Celesti L, Contegiacomo P, Renzini V, Perucci CA. Source: European Journal of Epidemiology. 2000; 16(9): 843-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11297227&dopt=Abstract

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Etiologic spectrum and pattern of antimicrobial drug susceptibility in bacterial meningitis in Sokoto, Nigeria. Author(s): Emele FE. Source: Acta Paediatrica (Oslo, Norway : 1992). 2000 August; 89(8): 942-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10976835&dopt=Abstract

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Etiology of central nervous system infections in the Philippines and the role of serum C-reactive protein in excluding acute bacterial meningitis. Author(s): Sutinen J, Sombrero L, Paladin FJ, Julkunen I, Leinikki P, Hernandez E, Saniel M, Brato D, Ruutu P. Source: International Journal of Infectious Diseases : Ijid : Official Publication of the International Society for Infectious Diseases. 1998-99 Winter; 3(2): 88-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10225986&dopt=Abstract

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Evaluation of antioxidant status in children with acute bacterial meningitis and encephalitis. Author(s): Caksen H, Dede S, Cemek M, Dulger H, Cemek F. Source: The International Journal of Neuroscience. 2003 November; 113(11): 1497-504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14585750&dopt=Abstract

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Evidence for fluid volume depletion in hyponatraemic patients with bacterial meningitis. Author(s): Bianchetti MG, Thyssen HR, Laux-End R, Schaad UB. Source: Acta Paediatrica (Oslo, Norway : 1992). 1996 October; 85(10): 1163-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8922076&dopt=Abstract

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Excess glutamate in the cerebrospinal fluid in bacterial meningitis. Author(s): Spranger M, Krempien S, Schwab S, Maiwald M, Bruno K, Hacke W. Source: Journal of the Neurological Sciences. 1996 November; 143(1-2): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8981310&dopt=Abstract

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Experience with ampicillin in bacterial meningitis. Author(s): Mathies AW Jr, Leedom JM, Thrupp LD, Ivler D, Portnoy B, Wehrle PF. Source: Antimicrobial Agents Chemother. 1965; 5: 610-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5327522&dopt=Abstract

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Expression of death-related proteins in dentate granule cells in human bacterial meningitis. Author(s): Gerber J, Bruck W, Stadelmann C, Bunkowski S, Lassmann H, Nau R. Source: Brain Pathology (Zurich, Switzerland). 2001 October; 11(4): 422-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11556687&dopt=Abstract

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Factitious bacterial meningitis revisited. Author(s): Peterson E, Thrupp L, Uchiyama N, Hawkins B, Wolvin B, Greene G. Source: Journal of Clinical Microbiology. 1982 October; 16(4): 758-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7153328&dopt=Abstract

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Factors contributing to delay in diagnosis of bacterial meningitis. Author(s): Dunn DW. Source: Southern Medical Journal. 1984 September; 77(9): 1115-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6333080&dopt=Abstract

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False-positive complement fixing antibodies against Mycoplasma pneumoniae in patients with bacterial meningitis. Author(s): Raisanen SM, Suni J, Ponka A, Leinikki PO. Source: Journal of Clinical Pathology. 1982 August; 35(8): 903. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6809798&dopt=Abstract

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Fas (APO-1/CD95) in inflammatory CNS diseases: intrathecal release in bacterial meningitis. Author(s): Fassbender K, Eschenfelder C, Hennerici M. Source: Journal of Neuroimmunology. 1999 January 1; 93(1-2): 122-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10378875&dopt=Abstract

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Fatal basilar vasculopathy complicating bacterial meningitis. Author(s): Perry JR, Bilbao JM, Gray T. Source: Stroke; a Journal of Cerebral Circulation. 1992 August; 23(8): 1175-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1636194&dopt=Abstract

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Fc gamma receptor allotypes in children with bacterial meningitis. A preliminary study. Author(s): Tezcan I, Berkel AI, Ersoy F, Sanal O, Kanra G. Source: Turk J Pediatr. 1998 October-December; 40(4): 533-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10028861&dopt=Abstract

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Fever during treatment for bacterial meningitis. Author(s): Lin TY, Nelson JD, McCracken GH Jr. Source: Pediatr Infect Dis. 1984 July-August; 3(4): 319-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6473134&dopt=Abstract

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Fever in adult patients with acute bacterial meningitis. Author(s): Domingo P, Mancebo J, Blanch L, Net A, Nolla J. Source: The Journal of Infectious Diseases. 1988 August; 158(2): 496. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3403999&dopt=Abstract

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Fever interval before diagnosis, prior antibiotic treatment, and clinical outcome for young children with bacterial meningitis. Author(s): Bonsu BK, Harper MB. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 February 15; 32(4): 566-72. Epub 2001 Feb 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11181119&dopt=Abstract

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Fifteen years of experience with bacterial meningitis. Author(s): Dawson KG, Emerson JC, Burns JL. Source: The Pediatric Infectious Disease Journal. 1999 September; 18(9): 816-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10493344&dopt=Abstract

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Five days of antibacterial therapy for bacterial meningitis in children? Author(s): Lutsar I, Gontmacher A, Narska M, Ruutel V, Topman M, Ilves P, Siirde T, Beilmann A. Source: Infection. 1995 March-April; 23(2): 113-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7622259&dopt=Abstract

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Fluid management and arginine vasopressin in bacterial meningitis. Author(s): Powell KR, Miller ME. Source: Am J Dis Child. 1992 May; 146(5): 540-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1621652&dopt=Abstract

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Fluid management of bacterial meningitis in developing countries. Author(s): Duke T. Source: Archives of Disease in Childhood. 1998 August; 79(2): 181-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9797606&dopt=Abstract

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Fosfomycin penetration into the cerebrospinal fluid of patients with bacterial meningitis. Author(s): Sicilia T, Estevez E, Rodriguez A. Source: Chemotherapy. 1981; 27(6): 405-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6794992&dopt=Abstract

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Fulminant bacterial meningitis without meningeal signs. Author(s): Callaham M. Source: Annals of Emergency Medicine. 1989 January; 18(1): 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2910168&dopt=Abstract

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Functional epidemiology of bacterial meningitis. Author(s): Makela PH. Source: Infection. 1984; 12 Suppl 1: S29-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6397448&dopt=Abstract

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Gamma delta T lymphocytes and proinflammatory cytokines in bacterial meningitis. Author(s): Raziuddin S, Mir NA, el-Awad M el-H, Telmesani AW, al-Janadi M. Source: The Journal of Allergy and Clinical Immunology. 1994 April; 93(4): 793-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8163789&dopt=Abstract

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Genetic predisposition and sensorineural hearing loss following bacterial meningitis: is there a link? Author(s): Jayarajan V, Patton MA, Rajenderkumar D. Source: The Journal of Infection. 2002 April; 44(3): 210. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099760&dopt=Abstract

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Geographic differences in bacterial meningitis: less may be as interesting as more. Author(s): McIntyre P. Source: Journal of Paediatrics and Child Health. 1998 April; 34(2): 109-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9588628&dopt=Abstract

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Glucose consumption by polymorphonuclear leukocytes in the cerebrospinal fluid of patients with bacterial meningitis. Author(s): Bretz G, Mauer AM. Source: The Journal of Pediatrics. 1967 May; 70(5): 767-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6022180&dopt=Abstract

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Glycerol treatment in bacterial meningitis. Author(s): Thurston JH, Hauhart RE, Dirgo JA. Source: The Pediatric Infectious Disease Journal. 1996 January; 15(1): 99-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8684893&dopt=Abstract

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Granulocytes in the subarachnoid space of humans and rabbits with bacterial meningitis undergo apoptosis and are eliminated by macrophages. Author(s): Nau R, Zettl U, Gerber J, Trostdorf F, Michel U, Bottcher T, Schmidt H, Adler S, Bruck W. Source: Acta Neuropathologica. 1998 November; 96(5): 472-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9829810&dopt=Abstract

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Guidelines for managing acute bacterial meningitis. Author(s): Moller K, Skinhoj P. Source: Bmj (Clinical Research Ed.). 2000 May 13; 320(7245): 1290. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10807603&dopt=Abstract

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Hearing evaluation in children with bacterial meningitis. Author(s): Gupta V. Source: Indian Pediatrics. 1993 October; 30(10): 1175-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8077007&dopt=Abstract

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Hearing impairment after bacterial meningitis: a review. Author(s): Fortnum HM. Source: Archives of Disease in Childhood. 1992 September; 67(9): 1128-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1417060&dopt=Abstract

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Hearing impairment in children after bacterial meningitis: incidence and resource implications. Author(s): Fortnum H, Davis A. Source: British Journal of Audiology. 1993 February; 27(1): 43-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8339060&dopt=Abstract

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Hearing loss at school age in survivors of bacterial meningitis: assessment, incidence, and prediction. Author(s): Koomen I, Grobbee DE, Roord JJ, Donders R, Jennekens-Schinkel A, van Furth AM. Source: Pediatrics. 2003 November; 112(5): 1049-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14595044&dopt=Abstract

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Hearing loss during bacterial meningitis. Author(s): Richardson MP, Reid A, Tarlow MJ, Rudd PT. Source: Archives of Disease in Childhood. 1997 February; 76(2): 134-8. Erratum In: Arch Dis Child 1997 April; 76(4): 386. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9068303&dopt=Abstract

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Hemorrhagic stroke as a complication of bacterial meningitis in adults: report of three cases and review. Author(s): Gironell A, Domingo P, Mancebo J, Coll P, Marti-Vilalta JL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 December; 21(6): 1488-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8749641&dopt=Abstract

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Hemorrhagic tendency as a complication of Moxalactam therapy in bacterial meningitis. Author(s): Chan-Lui WY, Stroebel AB, Yeung CY. Source: Brain & Development. 1983; 5(4): 417-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6638397&dopt=Abstract

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Hepatocyte growth factor levels in cerebrospinal fluid: a comparison between acute bacterial and nonbacterial meningitis. Author(s): Nayeri F, Nilsson I, Hagberg L, Brudin L, Roberg M, Soderstrom C, Forsberg P. Source: The Journal of Infectious Diseases. 2000 June; 181(6): 2092-4. Epub 2000 May 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10837201&dopt=Abstract

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High concentrations of intrathecal interleukin-6 in human bacterial and nonbacterial meningitis. Author(s): Chavanet P, Bonnotte B, Guiguet M, Zeller V, Solary E, Maurice L, Casasnovas O, Caillot D, Waldner A, Kisterman JP, et al. Source: The Journal of Infectious Diseases. 1992 August; 166(2): 428-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1634815&dopt=Abstract

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High incidence of gram-negative bacillary infection and high mortality in adult patients with bacterial meningitis and nasopharyngeal carcinoma. Author(s): Huang CR, Lu CH, Chien CC, Lee PY, Chang WN. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2003 August; 22(8): 509-11. Epub 2003 July 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884063&dopt=Abstract

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High levels of interleukin 10 and tumor necrosis factor alpha in cerebrospinal fluid during the onset of bacterial meningitis. Author(s): van Furth AM, Seijmonsbergen EM, Langermans JA, Groeneveld PH, de Bel CE, van Furth R. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 July; 21(1): 220-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7578738&dopt=Abstract

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High sensitivity and specificity of serum procalcitonin levels in adults with bacterial meningitis. Author(s): Viallon A, Zeni F, Lambert C, Pozzetto B, Tardy B, Venet C, Bertrand JC. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1999 June; 28(6): 1313-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10451174&dopt=Abstract

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Hospital-acquired neonatal bacterial meningitis: the impacts of cefotaxime usage on mortality and of amikacin usage on incidence. Author(s): Coovadia YM, Mayosi B, Adhikari M, Solwa Z, van den Ende J. Source: Annals of Tropical Paediatrics. 1989 December; 9(4): 233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2482005&dopt=Abstract

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How long to treat bacterial meningitis. Author(s): O'Neill P. Source: Lancet. 1993 February 27; 341(8844): 530. Erratum In: Lancet 1993 March 6; 341(8845): 642. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8094780&dopt=Abstract

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How preventable is bacterial meningitis. Author(s): Nelson JD. Source: The New England Journal of Medicine. 1982 November 11; 307(20): 1265-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7133057&dopt=Abstract

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How rapidly is cerebrospinal fluid pleocytosis manifested with bacterial meningitis? Author(s): Bonadio WA. Source: The Pediatric Infectious Disease Journal. 1989 May; 8(5): 337-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2726326&dopt=Abstract

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How should we manage when confronted with an acute bacterial meningitis. Author(s): Levy J, De Mol P. Source: Acta Clin Belg. 1987; 42(6): 462-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3434121&dopt=Abstract

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Human cerebrospinal fluid pharmacokinetics and treatment of bacterial meningitis with ceftizoxime. Author(s): Cable D, Edralin G, Overturf GD. Source: The Journal of Antimicrobial Chemotherapy. 1982 November; 10 Suppl C: 121-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6295997&dopt=Abstract

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Hyperglycemia is not associated with mortality in bacterial meningitis. Author(s): Powers WJ. Source: Annals of Neurology. 1983 July; 14(1): 82-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6614875&dopt=Abstract

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Hyponatraemia associated with pneumonia or bacterial meningitis. Author(s): Shann F, Germer S. Source: Archives of Disease in Childhood. 1985 October; 60(10): 963-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4062347&dopt=Abstract

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Iatrogenic bacterial meningitis after spinal anesthesia for pain relief during labor. Author(s): Lurie S, Feinstein M, Heifetz C, Mamet Y. Source: Journal of Clinical Anesthesia. 1999 August; 11(5): 438-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10526818&dopt=Abstract

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Identification of viridans streptococcal species causing bacterial meningitis in adults in Taiwan. Author(s): Chang WN, Wu JJ, Huang CR, Tsai YC, Chien CC, Lu CH. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2002 May; 21(5): 393-6. Epub 2002 May 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12072926&dopt=Abstract

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Imipenem/cilastatin treatment of bacterial meningitis in children. Author(s): Wong VK, Wright HT Jr, Ross LA, Mason WH, Inderlied CB, Kim KS. Source: The Pediatric Infectious Disease Journal. 1991 February; 10(2): 122-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2062603&dopt=Abstract

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Immunodiagnosis of bacterial meningitis. Author(s): Ichhpujani RL, Bhatia R. Source: J Commun Dis. 1984 March; 16(1): 30-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12055783&dopt=Abstract

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Impact of human immunodeficiency virus type 1 infection on the epidemiology and outcome of bacterial meningitis in South African children. Author(s): Madhi SA, Madhi A, Petersen K, Khoosal M, Klugman KP. Source: International Journal of Infectious Diseases : Ijid : Official Publication of the International Society for Infectious Diseases. 2001; 5(3): 119-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724667&dopt=Abstract

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In vitro antibiotic sensitivity pattern of common bacterial isolates from cases of acute bacterial meningitis with special reference to ceftriaxone. Author(s): Rao BN, Kashbur IM, Shembesh NM, el Bargathy SM. Source: Indian J Pediatr. 1997 November-December; 64(6): 849-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10771929&dopt=Abstract

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Incidence of bacteremia, urinary tract infections, and unsuspected bacterial meningitis in children with febrile seizures. Author(s): Teach SJ, Geil PA. Source: Pediatric Emergency Care. 1999 February; 15(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10069303&dopt=Abstract

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Increased activity of lysosomal acid hydrolases in the cell-free cerebrospinal fluid of bacterial meningitis. Author(s): Beratis NG, Mavrommatis T, Hatiris I, Kavaliotis J, Tsagaropoulou-Stiga H, Syrogiannopoulos GA. Source: Pediatric Research. 1997 February; 41(2): 235-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9029645&dopt=Abstract

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Increased endothelin levels in cerebrospinal fluid samples from adults with bacterial meningitis. Author(s): Koedel U, Gorriz C, Lorenzl S, Pfister HW. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1997 August; 25(2): 329-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9332538&dopt=Abstract

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Increased serum concentrations of tissue plasminogen activator correlate with an adverse clinical outcome in patients with bacterial meningitis. Author(s): Winkler F, Kastenbauer S, Koedel U, Pfister HW. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 October; 73(4): 456. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235321&dopt=Abstract

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Index of suspicion. Case 2. Diagnosis: recurrent bacterial meningitis. Author(s): Kumar S, Bennuri B. Source: Pediatrics in Review / American Academy of Pediatrics. 1998 April; 19(4): 137-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9557066&dopt=Abstract

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Indications and benefits of computed tomography in childhood bacterial meningitis. Author(s): Daoud AS, Omari H, al-Sheyyab M, Abuekteish F. Source: Journal of Tropical Pediatrics. 1998 June; 44(3): 167-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9680784&dopt=Abstract

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Initial presentation of systemic lupus erythematosus masquerading as bacterial meningitis. Author(s): Dong J, Suwanvecho S, Chen L, Keung YK. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2001 November-December; 14(6): 470-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11757892&dopt=Abstract

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Interleukin 6 activity in infants and children with bacterial meningitis. The Collaborative Study on Meningitis. Author(s): Rusconi F, Parizzi F, Garlaschi L, Assael BM, Sironi M, Ghezzi P, Mantovani A. Source: The Pediatric Infectious Disease Journal. 1991 February; 10(2): 117-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2062602&dopt=Abstract

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Interleukin-1beta and tumor necrosis factor-alpha in cerebrospinal fluid of children with bacterial meningitis. Author(s): Tang RB, Lee BH, Chung RL, Chen SJ, Wong TT. Source: Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery. 2001 August; 17(8): 453-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11508533&dopt=Abstract

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Intracranial aneurysms associated with bacterial meningitis. Author(s): Ojemann RG, New PF, Fleming TC. Source: Neurology. 1966 December; 16(12): 1222-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5951146&dopt=Abstract

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Intrathecal production of interleukin-12 and gamma interferon in patients with bacterial meningitis. Author(s): Kornelisse RF, Hack CE, Savelkoul HF, van der Pouw Kraan TC, Hop WC, van Mierlo G, Suur MH, Neijens HJ, de Groot R. Source: Infection and Immunity. 1997 March; 65(3): 877-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9038291&dopt=Abstract

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Intussusception associated with bacterial meningitis. Author(s): Crushell E, Flanagan O, Devins M, Dunne K, Gleeson J. Source: Archives of Disease in Childhood. 2001 July; 85(1): 56-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11420203&dopt=Abstract

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Is fluid volume depleted in bacterial meningitis? Author(s): Singhi S, Singhi PD. Source: Acta Paediatrica (Oslo, Norway : 1992). 1997 September; 86(9): 1023-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9343293&dopt=Abstract

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Issues in the management of bacterial meningitis. Author(s): Tunkel AR, Scheld WM. Source: American Family Physician. 1997 October 1; 56(5): 1355-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9337758&dopt=Abstract

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Kingella kingae, a rare cause of bacterial meningitis. Author(s): Van Erps J, Schmedding E, Naessens A, Keymeulen B. Source: Clinical Neurology and Neurosurgery. 1992; 94(2): 173-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1324818&dopt=Abstract

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Laboratory diagnosis of bacterial meningitis. Author(s): Sippel JE, Girgis NI, Kilpatrick ME, Farid Z. Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 1991; 85 Suppl 1: 6-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1803698&dopt=Abstract

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Lack of effectiveness of dexamethasone in neonatal bacterial meningitis. Author(s): Daoud AS, Batieha A, Al-Sheyyab M, Abuekteish F, Obeidat A, Mahafza T. Source: European Journal of Pediatrics. 1999 March; 158(3): 230-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094445&dopt=Abstract

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Latex agglutination testing in bacterial meningitis. Author(s): Finlay FO, Witherow H, Rudd PT. Source: Archives of Disease in Childhood. 1995 August; 73(2): 160-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7574863&dopt=Abstract

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Legacy of bacterial meningitis in infancy. Many children continue to suffer functionally important deficits. Author(s): Grimwood K. Source: Bmj (Clinical Research Ed.). 2001 September 8; 323(7312): 523-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11546680&dopt=Abstract

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Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis. Author(s): Kilpi T, Anttila M, Kallio MJ, Peltola H. Source: The Pediatric Infectious Disease Journal. 1993 March; 12(3): 184-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8451093&dopt=Abstract

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Lesson of the week: Recurrent bacterial meningitis: the need for sensitive imaging. Author(s): Carrol ED, Latif AH, Misbah SA, Flood TJ, Abinun M, Clark JE, Pugh RE, Cant AJ. Source: Bmj (Clinical Research Ed.). 2001 September 1; 323(7311): 501-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11532847&dopt=Abstract

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Level of transforming growth factor beta 1 is elevated in cerebrospinal fluid of children with acute bacterial meningitis. Author(s): Huang CC, Chang YC, Chow NH, Wang ST. Source: Journal of Neurology. 1997 October; 244(10): 634-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9402540&dopt=Abstract

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Levels of interleukin-10 and tumor necrosis factor alpha in patients with bacterial meningitis. Author(s): Torre D, Zeroli C, Martegani R, Speranza F. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1996 May; 22(5): 883-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8722971&dopt=Abstract

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Levels of nitric oxide correlate with high levels of tumor necrosis factor alpha in cerebrospinal fluid samples from children with bacterial meningitis. Author(s): van Furth AM, Seijmonsbergen EM, Groeneveld PH, van Furth R, Langermans JA. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1996 May; 22(5): 876-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8722965&dopt=Abstract

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Levels of serum immunoglobulin G, CSF IgG and IgG index in acute bacterial meningitis. Author(s): Giasuddin AS, Shembesh NM, el-Bargathy SM, Kashbur IM, Rao BN. Source: British Journal of Biomedical Science. 1998 December; 55(4): 253-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10436540&dopt=Abstract

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Levels of transforming growth factor beta 1, tumor necrosis factor alpha, and interleukin 6 in cerebrospinal fluid: association with clinical outcome for children with bacterial meningitis. Author(s): Ichiyama T, Hayashi T, Nishikawa M, Furukawa S. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1997 August; 25(2): 328-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9332537&dopt=Abstract

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Lipoprotein alterations in children with bacterial meningitis. Author(s): Henter JI, Carlson LA, Hansson M, Nilsson-Ehle P, Ortqvist E. Source: Acta Paediatrica (Oslo, Norway : 1992). 1993 August; 82(8): 694-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8374222&dopt=Abstract

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Localized extracranial infections in children with acute bacterial meningitis. Author(s): Akpede GO. Source: Journal of Tropical Pediatrics. 1994 August; 40(4): 231-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7932937&dopt=Abstract

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Long term follow-up of Estonian children after bacterial meningitis. Author(s): Lutsar I, Siirde T, Soopold T. Source: The Pediatric Infectious Disease Journal. 1995 July; 14(7): 624-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7567294&dopt=Abstract

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Long term sequelae of childhood acute bacterial meningitis in a developing country. A study from the Sudan. Author(s): Salih MA, Khaleefa OH, Bushara M, Taha ZB, Musa ZA, Kamil I, Hofvander Y, Olcen P. Source: Scandinavian Journal of Infectious Diseases. 1991; 23(2): 175-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1853165&dopt=Abstract

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Long-term follow-up of children with bacterial meningitis with emphasis on behavioural characteristics. Author(s): Berg S, Trollfors B, Hugosson S, Fernell E, Svensson E. Source: European Journal of Pediatrics. 2002 June; 161(6): 330-6. Epub 2002 April 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12029452&dopt=Abstract

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Low cerebrospinal fluid beta-amyloid 42 in patients with acute bacterial meningitis and normalization after treatment. Author(s): Sjogren M, Gisslen M, Vanmechelen E, Blennow K. Source: Neuroscience Letters. 2001 November 13; 314(1-2): 33-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11698140&dopt=Abstract

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Low sensitivity of serum procalcitonin in bacterial meningitis in adults. Author(s): Hoffmann O, Reuter U, Masuhr F, Holtkamp M, Kassim N, Weber JR. Source: Scandinavian Journal of Infectious Diseases. 2001; 33(3): 215-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11303813&dopt=Abstract

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Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Author(s): Kanegaye JT, Soliemanzadeh P, Bradley JS. Source: Pediatrics. 2001 November; 108(5): 1169-74. Erratum In: Pediatrics 2002 September; 110(3): 651. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11694698&dopt=Abstract

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Lumbar punctures in suspected bacterial meningitis: too many or too few? Author(s): Selby A, Isaacs D, Gillis J, Hanson R, O'Connell A, Schell D, Van Mai T. Source: Journal of Paediatrics and Child Health. 1994 April; 30(2): 160-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8198852&dopt=Abstract

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Management of acute bacterial meningitis. Author(s): McKendrick MW, Kennedy N, Green ST, Partridge S, Read RC. Source: Lancet. 1996 March 30; 347(9005): 903. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8622419&dopt=Abstract

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Management of acute bacterial meningitis. Author(s): Watt B. Source: Lancet. 1996 February 24; 347(9000): 539. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8596283&dopt=Abstract

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Management of acute bacterial meningitis. Author(s): Obaro SK. Source: Lancet. 1996 February 24; 347(9000): 538. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8596282&dopt=Abstract

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Management of acute bacterial meningitis. Author(s): Tamburlini G, Cattaneo A, Schindler Maggi R, Macaluso A, Pivetta S. Source: Lancet. 1996 February 24; 347(9000): 537-8; Author Reply 538-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8596281&dopt=Abstract

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Management of acute bacterial meningitis. Author(s): Eltringham I, Martin M, Birthistle K, Lee P. Source: Lancet. 1996 February 24; 347(9000): 537. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8596280&dopt=Abstract

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Management of acute bacterial meningitis. Author(s): Enting R, de Gans J. Source: Lancet. 1996 February 24; 347(9000): 536-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8596279&dopt=Abstract

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Management of bacterial meningitis in adults. Author(s): Cohen J. Source: Bmj (Clinical Research Ed.). 2003 May 10; 326(7397): 996-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742897&dopt=Abstract

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Management of bacterial meningitis. Author(s): Wehrle PF, mathies AW Jr, Leedom JM. Source: Clin Neurosurg. 1966; 14: 72-85. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5992198&dopt=Abstract

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Management of bacterial meningitis: 1998. Author(s): Wubbel L, McCracken GH Jr. Source: Pediatrics in Review / American Academy of Pediatrics. 1998 March; 19(3): 7884. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9509854&dopt=Abstract

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Matrix metalloproteinase (MMP)-8 and MMP-9 in cerebrospinal fluid during bacterial meningitis: association with blood-brain barrier damage and neurological sequelae. Author(s): Leppert D, Leib SL, Grygar C, Miller KM, Schaad UB, Hollander GA. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 July; 31(1): 80-4. Epub 2000 July 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10913401&dopt=Abstract

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Matrix metalloproteinases contribute to the blood-brain barrier disruption during bacterial meningitis. Author(s): Paul R, Lorenzl S, Koedel U, Sporer B, Vogel U, Frosch M, Pfister HW. Source: Annals of Neurology. 1998 October; 44(4): 592-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9778257&dopt=Abstract

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Matrix metalloproteinases: multifunctional effectors of inflammation in multiple sclerosis and bacterial meningitis. Author(s): Leppert D, Lindberg RL, Kappos L, Leib SL. Source: Brain Research. Brain Research Reviews. 2001 October; 36(2-3): 249-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11690622&dopt=Abstract

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Medical-legal considerations related to symptom duration and patient outcome after bacterial meningitis. Author(s): Bonadio WA. Source: The American Journal of Emergency Medicine. 1997 July; 15(4): 420-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9217542&dopt=Abstract

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Microbiologic features of adult community-acquired bacterial meningitis in Taiwan. Author(s): Fang CT, Chang SC, Hsueh PR, Chen YC, Sau WY, Luh KT. Source: J Formos Med Assoc. 2000 April; 99(4): 300-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10870313&dopt=Abstract

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Microorganisms involved in acute bacterial meningitis in children and the role of Haemophilus influenzae. Author(s): Kanra G, Akan O, Ecevit Z, Ceyhan M, Secmeer G. Source: Turk J Pediatr. 1996 October-December; 38(4): 407-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8993169&dopt=Abstract

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Migraine-like headache in bacterial meningitis. Author(s): Lampl C, Yazdi K, Buzath A, Klingler D. Source: Cephalalgia : an International Journal of Headache. 2000 October; 20(8): 738-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11167904&dopt=Abstract

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Mixed infection in adult bacterial meningitis. Author(s): Chang WN, Lu CH, Huang CR, Chuang YC. Source: Infection. 2000 January-February; 28(1): 8-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10697784&dopt=Abstract

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Modulation of nuclear factor-kappaB activation and decreased markers of neurological injury associated with hypothermic therapy in experimental bacterial meningitis. Author(s): Irazuzta JE, Pretzlaff RK, Zingarelli B, Xue V, Zemlan F. Source: Critical Care Medicine. 2002 November; 30(11): 2553-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12441769&dopt=Abstract

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Molecular mechanisms of brain damage in bacterial meningitis. Author(s): Braun JS, Tuomanen EI. Source: Adv Pediatr Infect Dis. 1999; 14: 49-71. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10079849&dopt=Abstract

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Most cerebrospinal fluid cultures in children with bacterial meningitis are positive within two days. Author(s): Bryant K, Marshall GS. Source: The Pediatric Infectious Disease Journal. 1999 August; 18(8): 732-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10462348&dopt=Abstract

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Need for Haemophilus influenzae type b vaccination in Asia as evidenced by epidemiology of bacterial meningitis. Author(s): Peltola H. Source: The Pediatric Infectious Disease Journal. 1998 September; 17(9 Suppl): S148-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9781749&dopt=Abstract

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Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital. Author(s): Laving AM, Musoke RN, Wasunna AO, Revathi G. Source: East Afr Med J. 2003 September; 80(9): 456-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14640166&dopt=Abstract

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Neonatal bacterial meningitis in southern Taiwan. Author(s): Chang CJ, Chang WN, Huang LT, Huang SC, Chang YC, Hung PL, Tasi CY, Lu CH, Cheng BC, Lee PY, Chang HW. Source: Pediatric Neurology. 2003 October; 29(4): 288-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14643389&dopt=Abstract

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Neonatal bacterial meningitis in the middle belt of Nigeria. Author(s): Airede AI. Source: Developmental Medicine and Child Neurology. 1993 May; 35(5): 424-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8495823&dopt=Abstract

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Neonatal bacterial meningitis. Author(s): Polin RA, Harris MC. Source: Seminars in Neonatology : Sn. 2001 April; 6(2): 157-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11483021&dopt=Abstract

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Neurogenic pulmonary oedema induced by bacterial meningitis: a case report. Author(s): D'Souza R, Kerr F. Source: Scott Med J. 2001 August; 46(4): 115-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11676042&dopt=Abstract

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Neurologic complications of bacterial meningitis in children. Author(s): Kaplan SL, Woods CR. Source: Curr Clin Top Infect Dis. 1992; 12: 37-55. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1353677&dopt=Abstract

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Neurologic evaluation of the patient with acute bacterial meningitis. Author(s): Ashwal S. Source: Neurologic Clinics. 1995 August; 13(3): 549-77. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7476819&dopt=Abstract

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Neurological sequelae and fatality as prognostic measures in 875 cases of bacterial meningitis. Author(s): Bohr VA, Rasmussen N. Source: Dan Med Bull. 1988 February; 35(1): 92-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3342649&dopt=Abstract

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Neurological sequelae of acute bacterial meningitis. Author(s): Dodge PR. Source: Pediatric Annals. 1994 February; 23(2): 101-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8196980&dopt=Abstract

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Neuronal injury in bacterial meningitis: mechanisms and implications for therapy. Author(s): Nau R, Bruck W. Source: Trends in Neurosciences. 2002 January; 25(1): 38-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801337&dopt=Abstract

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Neuroprotection by a caspase inhibitor in acute bacterial meningitis. Author(s): Braun JS, Novak R, Herzog KH, Bodner SM, Cleveland JL, Tuomanen EI. Source: Nature Medicine. 1999 March; 5(3): 298-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10086385&dopt=Abstract

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Neurotoxicity of carbapenem antibiotics: consequences for their use in bacterial meningitis. Author(s): Norrby SR. Source: The Journal of Antimicrobial Chemotherapy. 2000 January; 45(1): 5-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10629006&dopt=Abstract

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Neurotrophin-3 levels in cerebrospinal fluid from children with bacterial meningitis, viral meningitis, or encephalitis. Author(s): Mizuno Y, Takada H, Urakami K, Ihara K, Kira R, Suminoe A, Ohga S, Aoki T, Hara T. Source: Journal of Child Neurology. 2000 January; 15(1): 19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10641604&dopt=Abstract

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New issues in bacterial meningitis in adults. Antibiotic resistance has complicated treatment. Author(s): Spach DH. Source: Postgraduate Medicine. 2003 November; 114(5): 43-50; Quiz 8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14650092&dopt=Abstract

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New perspectives on bacterial meningitis. Author(s): Quagliarello VJ, Scheld WM. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1993 October; 17(4): 603-8; Quiz 609-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8268338&dopt=Abstract

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New therapies and vaccines for bacterial meningitis. Author(s): Foster C, Nadel S. Source: Expert Opinion on Investigational Drugs. 2002 August; 11(8): 1051-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150701&dopt=Abstract

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New treatment strategies for bacterial meningitis. Author(s): Roos KL. Source: Clinical Neuropharmacology. 1993 October; 16(5): 373-86. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8221700&dopt=Abstract

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Nitric oxide production in bacterial meningitis. Author(s): Pfister HW, Bernatowicz A, Kodel U, Wick M. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1995 March; 58(3): 384-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7897434&dopt=Abstract

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Nosocomial bacterial meningitis, including central nervous system shunt infections. Author(s): Morris A, Low DE. Source: Infectious Disease Clinics of North America. 1999 September; 13(3): 735-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10470564&dopt=Abstract

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Occult invasive pituitary adenoma predisposing to fatal bacterial meningitis. Author(s): Laszewski MJ, Moore SA. Source: Clin Neuropathol. 1990 March-April; 9(2): 101-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2187637&dopt=Abstract

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Onset of hearing loss in children with bacterial meningitis. Author(s): Kaplan SL, Catlin FI, Weaver T, Feigin RD. Source: Pediatrics. 1984 May; 73(5): 575-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6718111&dopt=Abstract

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Oral glycerol and intravenous dexamethasone in preventing neurologic and audiologic sequelae of childhood bacterial meningitis. The Finnish Study Group. Author(s): Kilpi T, Peltola H, Jauhiainen T, Kallio MJ. Source: The Pediatric Infectious Disease Journal. 1995 April; 14(4): 270-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7603807&dopt=Abstract

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Organ donors with adequately treated bacterial meningitis may be suitable for successful transplantation. Author(s): Paig i JM, Lopez-Navidad A, Lloveras J, Mir M, Orfila A, Quintana S, Vazquez-Sanchez A, Inigo V, Masramon J. Source: Transplantation Proceedings. 2000 February; 32(1): 75-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10700977&dopt=Abstract

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Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis. Author(s): Richardson MP, Williamson TJ, Reid A, Tarlow MJ, Rudd PT. Source: Pediatrics. 1998 December; 102(6): 1364-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9832570&dopt=Abstract

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Otologic features of bacterial meningitis of childhood. Author(s): Eavey RD, Gao YZ, Schuknecht HF, Gonzalez-Pineda M. Source: The Journal of Pediatrics. 1985 March; 106(3): 402-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3973777&dopt=Abstract

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Outcome of paediatric bacterial meningitis 1979-1989. Author(s): Thomas DG. Source: The Medical Journal of Australia. 1992 October 19; 157(8): 519-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1282655&dopt=Abstract

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Outcomes of bacterial meningitis in children: a meta-analysis. Author(s): Baraff LJ, Lee SI, Schriger DL. Source: The Pediatric Infectious Disease Journal. 1993 May; 12(5): 389-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8327300&dopt=Abstract

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Outpatient management of pediatric bacterial meningitis. Author(s): Waler JA, Rathore MH. Source: The Pediatric Infectious Disease Journal. 1995 February; 14(2): 89-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7746713&dopt=Abstract

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Oxidative stress in bacterial meningitis in humans. Author(s): Kastenbauer S, Koedel U, Becker BF, Pfister HW. Source: Neurology. 2002 January 22; 58(2): 186-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11805243&dopt=Abstract

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Oxidative stress in bacterial meningitis. Author(s): Koedel U, Pfister HW. Source: Brain Pathology (Zurich, Switzerland). 1999 January; 9(1): 57-67. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9989452&dopt=Abstract

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Parental perception of educational, behavioural and general health problems in school-age survivors of bacterial meningitis. Author(s): Koomen I, Grobbee DE, Jennekens-Schinkel A, Roord JJ, van Furth AM. Source: Acta Paediatrica (Oslo, Norway : 1992). 2003; 92(2): 177-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710643&dopt=Abstract

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Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. Author(s): Scheld WM, Koedel U, Nathan B, Pfister HW. Source: The Journal of Infectious Diseases. 2002 December 1; 186 Suppl 2: S225-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424702&dopt=Abstract

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PCR of cerebrospinal fluid for diagnosis of bacterial meningitis during meningococcal epidemics; an example from Sudan. Author(s): Issa M, Molling P, Backman A, Unemo M, Sulaiman N, Olcen P. Source: Scandinavian Journal of Infectious Diseases. 2003; 35(10): 719-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14606610&dopt=Abstract

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Phylogenetic distribution of virulence-associated genes among Escherichia coli isolates associated with neonatal bacterial meningitis in the Netherlands. Author(s): Johnson JR, Oswald E, O'Bryan TT, Kuskowski MA, Spanjaard L. Source: The Journal of Infectious Diseases. 2002 March 15; 185(6): 774-84. Epub 2002 February 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11920295&dopt=Abstract

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Polymerase chain reaction assay and bacterial meningitis surveillance in remote areas, Niger. Author(s): Sidikou F, Djibo S, Taha MK, Alonso JM, Djibo A, Kairo KK, Chanteau S, Boisier P. Source: Emerging Infectious Diseases. 2003 November; 9(11): 1486-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14718100&dopt=Abstract

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Potential for expansion of the donor pool using liver allografts from donors with bacterial meningitis. Author(s): Issa NC, Patel R. Source: Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2002 October; 8(10): 977-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12360446&dopt=Abstract

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Predicting outcome in childhood bacterial meningitis: are pneumococci stronger than glutamate? Author(s): Whalen MJ. Source: Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2003 April; 4(2): 260-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749667&dopt=Abstract

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Predictors of bacterial meningitis in the era after Haemophilus influenzae. Author(s): Freedman SB, Marrocco A, Pirie J, Dick PT. Source: Archives of Pediatrics & Adolescent Medicine. 2001 December; 155(12): 1301-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732947&dopt=Abstract

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Prevention, treatment and outcomes of bacterial meningitis in childhood. Author(s): Bedford H. Source: Prof Nurse. 2001 October; 17(2): 100-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12030056&dopt=Abstract

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Psychometric testing in bacterial meningitis: results of a long-term prospective study of infants and children treated between 1973 and 1977. Author(s): Dodge PR, Scaer M, Holmes SJ, Pomeroy SL, Feigin RD. Source: Journal of Child Neurology. 2001 November; 16(11): 854-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732773&dopt=Abstract

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Quadriplegia complicating Escherichia coli meningitis in a newborn infant: case report and review of 22 cases of spinal cord dysfunction in patients with acute bacterial meningitis. Author(s): Moffett KS, Berkowitz FE. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1997 August; 25(2): 211-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9332512&dopt=Abstract

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Quantitation of lymphocyte subsets in cerebrospinal fluid and blood during the clinical course of aseptic and bacterial meningitis. Author(s): Bamborschke S, Wullen T, Beil C. Source: European Neurology. 1990; 30(5): 291-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1702717&dopt=Abstract

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Quantitative levels of C-reactive protein in cerebrospinal fluid in patients with bacterial meningitis and other conditions. Author(s): Gray BM, Simmons DR, Mason H, Barnum S, Volanakis JE. Source: The Journal of Pediatrics. 1986 May; 108(5 Pt 1): 665-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3701510&dopt=Abstract

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Quinolone treatment for pediatric bacterial meningitis: a comparative study of trovafloxacin and ceftriaxone with or without vancomycin. Author(s): Saez-Llorens X, McCoig C, Feris JM, Vargas SL, Klugman KP, Hussey GD, Frenck RW, Falleiros-Carvalho LH, Arguedas AG, Bradley J, Arrieta AC, Wald ER, Pancorbo S, McCracken GH Jr, Marques SR; Trovan menigitis Study Group. Source: The Pediatric Infectious Disease Journal. 2002 January; 21(1): 14-22. Erratum In: Pediatr Infect Dis J 2002 March; 21(3): 270. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11791092&dopt=Abstract

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Rational antibiotics therapy in bacterial meningitis. Author(s): Dutta AK, Bhatnagar SK. Source: Indian J Pediatr. 2001 July; 68 Suppl 3: S32-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11980457&dopt=Abstract

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Recurrence of bacterial meningitis in a patient with Crouzon syndrome and pseudomeningocele. Author(s): Ohmori M, Kamio H, Inokuchi K, Tsutsumi H, Fujimura A. Source: Southern Medical Journal. 2002 July; 95(7): 780-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144091&dopt=Abstract

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Recurrent bacterial meningitis: the search for a cause. Author(s): Harsha WJ, Varon D, Pritchard PB 3rd. Source: J S C Med Assoc. 2002 August; 98(4): 193-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216381&dopt=Abstract

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Reducing intracranial pressure may increase survival among patients with bacterial meningitis. Author(s): Lindvall P, Ahlm C, Ericsson M, Gothefors L, Naredi S, Koskinen LO. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2004 February 1; 38(3): 384-90. Epub 2004 January 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14727209&dopt=Abstract

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Reprogramming the host response in bacterial meningitis: how best to improve outcome? Author(s): van der Flier M, Geelen SP, Kimpen JL, Hoepelman IM, Tuomanen EI. Source: Clinical Microbiology Reviews. 2003 July; 16(3): 415-29. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12857775&dopt=Abstract

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Rich nations, poor nations, and bacterial meningitis. Author(s): McCracken GH Jr. Source: Lancet. 2002 July 20; 360(9328): 183. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133648&dopt=Abstract

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Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients. Author(s): Federico G, Tumbarello M, Spanu T, Rosell R, Iacoangeli M, Scerrati M, Tacconelli E. Source: Scandinavian Journal of Infectious Diseases. 2001; 33(7): 533-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11515765&dopt=Abstract

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Risk of bacterial meningitis in children with cochlear implants. Author(s): Reefhuis J, Honein MA, Whitney CG, Chamany S, Mann EA, Biernath KR, Broder K, Manning S, Avashia S, Victor M, Costa P, Devine O, Graham A, Boyle C. Source: The New England Journal of Medicine. 2003 July 31; 349(5): 435-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890842&dopt=Abstract

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Role of dexamethasone in acute bacterial meningitis in adults. Author(s): Ahsan T, Shahid M, Mahmood T, Jabeen R, Jehangir U, Saleem M, Ahmed N, Shaheer A. Source: J Pak Med Assoc. 2002 June; 52(6): 233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12481630&dopt=Abstract

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Role of the urokinase plasminogen activator system in patients with bacterial meningitis. Author(s): Winkler F, Kastenbauer S, Koedel U, Pfister HW. Source: Neurology. 2002 November 12; 59(9): 1350-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427882&dopt=Abstract

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Self-mutilation resulting in bacterial meningitis. Author(s): Chillag S, Chillag KL, Bhanot VK. Source: W V Med J. 1991 March; 87(3): 115-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2031346&dopt=Abstract

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Sensorineural hearing loss following acute bacterial meningitis in non-neonates. Author(s): Cherian B, Singh T, Chacko B, Abraham A. Source: Indian J Pediatr. 2002 November; 69(11): 951-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12503658&dopt=Abstract

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Sequelae after bacterial meningitis in childhood. Author(s): Oostenbrink R, Maas M, Moons KG, Moll HA. Source: Scandinavian Journal of Infectious Diseases. 2002; 34(5): 379-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069024&dopt=Abstract

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Serum antibodies and bacterial meningitis. Author(s): Makela PH. Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 1991; 85 Suppl 1: 19-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1803693&dopt=Abstract

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Seven days vs. 10 days ceftriaxone therapy in bacterial meningitis. Author(s): Singhi P, Kaushal M, Singhi S, Ray P. Source: Journal of Tropical Pediatrics. 2002 October; 48(5): 273-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405169&dopt=Abstract

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Should repeat lumbar punctures be routinely done in neonates with bacterial meningitis?. Results of a survey into clinical practice. Author(s): Agarwal R, Emmerson AJ. Source: Archives of Disease in Childhood. 2001 May; 84(5): 451-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11360821&dopt=Abstract

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Signs of meningeal irritation at the emergency department: how often bacterial meningitis? Author(s): Oostenbrink R, Moons KG, Theunissen CC, Derksen-Lubsen G, Grobbee DE, Moll HA. Source: Pediatric Emergency Care. 2001 June; 17(3): 161-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11437138&dopt=Abstract

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Spectrum of complications and mortality of bacterial meningitis: an experience from a developing country. Author(s): Rabbani MA, Khan AA, Ali SS, Ahmad B, Baig SM, Khan MA, Wasay M. Source: J Pak Med Assoc. 2003 December; 53(12): 580-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14765936&dopt=Abstract

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Steroids in bacterial meningitis--the continuing controversy. Author(s): Nirgudkar S, Bhukhanwala F, Mehta PJ. Source: J Assoc Physicians India. 1996 February; 44(2): 87-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10999055&dopt=Abstract

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Subarachnoid haemorrhage following activated protein C for bacterial meningitis. Author(s): King D, Higgins D. Source: Anaesthesia. 2003 September; 58(9): 913-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911371&dopt=Abstract

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The antibiotic and anti-inflammatory treatment of bacterial meningitis in adults: do we have to change our strategies in an era of increasing antibiotic resistance? Author(s): Vandecasteele SJ, Knockaert D, Verhaegen J, Van Eldere J, Peetermans WE. Source: Acta Clin Belg. 2001 July-August; 56(4): 225-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11603252&dopt=Abstract

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The changing epidemiology of bacterial meningitis and invasive non-meningitic bacterial disease in scotland during the period 1983-99. Author(s): Kyaw MH, Christie P, Jones IG, Campbell H. Source: Scandinavian Journal of Infectious Diseases. 2002; 34(4): 289-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12064693&dopt=Abstract

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The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi. Author(s): Molyneux EM, Tembo M, Kayira K, Bwanaisa L, Mweneychanya J, Njobvu A, Forsyth H, Rogerson S, Walsh AL, Molyneux ME. Source: Archives of Disease in Childhood. 2003 December; 88(12): 1112-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14670782&dopt=Abstract

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The management of bacterial meningitis in children. Author(s): Duke T, Curtis N, Fuller DG. Source: Expert Opinion on Pharmacotherapy. 2003 August; 4(8): 1227-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877633&dopt=Abstract

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The potential roles of C-reactive protein and procalcitonin concentrations in the serum and cerebrospinal fluid in the diagnosis of bacterial meningitis. Author(s): Nathan BR, Scheld WM. Source: Curr Clin Top Infect Dis. 2002; 22: 155-65. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12520652&dopt=Abstract

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The use of liver grafts from donors with bacterial meningitis. Author(s): Satoi S, Bramhall SR, Solomon M, Hastings M, Mayer AD, de Goyet JV, Buckels JA, McMaster P, Mirza DF. Source: Transplantation. 2001 September 27; 72(6): 1108-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11579309&dopt=Abstract

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Three cases of bacterial meningitis after spinal and epidural anesthesia. Author(s): Trautmann M, Lepper PM, Schmitz FJ. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2002 January; 21(1): 43-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913500&dopt=Abstract

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Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis. Author(s): Cold GE, Moller K. Source: Acta Anaesthesiologica Scandinavica. 2002 November; 46(10): 1281-5; Author Reply. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421206&dopt=Abstract

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Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis. Author(s): Grande PO, Myhre EB, Nordstrom CH, Schliamser S. Source: Acta Anaesthesiologica Scandinavica. 2002 March; 46(3): 264-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939916&dopt=Abstract

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Triptans reduce the inflammatory response in bacterial meningitis. Author(s): Hoffmann O, Keilwerth N, Bille MB, Reuter U, Angstwurm K, Schumann RR, Dirnagl U, Weber JR. Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2002 August; 22(8): 98896. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172384&dopt=Abstract

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Uncal herniation secondary to bacterial meningitis in a newborn. Author(s): Feske SK, Carrazana EJ, Kupsky WJ, Volpe JJ. Source: Pediatric Neurology. 1992 March-April; 8(2): 142-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1580958&dopt=Abstract

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Urgent full blood count in children over 3 months of age with bacterial meningitis. Author(s): Riordan FA, Thomson AP, Sills JA, Hart CA. Source: Journal of Accident & Emergency Medicine. 1995 June; 12(2): 126-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7582408&dopt=Abstract

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Use of cerebrospinal fluid C-reactive protein in laboratory diagnosis of bacterial meningitis. Author(s): Diaz V, Alvarez C, Sanz R, Alonso T. Source: Clinical Chemistry. 1988 June; 34(6): 1357. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3378337&dopt=Abstract

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Use of corticosteroids in bacterial meningitis. Author(s): Gulati S, Prakash D, Marwaha RK. Source: Indian Pediatrics. 1991 May; 28(5): 563-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1752688&dopt=Abstract

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Use of CSF C-reactive protein in differentiating bacterial and non-bacterial meningitis. Author(s): Vaidya AK, Wagle NM, Merchant SM. Source: Journal of Postgraduate Medicine. 1987 April; 33(2): 58-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3681748&dopt=Abstract

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Use of oligoprobes on amplified DNA in the diagnosis of bacterial meningitis. Author(s): Dicuonzo G, Lorino G, Lilli D, Rivanera D, Guarino P, Angeletti S, Gherardi G, Candida S, Filadoro F. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 1999 May; 18(5): 352-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10421043&dopt=Abstract

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Use of reagent strips to diagnose bacterial meningitis. Author(s): Bonev V, Gledhill RF. Source: Lancet. 1997 January 25; 349(9047): 287-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9014941&dopt=Abstract

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Use of universal PCR on cerebrospinal fluid to diagnose bacterial meningitis in culture-negative patients. Author(s): Margall Coscojuela N, Majo Moreno M, Latorre Otin C, Fontanals Amyerich D, Dominguez Garcia A, Prats Pastor G. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2002 January; 21(1): 67-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913508&dopt=Abstract

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Usefulness of clinical scores to predict outcome in bacterial meningitis. Author(s): Merkelbach S, Rohn S, Konig J, Muller M. Source: Infection. 1999; 27(4-5): 239-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10885833&dopt=Abstract

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Utility of prognostic stratification in adults with community-acquired bacterial meningitis. Author(s): Aronin SI, Quagliarello VJ. Source: Compr Ther. 2001 Spring; 27(1): 72-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11280860&dopt=Abstract

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Vaccines against bacterial meningitis. An unfinished story. Author(s): Fraser DW. Source: Postgraduate Medicine. 1977 August; 62(2): 105-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=329246&dopt=Abstract

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Value of CSF lactate in the differential diagnosis between bacterial meningitis and other diseases with meningeal involvement. Author(s): Lester A, Stilbo I, Bartels P, Bruun B. Source: Acta Pathol Microbiol Immunol Scand [b]. 1985 February; 93(1): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3984742&dopt=Abstract

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Vancomycin for treatment of bacterial meningitis. Author(s): Gump DW. Source: Reviews of Infectious Diseases. 1981 November-December; 3 Suppl: S289-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6896243&dopt=Abstract

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Vancomycin therapy of bacterial meningitis. Author(s): Hawley HB, Gump DW. Source: Am J Dis Child. 1973 August; 126(2): 261-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4724121&dopt=Abstract

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Vascular endothelial growth factor in bacterial meningitis: detection in cerebrospinal fluid and localization in postmortem brain. Author(s): van der Flier M, Stockhammer G, Vonk GJ, Nikkels PG, van DiemenSteenvoorde RA, van der Vlist GJ, Rupert SW, Schmutzhard E, Gunsilius E, Gastl G, Hoepelman AI, Kimpen JL, Geelen SP. Source: The Journal of Infectious Diseases. 2001 January 1; 183(1): 149-53. Epub 2000 November 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11106541&dopt=Abstract

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Vasopressin levels in infants during the course of aseptic and bacterial meningitis. Author(s): Padilla G, Ervin MG, Ross MG, Leake RD. Source: Am J Dis Child. 1991 September; 145(9): 991-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1877580&dopt=Abstract

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Ventriculitis with neonatal bacterial meningitis: identification by real-time ultrasound. Author(s): Hill A, Shackelford GD, Volpe JJ. Source: The Journal of Pediatrics. 1981 July; 99(1): 133-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7252650&dopt=Abstract

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Ventriculomegaly in childhood bacterial meningitis. Author(s): Snyder RD. Source: Neuropediatrics. 1984 August; 15(3): 136-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6332996&dopt=Abstract

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Viral and bacterial meningitis. Author(s): Glass B, Collipp PJ, Waldman MA. Source: N Y State J Med. 1971 September 15; 71(8): 2182-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4998474&dopt=Abstract

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Viral vs. bacterial meningitis. Author(s): White K, Hoch D. Source: Clin Lab Sci. 1996 March-April; 9(2): 123-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10163347&dopt=Abstract

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Water transport becomes uncoupled from K+ siphoning in brain contusion, bacterial meningitis, and brain tumours: immunohistochemical case review. Author(s): Saadoun S, Papadopoulos MC, Krishna S. Source: Journal of Clinical Pathology. 2003 December; 56(12): 972-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14645363&dopt=Abstract

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CHAPTER 2. NUTRITION AND BACTERIAL MENINGITIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and bacterial meningitis.

Finding Nutrition Studies on Bacterial Meningitis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “bacterial meningitis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “bacterial meningitis” (or a synonym): •

Bacterial meningitis and the newborn infant. Author(s): Department of Pediatrics, University of California San Diego School of Medicine, USA. Source: Pong, A Bradley, J S Infect-Dis-Clin-North-Am. 1999 September; 13(3): 711-33, viii 0891-5520

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Cerebral vasculature is the major target of oxidative protein alterations in bacterial meningitis. Author(s): Institute for Infectious Diseases, University of Berne, Switzerland. Source: Schaper, Manuela Gergely, Suzanne Lykkesfeldt, Jens Zbaren, Jakob Leib, Stephen L Tauber, Martin G Christen, Stephan J-Neuropathol-Exp-Neurol. 2002 July; 61(7): 605-13 0022-3069

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Cerebrospinal fluid concentrations of leukotriene B4 in bacterial meningitis. Author(s): Department of Paediatrics, University of Kiel, Germany. Source: Santer, R Sievers, E Schaub, J Acta-Paediatr. 1996 August; 85(8): 902-5 0803-5253

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Corticosteroids as adjunctive therapy in bacterial meningitis. A meta-analysis of clinical trials. Author(s): Department of Pediatrics, Medical College of Wisconsin, Milwaukee. Source: Havens, P L Wendelberger, K J Hoffman, G M Lee, M B Chusid, M J Am-J-DisChild. 1989 September; 143(9): 1051-5 0002-922X

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Could antioxidant therapy reduce the incidence of deafness following bacterial meningitis? Author(s): Department of Pathology, Houston Medical Center, Warner Robins, GA 31093, USA. Source: Maurizi, C P Med-Hypotheses. 1999 January; 52(1): 85-7 0306-9877

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Current concepts in bacterial meningitis. Source: Hahn, S M West-J-Med. 1989 August; 151(2): 180-6 0093-0415

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Imipenem/cilastatin treatment of bacterial meningitis in children. Author(s): Department of Pediatrics, Children's Hospital of Los Angeles, USC School of Medicine 90027. Source: Wong, V K Wright, H T Ross, L A Mason, W H Inderlied, C B Kim, K S PediatrInfect-Dis-J. 1991 February; 10(2): 122-5 0891-3668

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Management of bacterial meningitis. Author(s): Department of Medical Microbiology, University of Liverpool, UK. Source: Hart, C A Cuevas, L E Marzouk, O Thomson, A P Sills, J J-AntimicrobChemother. 1993 July; 32 Suppl A49-59 0305-7453

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Matrix metalloproteinases contribute to the blood-brain barrier disruption during bacterial meningitis. Author(s): Department of Neurology, Ludwig-Maximilians-University of Munich, Klinikum Brosshadern, Germany. Source: Paul, R Lorenzl, S Koedel, U Sporer, B Vogel, U Frosch, M Pfister, H W AnnNeurol. 1998 October; 44(4): 592-600 0364-5134

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Migraine-like headache in bacterial meningitis. Author(s): Department of Neurology, Psychiatry and Pain Clinic, General Hospital Linz, Austria. [email protected] Source: Lampl, C Yazdi, K Buzath, A Klingler, D Cephalalgia. 2000 October; 20(8): 738-9 0333-1024

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Neurologic evaluation of the patient with acute bacterial meningitis. Author(s): Department of Pediatrics, Loma Linda University School of Medicine, California, USA. Source: Ashwal, S Neurol-Clin. 1995 August; 13(3): 549-77 0733-8619

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New perspectives on bacterial meningitis. Author(s): Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510. Source: Quagliarello, V J Scheld, W M Clin-Infect-Dis. 1993 October; 17(4): 603-8; quiz 609-10 1058-4838

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Nitric oxide and prostaglandin E2 formation parallels blood-brain barrier disruption in an experimental rat model of bacterial meningitis. Author(s): Department of Pharmaceutics, School of Pharmacy, University of Buffalo, NY 14260-1200, USA. Source: Jaworowicz, D J Korytko, P J Singh Lakhman, S Boje, K M Brain-Res-Bull. 1998 August; 46(6): 541-6 0361-9230

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Oxidative stress in bacterial meningitis in humans. Author(s): Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany. Source: Kastenbauer, S Koedel, U Becker, B F Pfister, H W Neurology. 2002 January 22; 58(2): 186-91 0028-3878

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Pediatric bacterial meningitis in the emergency department. Author(s): Foote Hospital, Jackson, Michigan, USA. Source: Strawser, D J-Emerg-Nurs. 1997 August; 23(4): 310-5 0099-1767

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Pentoxifylline modulates meningeal inflammation in experimental bacterial meningitis. Author(s): Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235. Source: Saez Llorens, X Ramilo, O Mustafa, M M Mertsola, J de Alba, C Hansen, E McCracken, G H Antimicrob-Agents-Chemother. 1990 May; 34(5): 837-43 0066-4804

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Prevention of auditory sequelae in pediatric bacterial meningitis: a meta-analysis. Author(s): Department of Pharmacy, University of Cincinnati Hospital, Ohio. Source: Yurkowski, P J Plaisance, K I Pharmacotherapy. 1993 Sep-October; 13(5): 494-9 0277-0008

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Rapid diagnosis of acute pyogenic meningitis by a combined PCR dot-blot assay. Author(s): Astra Research Centre India, 18th Cross, Malleswaram, Bangalore-560003, India. [email protected] Source: Balganesh, M Lalitha, M K Nathaniel, R Mol-Cell-Probes. 2000 April; 14(2): 61-9 0890-8508

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Rational antibiotics therapy in bacterial meningitis. Author(s): Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi. Source: Dutta, A K Bhatnagar, S K Indian-J-Pediatr. 2001 July; 68 Suppl 3: S32-9 00195456

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Rational basis of modern therapy of bacterial meningitis. Review of the literature and our clinical experience of 122 pediatric cases. Author(s): Intake Service, Regina Margherita Children's Hospital, Turin. Source: Pecco, P Pavesio, D Peisino, M G Panminerva-Med. 1991 Oct-December; 33(4): 185-90 0031-0808

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Should corticosteroids be used in the treatment of bacterial meningitis? Pro and con. Author(s): Department of Pediatrics, State University of New York, Buffalo. Source: Kornberg, A E Welliver, R C Duffy, L C Stapleton, F B Pediatr-Emerg-Care. 1991 August; 7(4): 234-41 0749-5161

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Steroid therapy for bacterial meningitis. Source: Grossman, M West-J-Med. 1990 December; 153(6): 651-2 0093-0415

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The receptor for complement anaphylatoxin C3a is expressed by myeloid cells and nonmyeloid cells in inflamed human central nervous system: analysis in multiple sclerosis and bacterial meningitis. Author(s): Department of Medical Biochemistry, University of Wales College of Medicine, Cardiff, United Kingdom. [email protected] Source: Gasque, P Singhrao, S K Neal, J W Wang, P Sayah, S Fontaine, M Morgan, B P JImmunol. 1998 April 1; 160(7): 3543-54 0022-1767

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The use of corticosteroids in the management of bacterial meningitis in adults. Author(s): Department of Internal Medicine, University of Virginia, Charlottesville 22908, USA. Source: Townsend, G C Scheld, W M J-Antimicrob-Chemother. 1996 June; 37(6): 1051-61 0305-7453

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Therapy for bacterial meningitis: which drugs, and for how long? Source: Stutman, H R Marks, M I J-Pediatr. 1987 May; 110(5): 812-4 0022-3476

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND BACTERIAL MENINGITIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to bacterial meningitis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to bacterial meningitis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “bacterial meningitis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to bacterial meningitis: •

Acute confusion, Chinese herbal medicines and tuberculous meningitis. Author(s): Chan JC, Tomlinson B, Kay R, Chan TY, Critchley JA. Source: Aust N Z J Med. 1994 October; 24(5): 590-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7848176&dopt=Abstract

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Acute lymphoblastic leukemia in very young children. Diagnostic and therapeutic aspects of 43 cases. Author(s): Leverger G, Bancillon A, Schaison G, Alby N, Boiron M. Source: Am J Pediatr Hematol Oncol. 1986 Fall; 8(3): 213-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3464219&dopt=Abstract

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An outbreak of pneumonia and meningitis caused by a previously undescribed gramnegative bacterium in a hot spring spa.

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Author(s): Hubert B, de Mahenge A, Grimont F, Richard C, Peloux Y, de Mahenge C, Fleurette J, Grimont PA. Source: Epidemiology and Infection. 1991 October; 107(2): 373-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1936159&dopt=Abstract •

Bacterial meningitis and lumbar epidural hematoma due to lumbar acupunctures: a case report. Author(s): Chen CY, Liu GC, Sheu RS, Huang CL. Source: Kaohsiung J Med Sci. 1997 May; 13(5): 328-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9226976&dopt=Abstract

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Bacterial meningitis observed in a phase I trial of vinorelbine, cisplatin and thoracic radiotherapy for non-small cell lung cancer: report of a case and discussion on doselimiting toxicity. Author(s): Sekine I, Matsuda T, Saisho T, Watanabe H, Yamamoto N, Kunitoh H, Ohe Y, Tamura T, Kodama T, Saijo N. Source: Japanese Journal of Clinical Oncology. 2000 September; 30(9): 401-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095138&dopt=Abstract

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Balneatrix alpica gen. nov., sp. nov., a bacterium associated with pneumonia and meningitis in a spa therapy center. Author(s): Dauga C, Gillis M, Vandamme P, Ageron E, Grimont F, Kersters K, de Mahenge C, Peloux Y, Grimont PA. Source: Research in Microbiology. 1993 January; 144(1): 35-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8327781&dopt=Abstract

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Binding of mannan-binding protein to various bacterial pathogens of meningitis. Author(s): van Emmerik LC, Kuijper EJ, Fijen CA, Dankert J, Thiel S. Source: Clinical and Experimental Immunology. 1994 September; 97(3): 411-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8082295&dopt=Abstract

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Branding still a “treatment” in rural India. Author(s): Lakhani JD, Pathak KJ, Parikh N, Kotecha PV. Source: Lancet. 1982 July 17; 2(8290): 152. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6123857&dopt=Abstract

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Comparison of counterimmunoelectrophoresis, latex agglutination and bacterial culture for the diagnosis of bacterial meningitis using urine, serum and cerebrospinal fluid samples. Author(s): Requejo HI, Nascimento CM, Fahrat CK.

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Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 1992; 25(4): 357-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1342212&dopt=Abstract •

Confronting diversity: experiences of nurses in a sanatorium. Author(s): Herselman S. Source: Curationis. 1997 March; 20(1): 2-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9287545&dopt=Abstract

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Detecting polysaccharide antigen of Neisseria meningitidis group C in cerebrospinal fluid by dot-ELISA assay. Author(s): Correia Barbosa SF, Alkmin MG, Landgraf IM. Source: The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases. 2000 June; 4(3): 144-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10934498&dopt=Abstract

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Development of a protocol for early treatment of endemic meningitis in children in Vanuatu. Author(s): Harris M, Carrol K, Carrol C. Source: J Trop Med Hyg. 1991 February; 94(1): 8-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1995940&dopt=Abstract

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Effect of catalase on regional cerebral blood flow and brain edema during the early phase of experimental pneumococcal meningitis. Author(s): Pfister HW, Kodel U, Dirnagl U, Haberl RL, Ruckdeschel G, Einhaupl KM. Source: The Journal of Infectious Diseases. 1992 December; 166(6): 1442-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1431262&dopt=Abstract

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Effects of TENS and methylphenidate in tuberculous meningo-encephalitis. Author(s): Scherder EJ, Van Deursen S, Van Manen SR, Ferenschild K, Simis R, Vuyk PJ. Source: Brain Injury : [bi]. 2001 June; 15(6): 545-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394974&dopt=Abstract

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Epidemic hysteria in Gondar City, Western Ethiopia. Author(s): Maru M. Source: East Afr Med J. 1982 May; 59(5): 311-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7173067&dopt=Abstract

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Feasibility of intraventricular administration of etoposide in patients with metastatic brain tumours. Author(s): Fleischhack G, Reif S, Hasan C, Jaehde U, Hettmer S, Bode U.

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Source: British Journal of Cancer. 2001 June 1; 84(11): 1453-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11384092&dopt=Abstract •

Haemophilus influenzae meningitis: an evolving therapeutic regimen. Author(s): Barkin RM, Greer CC, Schumacher CJ, McIntosh K. Source: Am J Dis Child. 1976 December; 130(12): 1318-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1087110&dopt=Abstract

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Haemophilus influenzae type b purpura fulminans treated with hyperbaric oxygen. Author(s): Dollberg S, Nachum Z, Klar A, Engelhard D, Ginat-Israeli T, Hurvitz H, Melamed Y, Branski D. Source: The Journal of Infection. 1992 September; 25(2): 197-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1431173&dopt=Abstract

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Hearing loss and pneumococcal meningitis: an animal model. Author(s): Bhatt S, Halpin C, Hsu W, Thedinger BA, Levine RA, Tuomanen E, Nadol JB Jr. Source: The Laryngoscope. 1991 December; 101(12 Pt 1): 1285-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1766298&dopt=Abstract

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Homeopathic treatment for sequelae of meningococcal septicemia. Author(s): Leckridge B. Source: Alternative Therapies in Health and Medicine. 1998 July; 4(4): 124-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9729105&dopt=Abstract

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Immunodiagnosis of pneumococcal meningitis using Dot-enzyme-linked immunosorbent assay. Author(s): Requejo HI, das Gracas M, Alkmin A, Landgraf IM. Source: Journal of Tropical Pediatrics. 2001 October; 47(5): 288-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11695728&dopt=Abstract

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Invasive Haemophilus influenzae type b disease in Australia: the beginning of the end? Author(s): McIntyre P. Source: The Medical Journal of Australia. 1992 April 20; 156(8): 516-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1565040&dopt=Abstract

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Listeria monocytogenes infection and activation of human brain microvascular endothelial cells. Author(s): Wilson SL, Drevets DA.

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Source: The Journal of Infectious Diseases. 1998 December; 178(6): 1658-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9815218&dopt=Abstract •

Miracles of healing in Anglo-Celtic Northumbria as recorded by the venerable Bede and his contemporaries: a reappraisal in the light of twentieth century experience. Author(s): Gardner R. Source: British Medical Journal (Clinical Research Ed.). 1983 December 24-31; 287(6409): 1927-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6418275&dopt=Abstract

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Prevention of antibiotic-associated diarrhea in infants by probiotics. Author(s): Jirapinyo P, Densupsoontorn N, Thamonsiri N, Wongarn R. Source: J Med Assoc Thai. 2002 August; 85 Suppl 2: S739-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403254&dopt=Abstract

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Prevention of hearing loss in experimental pneumococcal meningitis by administration of dexamethasone and ketorolac. Author(s): Rappaport JM, Bhatt SM, Burkard RF, Merchant SN, Nadol JB Jr. Source: The Journal of Infectious Diseases. 1999 January; 179(1): 264-8. Erratum In: J Infect Dis 1999 March; 179(3): 753. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9841852&dopt=Abstract

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Primary pseudomonas meningitis in an adult, splenectomized, multitransfused thalassaemia major patient. Author(s): Ghosh K, Daar S, Hiwase D, Nursat N. Source: Haematologia. 2000; 30(1): 69-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10841329&dopt=Abstract

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Proteases of the pathogenic neisseriae: possible role in infection. Author(s): O'Reilly TM, Bhatti AR. Source: Microbios. 1986; 45(183): 113-29. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3086672&dopt=Abstract

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Protective effect of flavonoids against aging- and lipopolysaccharide-induced cognitive impairment in mice. Author(s): Patil CS, Singh VP, Satyanarayan PS, Jain NK, Singh A, Kulkarni SK. Source: Pharmacology. 2003 October; 69(2): 59-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928578&dopt=Abstract

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Sepsis in a newborn due to Pseudomonas aeruginosa from a contaminated tub bath. Author(s): Vochem M, Vogt M, Doring G.

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Source: The New England Journal of Medicine. 2001 August 2; 345(5): 378-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11484709&dopt=Abstract •

Streptomycin in postwar Britain: a cultural history of a miracle drug. Author(s): Yoshioka A. Source: Clio Medica (Amsterdam, Netherlands). 2002; 66: 203-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028678&dopt=Abstract

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Ultrasound-enhanced latex immunoagglutination test (USELAT) for detection of capsular polysaccharide antigen of Neisseria meningitidis from CSF and plasma. Author(s): Porritt RJ, Mercer JL, Munro R. Source: Pathology. 2003 February; 35(1): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701687&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to bacterial meningitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Epilepsy Source: Integrative Medicine Communications; www.drkoop.com Meningitis Source: Integrative Medicine Communications; www.drkoop.com Seizure Disorders Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON BACTERIAL MENINGITIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “bacterial meningitis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on bacterial meningitis, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Bacterial Meningitis By performing a patent search focusing on bacterial meningitis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on bacterial meningitis: •

Combined meningitis vaccine Inventor(s): Ceccarini; Costante (Castelnuovo Berardenga, IT), Costantino; Paolo (Colle Val D'Elsa, IT), D'Ascenzi; Sandro (Colle Val D'Elsa, IT), Giannozzi; Aldo (Siena, IT), Norelli; Francesco (Siena, IT) Assignee(s): Chiron S.p.a. (siena, It) Patent Number: 6,251,401 Date filed: May 1, 1997 Abstract: A combined vaccine for bacterial meningitis comprises Hib and MenC oligosaccharide conjugates. Excerpt(s): The present invention relates to a combined vaccine for the treatment of bacterial meningitis. In particular, the combined vaccine effectively protects against infection by Haemophilus influenzae type B (Hib) and Neisseria meningitidis (meningococcus) serotypes B and C (MenB, MenC). Bacterial meningitis caused by infection with Hib, MenB and/or MenC represents a worldwide problem. Infection by these organisms can result in permanent disability and death among young children. Recently, however, a conjugate Hib vaccine has become generally available and has resulted in the effective control of Hib infections. Similar vaccines are shortly to become available for MenC infection and also for MenB infection (see Costantino et al., 1992 Vaccine, 10,691-698). The Hib and meningococcal vaccines are based on conjugates between oligosaccharides derived from the bacterial surface, which define epitopes specific for the bacterium in question, conjugated to carrier proteins, such as non-toxic mutants of diphtheria toxin, for example CRM197. Web site: http://www.delphion.com/details?pn=US06251401__

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Enzymatic detection of bacterial capsular polysaccharide antigens Inventor(s): Taylor; Peter W. (West Haven, CT) Assignee(s): Molecular Diagnostics, Inc. (west Haven, Ct) Patent Number: 4,695,541 Date filed: January 31, 1985 Abstract: A substantially pure enzyme which hydrolyzes a polymer containing an.alpha. 2,8-linked N-acetyl neuraminic acid is obtained from K1-specific bateriophages and used for assays of bacterial polysaccharides in samples such as cerebrospinal fluid for testing for various disorders such as bacterial meningitis, septicemia, bacteremia, and the like. The enzyme may also be used therapeutically in treating such disorders by attacking cells which have an increased level of a polymer containing an.alpha. 2,8linked N-acetyl neuraminic acid. Excerpt(s): The present invention relates to a process for assaying biological samples for the presence of a polymer containing a particular monomer unit, to an enzyme for hydrolyzing such polymer and to the use of such enzyme therapeutically as well as diagnostically. The majority of cases of bacterial meningitis are caused by five bacterial species, namely Streptococcus (Group B), Escherichia coli, Haemophilus influenzae,

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Streptococcus pneumoniae and Neisseria meningitidis. The first two organisms are the major cause of the disease in neonates; after the first ten weeks of life infections due to the latter three organisms predominate. These pathogenic bacteria characteristically produce polysaccharide capsules that constitute the major virulence determinant in meningitis, as evidenced by the fact that protection against the disease is conferred by antibodies directed against the capsular material. Although some of these bacterial species produce a wide variety of serologically-defined capsular types, relatively few serotypes possess the ability to cause meningitis. For example, of the six capsular serotypes of H. influenzae one, serotype b, is associated with virtually all invasive disease due to this species. The situation with E. coli is even more marked; although more than 70 acidic polysaccharide capsular (K) antigens are currently recognized by the WHO reference center, one K type, K1, is associated with 80-85% of all E. coli isolates from the cerebrospinal fluid of neonates with meningitis. Because of the acute and lifethreatening nature of the disease, and of the necessity for prompt initiation of effective therapy, rapid diagnosis of infection and reliable identification of the etiologic agent are essential components of meningitis management. Currently, several procedures are available for the detection of capsular antigens associated with many of the major meningitis pathogens; these methods include countercurrent immunoelectrophoresis, latex particle agglutination and staphylococcal coagglutination in addition to traditional direct culture methods. Although some of these methods achieve sufficient sensitivity to enable routine determination of antigen concentration over the clinically relevant range, they are limited by a high incidence of non-specific reactivity, by the additional steps required to minimize false positives and by the commercial unavailability of many of the antibody-coated reagents. Furthermore, two of the most important capsular antigens, from E. coli K1 strains and the structurally and serologically identical meningococcus B antigen, are such poor immunogens that practically no antisera are currently available. Consequently no standard procedure is widely applicable for the routine detection and quantitation of these important antigens in cerebrospinal fluid and other clinically relevant sample fluids. Web site: http://www.delphion.com/details?pn=US04695541__ •

Method for differential diagnosis of meningitis with a limulus lysate test Inventor(s): Khan; Waheed N. (Potomac, MD) Assignee(s): Research Foundation of Children's Hospital (washington, Dc) Patent Number: 4,067,776 Date filed: November 25, 1975 Abstract: A method for rapid bedside diagnostic differentiation between aseptic meningitis and Gram-negative bacterial meningitis is carried out in a positive control vessel, a negative control vessel and a test vessel, wherein each vessel contains an equal amount of lyophilized limulus lysate and the positive control vessel also contains an amount of lyophilized Gram-negative bacterial endotoxin. Excerpt(s): As is known in the art, meningitis may be broadly characterized as aseptic meningitis or bacterial meningitis. Aseptic meningitis may refer to two different but related forms of meningitis. Firstly, it may be referring to an acute febrile illness with meningeal irritation and cerebro-spinal fluid (CSF) pleocytosis, but with normal glucose contents and on culture of the CSF no bacterial isolation is obtained. The second form of aseptic meningitis can be characterized by CSF pleocytosis, normal glucose and the absence of organism involvement. This can include not only viral but other infections as

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well as non-infectious causes. When viral infections of the central nervous system are invovled, these infections may take three different forms. In the first form, there may be no symptoms and only fever and malaise, but the CSF may be abnormal with a lymphocytic pleocytosis. In a second form, the symptoms may be confined to meningeal manifestations, such as fever, headache, vomiting, stiff neck and back and the like. In the third form, referred to as encephalitis, the meningeal symptoms, noted above, may be accompanied by cerebral disorders including alterations of consciousness, personality changes and the like. Bacterial meningitis may be caused by one or more of several known bacteria. Among the generally accepted bacteria are the Gram-negative bacteria Neisseria meningitidis, Haemophilus influenzae, Escherichia coli, Salmonella enteridis (or group B), Proteus species (indole positive and negative) and Pseudomonas arugeniosa, and the Gram-positive bacteria, Diplococcus pneumoniae, Strepococcus pyogenes, and Straphylococcus aureus. In bacterial meningitis, clinical indications show brain and meninges involvement. Some of the clinical signs can include fever, headache, stiff neck and vomiting. Thus, from a clinical observation, it is difficult to tell whether aseptic meningitis or bacterial meningitis is involved, since the clinical symptoms of the different forms of meningitis can be, at least, overlapping in their manifestations. However, the proper treatment for the forms of meningitis vary significantly, and a rapid and positive diagnosis of the form of meningitis is extremely important in the treatment of meningitis. If the meningitis is diagnosed as bacterial meningitis, the more usual therapy involves administration of antibiotics, of specific types, and such administration should be given as promptly as possible once the diagnosis has been established. The prompt commencement of the thereapy is fundamental to the more successful treatment of bacterial meningitis. Web site: http://www.delphion.com/details?pn=US04067776__ •

Method of discriminating bacterial from aseptic meningitis Inventor(s): Barnum; Scott R. (Sterrett, AL), Stahel; Phillip (Birmingham, AL) Assignee(s): Uab Research Foundation (birmingham, Al) Patent Number: 5,778,895 Date filed: January 29, 1997 Abstract: The present invention provides a method for the differential diagnosis of bacterial meningitis in an individual in need of such diagnosis, comprising the steps of: measuring the levels of complement C3 and complement factor B in the cerebrospinal fluid of the individual; and determining whether that individual has bacterial menigitis based on the levels of complement C3 and complement factor B in the cerebrospinal fluid of that individual. Also provided is a method for the differential diagnosis of bacterial menigitis in an individual in need of such diagnosis, comprising the steps of: measuring the levels of complement factor B in a sample from the individual; and determining whether that individual has bacterial menigitis based on the levels of complement factor B in the sample from that individual. Excerpt(s): The present invention relates generally to the fields of medicine, neuroimmunology and protein chemistry. More specifically, the present invention relates to a method of discriminating bacterial from aseptic meningitis. Bacterial meningitis occurs in about 25,000 cases per year in the United States with an overall mortality rate of from 10-35%. About 30% of individuals with acute bacterial meningitis experience seizures and about 10-30% of those who survive a case of bacterial meningitis exhibit long-term neurological sequelae. Bacterial meningitis remains a

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major cause of morbidity and mortality, with a high incidence of residual neurological impairment (reviewed in Quagliarello & Scheld 1992). Early diagnosis and immediate onset of adequate antimicrobial treatment are essential for the survival of patients with bacterial meningitis (Lieu et al. 1992). However, establishing the diagnosis of bacterial meningitis represents a difficult task in most cases, since clinical signs of acute meningitis are non-specific, and laboratory examinations of cerebrospinal fluid (CSF) often do not accurately differentiate between bacterial and aseptic meningitis (Lindquist et al. 1988, Rodewald et al. 1991). Accurate differentiation between bacterial and aseptic (viral) meningitis is difficult as both are inflammatory diseases that elicit similar host defense responses and clinical symptoms. Differential diagnosis can be made on positive identification of the bacteria from the cerebrospinal fluid of the affected individual. Unfortunately, it may take several days to grow and identify the bacteria and twentyfive percent of the time culture results are negative or equivocal even though the patients have bacterial meningitis. Similar or greater error rates affect nearly every laboratory parameter used for diagnostic purposes. Web site: http://www.delphion.com/details?pn=US05778895__ •

Method of treating bacterial meningitis with anti-tumor necrosis factor antibody Inventor(s): Collins; Michael S. (Madison, CT), Hector; Richard F. (Dublin, CA) Assignee(s): Bayer Corporation (berkeley, Ca) Patent Number: 5,616,321 Date filed: March 23, 1995 Abstract: Bacterial meningitis infection in a mammal is treated by intravenous infusion of a therapeutically effective amount of a monoclonal antibody which binds to tumor necrosis factor alpha and an antibiotic. Treatment can be initiated up to five hours after bacterial challenge and the antibiotic is preferably selected from cephalosporins and aminoglycosides. Excerpt(s): This application is concerned generally with a treatment of infection and specifically with the use of monoclonal antibodies that bind to TNF to treat bacterial meningitis. Bacterial meningitis remains one of the more difficult management problems in clinical medicine. Evidence suggests that bacterial meningitis represents infection in a site with a reduced potential for host resistance. With essentially no antibodies or complement present in the spinal fluid, polymorphonucleocytes are essentially unable to contribute to the clearing of the intruding bacteria in the early steps of disease. Morbidity and mortality from bacterial meningitis remains high; a death rate of 30% for pneumococcal meningitis has not changed over the past 40 years despite new antibiotics and improved understanding of therapy practices. Bacterial meningitis is described in detail in Cecil, Textbook of Medicine, 19th addition at pages 1655-161, the details of which are incorporated into this application. The role of tumor necrosis factor (TNF) in bacterial meningitis is described in an article by Arditi et al. in the Journal of Infectious Diseases, 162:p. 139-145(1990). See also related articles by Arditi et al., in the Journal of Infectious Diseases, vol. 160, no. 6, pp. 1005-1011, December 1989 and an article by Mustafa et al., the Journal of Infectious Diseases, vol. 160, no. 5, pp. 818-825, November 1989. Web site: http://www.delphion.com/details?pn=US05616321__

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Multi oligosaccharide glycoconjugate bacterial meningitis vaccines Inventor(s): Chong; Pele (Richmond Hill, CA), Klein; Michel H. (Willowdale, CA), Lindberg; Alf (Lyons, FR) Assignee(s): Aventis Pasteur Limited (toronto, Ca) Patent Number: 6,656,472 Date filed: December 22, 2000 Abstract: Multivalent immunogenic molecules comprise a carrier molecule containing at least one functional T-cell epitope and multiple different carbonhydrate fragments each linked to the carrier molecule and each containing at least one functional B-cell epitope. The carrier molecule inparts enhanced immunogenicity to the multiple carbohydrate fragments. The carbohydrate fragments may be capsular oligosaccharide fragments from Streptococcus pneumoniae which may be serotypes (1, 4, 5, 6B, 9V, 14, 18C, 19F or 23F), or Neisseria meningitidis, which may be serotype (A, B, C) W-135 or Y. Such oligosaccharide fragments may be sized from about 2 to about 5 kDa. Alternatively, the carbohydrate fragments may be fragments of carbohydrate-based tumor antigens, such as Globo H, Le.sup.Y or STn. The multivalent molecules may be produced by random conjugation or site-directed conjugation of the carbohydrate fragments to the carrier molecule. The multivalent molecules may be employed in vaccines or in the generation of antibodies for diagnostic applications. Excerpt(s): The present invention is related to the field of vaccines and is particularly related to the development of novel glycoconjugation technologies which can be used to prepare glycoconjugates in which multi-oligosaccharides are covalently linked to the same carrier protein. Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae are major causes of bacterial meningitis in children under five years of age. All these bacteria are protected from phagocytosis by a polysaccharidic capsule. Antibodies induced against the capsular polysaccharide (CPs) of the organism are protective in most cases. Effective Hib conjugate vaccines in which Hib CPs, PRP, is linked to different carrier proteins, such as diphtheria toxoid (PRP-D), tetanus toxoid (PRP-T), CRM 197 (HbOC) and the outer membrane proteins of N. meningitidis (PRPOMP), have been developed. Four Hib conjugate vaccines are now commercially available. New glycoconjugate vaccines against N. meningitidis and S. pneumoniae are highly recommended by the American College of Physicians. The development of multivalent pneumococcal vaccines for the prevention of both systemic and noninvasive pneumococcal diseases in infants, the elderly and immune-compromised individuals has gained increasing importance over the last decade. For more detailed reviews of pneumococcal disease, epidemiology, or the polysaccharide vaccine, numerous review articles are available (ref. 1, various references are referred to in parenthesis to more fully describe the state of the art to which this invention pertains. Full bibliographic information for each citation is found at the end of the specification, immediately preceding the claims. The disclosure of these references are hereby incorporated by reference into the present disclosure). Web site: http://www.delphion.com/details?pn=US06656472__

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Screening method for inflammatory diseases using neutrophil defensins and lactoferrin Inventor(s): Heine; Robert Phillips (Pittsburgh, PA) Assignee(s): University of Pittsburgh (pittsburgh, Pa) Patent Number: 6,174,664 Date filed: May 5, 1999 Abstract: The present invention provides a relatively accurate, rapid and economical method of screening a patient for the presence of inflammatory diseases such as an intraamniotic infection, bacterial meningitis and the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis. The method of the present invention involves measuring the concentration of neutrophil defensins HNP1-3 and the concentration of lactoferrin, found in a bodily fluid, tissue or a combination thereof, adding these two concentrations together to yield a summed total, and correlating the measured summed total to known summed totals to give an indication of whether the patient is at risk of suffering from inflammatory diseases such as an intraamniotic infection, bacterial meningitis or the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis. Excerpt(s): The present invention relates to a method of screening for inflammatory diseases in a patient. More particularly, this invention concerns the method of screening a patient for the presence of inflammatory diseases such as an intraamniotic infection, bacterial meningitis and the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis, by utilizing neutrophil defensins and lactoferrin, found in a bodily fluid, a tissue or a combination thereof, to give an indication of whether the patient is at risk of suffering from one or more such inflammatory diseases. The methods of disease detection may be divided into two general types: diagnosis and screening. Diagnosis is the method whereby a physician determines the nature of a disease based upon the patient's signs and symptoms. Screening is the method of suggesting the presence, or the absence, of a particular disease, or class of diseases, in a patient. When a screening test indicates that a patient does not have a disease, in many cases the need for further diagnostic testing has been eliminated. Used in this manner, screening saves money for patients, health insurance companies and government health programs by precluding the unwarranted diagnostic testing of people shown not to suffer from the disease or class of diseases. To be effective in reducing unnecessary diagnostic testing, however, a screening method must be widely used. In order that a screening method is widely used, the screening test should be relatively accurate, quick, and economical to use. In addition, screening provides a way for patients to avoid the cost and discomfort associated with the more invasive procedures often necessary to collect the samples required for diagnostic testing. The following are some of the conventional methods used for screening and diagnosing inflammatory conditions such as an intraamniotic infection, bacterial meningitis, and the sexually transmitted diseases; gonorrhea, chlamydia and trichomoniasis. Web site: http://www.delphion.com/details?pn=US06174664__

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Patent Applications on Bacterial Meningitis As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to bacterial meningitis: •

Bacterial phage associated lysing enzymes for the prophylactic and therapeutic treatment of colonization and infections caused by streptococcus pneumoniae Inventor(s): Daniel, Nelson; (New York, NY), Jutta, Loeffler; (New York, NY), Loomis, Lawrence; (Columbia, MD), Vincent, Fischetti; (West Hempstead, NY) Correspondence: Jonathan E. Grant; Grant Patent Services; Suite 210; 2120 L Street, N. W.; Washington; DC; 20037; US Patent Application Number: 20020136712 Date filed: September 21, 2001 Abstract: A method for the prophylactic and therapeutic treatment of Streptococcal pneumoniae infections is disclosed which comprises the treating of an individual with an effective amount of a lytic enzyme composition specific for the infecting bacteria, and a carrier for delivering said lytic enzyme. This method, and composition can be used for the treatment of upper respiratory infections, lower respiratory infections, septicemia, bacterial meningitis, and other infections involving Streptococcal pneumoniae. Excerpt(s): The following application is a continuation-in-part of U.S. patent application Ser. No. 09/846,688, filed May 2, 2001, which is a continuation in part of Ser. No. 09/497,495, filed Apr. 18, 2000, now U.S. Pat. No. 6,238,661, which was a continuation of U.S. patent application Ser. No. 09/395,636, filed Sep. 14,1999, now U.S. Pat. No. 6,056,954, issued May 2, 2000, which was a continuation in part of U.S. patent application Ser. No. 08/962,523, filed Oct. 31, 1997, now U.S. Pat. No. 5,997,862. The present invention relates to methods and compositions for the prophylaxis and treatment of Streptococcus pneumoniae. In the past, antibiotics have been used to treat various infections. The work of Selman Waksman in the introduction and production of Streptomycetes, and Dr. Fleming's discovery of penicillin, as well as the work of numerous others in the field of antibiotics, are well known. Over the years, there have been additions and chemical modifications to the "basic" antibiotics to make them more powerful, or to treat people allergic to these antibiotics. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Epidural catheter dispenser system to contain and control an epidural catheter, maintain epidural catheter sterility and prevent epidural catheter contamination Inventor(s): Simpson, Robert C.; (Tallahassee, FL) Correspondence: Robert J. Mcaughan, JR.; Howrey Simon Arnold & White, Llp; 750 Bering Drive; Houston; TX; 77057-2198; US Patent Application Number: 20030094731 Date filed: November 20, 2001

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This has been a common practice outside the United States prior to December 2000.

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Abstract: An epidural injection is used in medical procedure to administer medication to a patient's epidural space in the spine, usually to alleviate pain. Although effective in purpose, current medical procedure to administer an epidural injection does contain a flaw that exposes the patient to possible infection, usually manifested as an epidural abscess or bacterial meningitis. A source for infection stems from the manner the epidural catheter, specifically the proximal end not being inserted into the patient, is traditionally handled throughout the procedure--usually freely hanging, susceptible to breaking the sterile field and becoming contaminated. The current invention, an epidural catheter dispenser system, seeks to eliminate this risk of epidural catheter contamination by maintaining the epidural catheter, especially the proximal catheter end, in a sterile dispenser that can be easily manipulated by a physician. The epidural catheter dispenser system defines an inner cavity in which an epidural catheter may be loaded. When ready for use, a distal catheter end is extracted from the dispenser's inner cavity through a dispenser aperture on the dispenser's distal end piece, or top, allowing the physician to direct the epidural catheter into an epidural needle bore and into a patient's epidural space. Because the epidural catheter dispenser system and its epidural catheter contents fit easily into the palm of a physician's hand, the proximal catheter end is permanently in a controlled, contained sterile environment throughout the entire catheter placement procedure until extracted from the dispenser. The current invention minimizes and virtually eliminates the risk of epidural catheter contamination. Thus, the epidural catheter dispenser system provides benefits beyond existing epidural injection procedures including: (1) reduced risk of infection of the patient receiving an epidural injection; (2) easier catheter management for the physician; (3) better control of the medical microenvironment for the physician; and (4) improved medical efficiencies. Excerpt(s): An epidural injection is a medical anesthetic technique whereby medication, typically an anesthetic agent with or without a steroidal component, is administered to a patient's spine, specifically in the epidural space. The epidural space consists of the space between a patient's bony spinal vertebrae and the dura mater, or tough outer layer of the spinal cord. Epidural injections are most commonly used to alleviate pain associated with childbirth or nerve root impingement. Nerve roots are bands of nerves extending from the spinal cord in the vertebral canal to the body through intervertebral foramina, or spaces between vertebrae. Nerve roots can become impinged as a result of a bulging, herniated or ruptured intervertebral disc due to compression or wear. Nerve root impingement can also occur as a result of a radiculopathy, bony osteophyte or projection compressing the nerve root. For the administration of an epidural injection, a physician will request the patient to lie in a fetal position, whereby the patient's knees are pulled closely to her chest. This creates a convex curvature for the patient's spine, resulting in the widening of the intervertebral space between each vertebra's spinous process. The physician may then palpate the intervertebral space at the level of the spine in which the epidural injection is desired to be administered to alleviate pain. After locating the precise point to administer the epidural injection, the physician will use an aseptic technique to prep and drape the area and cleanse the area of bacteria to prevent infection. During the prep and drape process, the physician will use iodine and a brush to scrub the skin surface several times. The physician will also drape the local area with sterile cloths, leaving only the small area to administer the epidural uncovered. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Novel meningitis conjugate vaccine Inventor(s): Arnold, Frank J.; (Newfoundland, PA), D'Ambra, Anello J.; (Mount Pocono, PA), Maleckar, James R.; (Nazareth, PA), McMaster, Ronald P.; (Stroudsburg, PA) Correspondence: Aventis Pasteur, INC.; Route 611, Discovery Drive; Swiftwater; PA; 18370; US Patent Application Number: 20030035806 Date filed: May 9, 2002 Abstract: The present invention relates to immunogenic protein-polysaccharide conjugates comprising pneumococcal surface protein (PspA) obtained from Streptococcus pneumoniae conjugated to a capsular polysaccharide from N. meningitidis, and compositions comprising the same. Also provided are methods of manufacture of such immunogenic combinations as well as methods of use of such immunogenic combinations in the prevention and treatment of bacterial meningitis, particularly pneumococcal and meningococcal meningitis. Excerpt(s): The present invention relates to the fields of immunology, vaccines and the prevention of bacterial infections by immunization, more specifically to polysaccharideprotein conjugates useful as vaccines, vaccine compositions comprising two or more polysaccharide-protein conjugates and methods of vaccination using the same. Neisseria meningitidis (N. meningitidis) is a leading cause of bacterial meningitis and sepsis throughout the world. Pathogenic meningococci are enveloped by a polysaccharide capsule that is attached to the outer membrane surface of the organism. N. meningitidis is classified by the immunological specificity of the capsular polysaccharide. Thirteen different serogroups of meningococci have been identified, of which five (A, B, C, W135, and Y) cause the majority of meningococcal disease. Serogroup A is responsible for most epidemic disease, which is rare in the industrialized world but occurs periodically in developing countries. Serogroups B, C, and Y cause the majority of endemic disease and localized outbreaks. Although more rare, serogroup W135 outbreaks have increased worldwide in recent years. [Samuelsson S., Eurosurveillance Weekly, 2000:17:1-5.] There are approximately 2,600 cases of bacterial meningitis per year in the United States and on average 330,000 cases in developing countries, with case fatality rates ranging between 10 and 20%. Current meningococcal vaccines elicit an immune response against the capsular polysaccharide. The antibodies thus generated are capable of complementmediated bacteriolysis of the serogroup specific meningococci. Meningococcal polysaccharide vaccines have been shown to be efficacious in older children and adults (Artenstein, M. S., et al. New Engl. J. Med. 282: 417-420, 1970 and Peltola, H., et al. New Engl. J. Med. 297: 686-691, 1977, but the efficacy is limited in infants and young children Reingold, A. L., et al. Lancet 2: 114-118, 1985). Subsequent doses of polysaccharide in younger populations elicited weak or no booster responses (Goldschneider, I., et al. J. Inf. Dis. 128: 769-776, 1973 and Gold, R., et al. J. Inf. Dis. 136: S31-S35, 1977). Also, the protection elicited by the meningococcal polysaccharide vaccines is not long-lasting having been estimated to be between 3 to 5 years (Brandt, B., et al. J. Inf. Dis. 131: S69S72, 1975, and Kyhty, H., et al. J. Inf. Dis. 142: 861-868, 1980, and Ceesay, S. J., et al. J. Inf. Dis. 167: 1212-1216, 1993). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 89

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NOVEL MULTI-OLIGOSACCHARIDE MENINGITIS VACCINES

GLYCOCONJUGATE

BACTERIAL

Inventor(s): CHONG, PELE; (RICHMOND HILL, CA), KLEIN, MICHEL; (WILLOWDALE, CA), LINDBERG, ALF; (LYON, FR) Correspondence: Sim & Mcburney; 6th Floor 330 University Avenue; Toronto; M5g1r7; CA Patent Application Number: 20010048929 Date filed: February 23, 1998 Abstract: Multivalent immunogenic molecules comprise a carrier molecule containing at least one functional T-cell epitope and multiple different carbohydrate fragments each linker to the carrier molecule and each containing at least one functional B-cell epitope. The carrier molecule inputs enhanced immunogenicity to the multiple carbohydrate fragments. The carbohydrate fragments may be capsular oligosaccharide fragments from Streptococcus pneumoniae, which may be serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F or 23F, or Neisseria meningitidis, which may be serotype A, B, C, W-135 or Y. Such oligosaccharide fragments may be sized from 2 to 5 kDa. Alternatively, the carbohydrate fragments may be fragments of carbohydrate-based tumor antigens, such as Globo H, Le.sup.Y or STn. The multivalent molecules may be produced by random conjugation or site-directed conjugation of the carbohydrate fragments to the carrier molecule. The multivalent molecules may be employed in vaccines or in the generation of antibodies for diagnostic application. Excerpt(s): The present invention is related to the field of vaccines and is particularly related to the development of novel glycoconjugation technologies which can be used to prepare glycoconjugates in which multi-oligosaccharides are covalently linked to the same carrier protein. Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae are major causes of bacterial meningitis in children under five years of age. All these bacteria are protected from phagocytosis by a polysaccharidic capsule. Antibodies induced against the capsular polysaccharide (CPs) of the organism are protective in most cases. Effective Hib conjugate vaccines in which Hib CPs, PRP, is linked to different carrier proteins, such as diphtheria toxoid (PRP-D), tetanus toxoid (PRP-T), CRM 197 (HbOC) and the outer membrane proteins of N. meningitidis (PRPOMP), have been developed. Four Hib conjugate vaccines are now commercially available. New glycoconjugate vaccines against N. meningitidis and S. pneumoniae are highly recommended by the American College of Physicians. The development of multivalent pneumococcal vaccines for the prevention of both systemic and noninvasive pneumococcal diseases in infants, the elderly and immune-compromised individuals has gained increasing importance over the last decade. For more detailed reviews of pneumococcal disease, epidemiology, or the polysaccharide vaccine, numerous review articles are available (ref. 1, various references are referred to in parenthesis to more fully describe the state of the art to which this invention pertains. Full bibliographic information for each citation is found at the end of the specification, immediately preceding the claims. The disclosure of these references are hereby incorporated by reference into the present disclosure). Streptococcus pneumoniae is a capsulated, grampositive bacterium that is present as normal flora in the human upper respiratory tract. It is a frequent and major cause of pneumonia, meningitis, bacteremia and noninvasive bacterial otitis media. Disease incidence is highest in infants and the elderly. In the United States alone, the overall incidence of systemic pneumococcal infections is estimated to be 50/100,000 in the geriatric population and 160/100,000 in children less than 2 years old (refs. 2, 3). Case fatalities can be as high as 40,000/year, especially in the

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geriatric population. Many serotypes of S. pneumoniae are developing resistance to conventional antibiotic treatments. The incidence of otitis media in children approaches 90% by the age of 5 and the peak incidence occurs at 6 to 15 months of age. It was estimated that over 1.2 million cases of otitis media occur annually. Recent studies on the epidemiology of pneumococcal disease (ref. 4) have shown that five serotypes (6B, 14, 19F, 23F and 18C) of the 85 known serotypes account for 70 to 80% of pneumococcal disease in infants and that in the United States, types 9V and 4 are ranked sixth and seventh. In Europe and developing countries, types 1 and 5 are more prevalent than types 4 and 9V. Thus, a pneumococcal conjugate vaccine for the United States should contain at least seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) to achieve a 75 to 85% coverage. Conjugate vaccine formulations for Europe and elsewhere should include serotypes 1, 5, 6B, 14, 18C, 19F and 23F. A broad-spectrum multivalent pneumococcal conjugate vaccine should then contain CPs from nine serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, and 23F. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel therapeutic agents interfering in neutrophil migration Inventor(s): Hoepelman, Ilja Mohandas; (Utrecht, NL) Correspondence: Trask Britt; P.O. Box 2550; Salt Lake City; UT; 84110; US Patent Application Number: 20030191088 Date filed: April 9, 2003 Abstract: The present invention provides methods and means to influence neutrophil migration which occurs in a number of serious illnesses, such as acute trauma and inflammatory diseases. In bacterial meningitis for instance a high influx of neutrophils in the brain leads to an unfavorable prognosis. Typically IL-8 is involved in the chemoattraction of neutrophils. According to the present invention, glucoronoxylmannan or a functional equivalent thereof is used to interfere with neutrophil migration. This constitutes a first medical use of this group of substances. Excerpt(s): This application is a continuation of application Ser. No. 09/680,671, filed Oct. 6, 2000, pending, which is a continuation of PCT International Application No. PCT/NL99/00211, filed on Apr. 8, 1999, designating the United States of America. The present invention relates to the field of diseases involving the immune system and, in particular, diseases involving neutrophil migration. A number of serious illnesses involve neutrophil transmigration at one stage or another. Such diseases include acute traumas (especially trauma to the brain), infections, ischemic neurological injury and other inflammatory diseases (such as autoimmune diseases). A very important disease for which no successful drug has been developed so far is bacterial meningitis. Bacterial meningitis is a serious illness, affecting annually in the United States about 3 individuals per 100,000. The case fatality rate is estimated at 25%, and a substantial percentage of the survivors will suffer permanent neurological impairment. Typically, a patient presents with serious clinical symptoms and a high leukocyte count in their cerebrospinal fluid (CSF). Extensive literature evidence suggests that these leukocytes, which are mainly neutrophil leukocytes, play an important adverse role in the pathogenesis of neurological damage. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Transcriptional silencer protein NRF Inventor(s): Hauser, Hansjorg; (Braunschweig, DE), Nourbakhsh, Mahtab; (Braunschweig, DE) Correspondence: Marshall, Gerstein & Borun; 6300 Sears Tower; 233 South Wacker; Chicago; IL; 60606-6357; US Patent Application Number: 20030125286 Date filed: September 16, 2002 Abstract: NRF is a novel inhibitory transcription factor binding to specific DNA sequences and silencing transcriptional activity of proximal DNA-binding activators, e.g. NF-.sub.KB binding sites.NRF is a modulator protein of NF-.sub.KB family members controlling genes of significant biomedical importance such as those encoding inflammatory cytokines, MHC proteins, cell adhesion molecules, and viruses. Based on this it represents a molecular target in the development of novel anti-inflammatory therapies for a variety of pathologic disorders such as ischemia, hemorrhagic and septic shock, allograft rejection, bacterial meningitis, acute airway inflammation and the pulmonary complications induced by cardiopulmonary bypass. Furthermore, this might apply for certain cancers and other diseases.NRF as a target for drugs (obtained e.g. by IITS) is protected. Agonists as well as antagonists of NRF are also protected. Further applications such as the use of NRF protein and its fusion proteins or NRF DNA sequence in sense or antisense orientation in gene therapy are also protected. Excerpt(s): This is a continuation of International Application No. PCT/EP98/04661 filed Jul. 24, 1998 (International Publication No. WO 99/05269 dated Feb. 4, 1999). The respective disclosures of International Application No. PCT/EP98/04661 and International Publication No. WO 99/05269 are incorporated herein by reference. The invention concerns the transcriptional silencer protein NRF which is a novel inhibitory transcription factor, and several related subject matters. The background of the invention is as follows. The family of NF-.sub.KB/rel transcription factors regulates a variety of promoters through specific DNA-binding sites. NF-.sub.KB/rel-binding sites act as weak constitutive enhancers. However, many promoters which contain NF.sub.KB/rel-binding sites do not show base level activity. This is explained by the existence of silencer elements. Further to the constitutive enhancing activity of the NF.sub.KB binding sites, many inducers like viruses, TNF-A or PMA induce a signalling cascade that increases the activity of the NE-.sub.KB enhancers transiently. These inducers lead to a transient inactivation of IkB, the cytoplasmic inhibitor of certain NF.sub.KB members. This results in a nuclear translocation of the prototype NF-.sub.KB (a heterodimer of p50 and p65) and the activation of the above mentioned target genes by binding and activation of transcription. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with bacterial meningitis, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “bacterial

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meningitis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on bacterial meningitis. You can also use this procedure to view pending patent applications concerning bacterial meningitis. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON BACTERIAL MENINGITIS Overview This chapter provides bibliographic book references relating to bacterial meningitis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on bacterial meningitis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “bacterial meningitis” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “bacterial meningitis” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “bacterial meningitis” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Bacterial Meningitis by Allan R. Tunkel; ISBN: 0781711029; http://www.amazon.com/exec/obidos/ASIN/0781711029/icongroupinterna

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Bacterial Meningitis by J. D. Williams (Editor), J. Burnie (Editor); ISBN: 0127551557; http://www.amazon.com/exec/obidos/ASIN/0127551557/icongroupinterna

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Bacterial Meningitis (Antibiotics and Chemotherapy, Vol 45) by H. Schonfeld, et al; ISBN: 3805554842; http://www.amazon.com/exec/obidos/ASIN/3805554842/icongroupinterna

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Bacterial Meningitis (Contemporary Issues in Infectious Disease Vol 3) by Merle A. Sande, et al; ISBN: 0443083266; http://www.amazon.com/exec/obidos/ASIN/0443083266/icongroupinterna

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Neontal Bacterial Meningitis by Rudd (Author); ISBN: 0521412811; http://www.amazon.com/exec/obidos/ASIN/0521412811/icongroupinterna

Chapters on Bacterial Meningitis In order to find chapters that specifically relate to bacterial meningitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and bacterial meningitis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “bacterial meningitis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on bacterial meningitis: •

Management in Bilaterally Obliterated Cochleae Source: in Uziel, A.S.; Mondain, M., eds. Cochlear Implants in Children: Advances in Otorhinolaryngology, Volume 50. Basel, Switzerland: S. Karger AG. 1995. p. 54-58. Contact: Available from S. Karger AG. 26 West Avon Road, P.O. Box 529, Framington, CT 06085. (800) 828-5479 or (203) 675-7834. PRICE: $99.50 plus shipping and handling, unless prepaid. ISBN: 3805560958. Summary: Bacterial meningitis is known to lead to a bony or scar tissue obliteration of the inner ear. In this chapter from a text on cochlear implants in children, the authors recommend a strategy for the management of meningitis deafness. Topics covered include the need for early diagnosis; diagnostic and screening tests used; determining cochlear implant candidacy; informing and working with the child's parents; and long term monitoring of the child. The authors present their experiences with three young children and one adolescent. They stress that early diagnosis of postmeningitic deafness is possible by watchful pediatricians. Only close cooperation among pediatrician, otologist, and radiologist allows satisfactory management of imminent cochlear obliteration. 5 figures. 5 references. (AA-M).

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Acquired Hearing Loss Due to Other Infections and Causes Source: in Pappas, D.G. Diagnosis and Treatment of Hearing Impairment in Children. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1998. p. 115-168. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545. Fax (800) 774-8398. E-mail: [email protected]. Website: www.singpub.com. PRICE: $55.00 plus shipping and handling. ISBN: 1565938658. Summary: This chapter on acquired hearing loss due to other infections (non viral) and causes is from a text that discusses the prevention, diagnosis, and treatment of hearing impairment in children. A follow up to the chapter on viral infections, this chapter focuses on serous otitis media (otitis media with effusion, or OME), the incidence of OME, complications from chronic otitis media, preexisting sensorineural hearing loss (SNHL) and negative middle ear pressure, organism (i.e., bacteria) and drug related factors, the pathogenesis of OME, the benefits of ventilation tubes, the surgical management of chronic otitis media (with ventilation tube placement), complications with ventilation tubes, when to remove a ventilation tube, protection from water when

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tubes are in place, the technique of closure of posttympanotomy perforation (when a tympanotomy tube perforates the eardrum), congenital cholesteatoma, bacterial meningitis (including routes of infections, diagnosis, treatment, pathophysiology, and vestibular involvement), complications of hearing loss associated with meningitis, perilymph fistula in children with preexisting SNHL, autoimmune inner ear disease, and SNHL in children with autoimmune inner ear disease. In each case, the authors focus on the diagnostic tests and treatment options for children with that particular condition. 11 figures. 7 tables. 133 references.

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CHAPTER 6. PERIODICALS AND NEWS ON BACTERIAL MENINGITIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover bacterial meningitis.

News Services and Press Releases One of the simplest ways of tracking press releases on bacterial meningitis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “bacterial meningitis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to bacterial meningitis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “bacterial meningitis” (or synonyms). The following was recently listed in this archive for bacterial meningitis: •

Cochlear implants raise risk of bacterial meningitis in children Source: Reuters Medical News Date: July 30, 2003

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Bacterial meningitis a concern among children with cochlear implants Source: Reuters Medical News Date: June 23, 2003

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Steroid may cut death risk of bacterial meningitis Source: Reuters Health eLine Date: November 13, 2002

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Dexamethasone benefits adults with bacterial meningitis Source: Reuters Industry Breifing Date: November 13, 2002

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Five-factor diagnostic rule differentiates tuberculous from bacterial meningitis Source: Reuters Medical News Date: October 28, 2002

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Non-bacterial meningitis linked to Vioxx use Source: Reuters Health eLine Date: March 25, 2002

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Possible role seen for thalidomide in treating bacterial meningitis Source: Reuters Industry Breifing Date: September 14, 2000

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Neurological, auditory, behavior abnormalities persist after bacterial meningitis Source: Reuters Medical News Date: August 30, 2000

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CSF cytokine levels can predict mortality in acute bacterial meningitis Source: Reuters Medical News Date: June 26, 2000

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Meropenem as effective as cefotaxime for treatment of bacterial meningitis in children Source: Reuters Medical News Date: August 12, 1999

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C-reactive protein test differentiates viral and Gram-negative bacterial meningitis Source: Reuters Medical News Date: June 30, 1999

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Rifampin shows promise in treatment of bacterial meningitis Source: Reuters Medical News Date: June 01, 1999

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Risk stratification system for bacterial meningitis developed Source: Reuters Medical News Date: December 30, 1998

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Thalidomide-antibiotic combination therapy may combat mycobacterial meningitis Source: Reuters Medical News Date: June 08, 1998

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Bacterial Meningitis On The Decline Source: Reuters Medical News Date: October 02, 1997

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Glutamate Levels Affect Bacterial Meningitis Prognosis Source: Reuters Medical News Date: October 21, 1996

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Major Epidemic Of Bacterial Meningitis Reported In West Africa Source: Reuters Medical News Date: May 09, 1996

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JOPLIN, Mo., Dec 28 (Reuters) - Two new cases surfaced in an outbreak of bacterial meningitis that has caused four fatalities in southwest Missouri, health officials said Wednesday. Source: Reuters Medical News Date: December 29, 1995

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Evidence Lacking For Routine Use Of Dexamethasone To Treat Acute Bacterial Meningitis Source: Reuters Medical News Date: July 25, 1995

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Cytokine Elevations In CSF Of Infants Signal Bacterial Meningitis Source: Reuters Medical News Date: June 28, 1995

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Neonatal Bacterial Meningitis: Only A Lumbar Puncture Will Tell Source: Reuters Medical News Date: June 09, 1995

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Outpatient Therapy: Option In Selected Cases Of Pediatric Bacterial Meningitis Source: Reuters Medical News Date: March 06, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “bacterial meningitis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

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Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “bacterial meningitis” (or synonyms). If you know the name of a company that is relevant to bacterial meningitis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “bacterial meningitis” (or synonyms).

Academic Periodicals covering Bacterial Meningitis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to bacterial meningitis. In addition to these sources, you can search for articles covering bacterial meningitis that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “bacterial meningitis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 13250 29 797 51 17 14144

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “bacterial meningitis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on bacterial meningitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to bacterial meningitis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to bacterial meningitis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “bacterial meningitis”:

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Guides on bacterial meningitis Meningitis http://www.nlm.nih.gov/medlineplus/meningitis.html

•

Other guides Bacterial Infections http://www.nlm.nih.gov/medlineplus/bacterialinfections.html Hearing Problems in Children http://www.nlm.nih.gov/medlineplus/hearingproblemsinchildren.html Immune System and Disorders http://www.nlm.nih.gov/medlineplus/immunesystemanddisorders.html Pneumonia http://www.nlm.nih.gov/medlineplus/pneumonia.html Streptococcal Infections http://www.nlm.nih.gov/medlineplus/streptococcalinfections.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Meningococcal Disease Summary: A consumer fact sheet provides basic information about meningococcal disease -- bacterial meningitis. Topics covered include symptoms, diagnosis, prevention (vaccines) and treatment. Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2138 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to bacterial meningitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information

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for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of health topics covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to bacterial meningitis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with bacterial meningitis. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about bacterial meningitis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations.

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The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “bacterial meningitis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “bacterial meningitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “bacterial meningitis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “bacterial meningitis” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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BACTERIAL MENINGITIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acatalasia: A rare autosomal recessive disorder resulting from the absence of catalase activity. Though usually asymptomatic, a syndrome of oral ulcerations and gangrene may be present. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acremonium: A mitosporic fungal genus with many reported ascomycetous teleomorphs. Cephalosporin antibiotics are derived from this genus. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH] Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the

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tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amikacin: A broad-spectrum antibiotic derived from kanamycin. It is reno- and ototoxic like the other aminoglycoside antibiotics. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH]

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Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anode: Electrode held at a positive potential with respect to a cathode. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH]

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Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight

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of the atmospheric gases above the point concerned. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autoradiography: A process in which radioactive material within an object produces an image when it is in close proximity to a radiation sensitive emulsion. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Aztreonam: A monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum. It is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. It may cause a superinfection with grampositive organisms. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriolysis: Rupture of bacterial cells due to mechanical force, chemical action, or the lytic growth of bacteriophages. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophil: A type of white blood cell. Basophils are granulocytes. [NIH]

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Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bioterrorism: The use of biological agents in terrorism. This includes the malevolent use of bacteria, viruses, or toxins against people, animals, or plants. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Body Fluids: Liquid components of living organisms. [NIH]

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Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchial: Pertaining to one or more bronchi. [EU] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs.

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[NIH]

Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cefoperazone: Semisynthetic broad-spectrum cephalosporin with a tetrazolyl moiety that is resistant to beta-lactamase. It has been proposed especially against Pseudomonas infections. [NIH]

Cefotaxime: Semisynthetic broad-spectrum cephalosporin. [NIH] Cefoxitin: Semisynthetic cephamycin antibiotic resistant to beta-lactamase. [NIH] Ceftazidime: Semisynthetic, broad-spectrum antibacterial derived from cephaloridine and used especially for Pseudomonas and other gram-negative infections in debilitated patients. [NIH]

Ceftizoxime: A semisynthetic cephalosporin antibiotic which can be administered intravenously or by suppository. The drug is highly resistant to a broad spectrum of betalactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative organisms. It has few side effects and is reported to be safe and effective in aged patients and in patients with hematologic disorders. [NIH] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [NIH] Cefuroxime: Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Adhesion Molecules: Surface ligands, usually glycoproteins, that mediate cell-to-cell adhesion. Their functions include the assembly and interconnection of various vertebrate systems, as well as maintenance of tissue integration, wound healing, morphogenic movements, cellular migrations, and metastasis. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter

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cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cephaloridine: A cephalosporin antibiotic. [NIH] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chickenpox: A mild, highly contagious virus characterized by itchy blisters all over the body. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases

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in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cilastatin: A renal dehydropeptidase-I and leukotriene D4 dipeptidase inhibitor. Since the antibiotic, imipenem, is hydrolyzed by dehydropeptidase-I, which resides in the brush border of the renal tubule, cilastatin is administered with imipenem to increase its effectiveness. The drug also inhibits the metabolism of leukotriene D4 to leukeotriene E4. [NIH]

Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU]

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Cochlear Duct: Spiral tube in the bony canal of the cochlea, lying on its outer wall between the scala vestibuli and scala tympani. [NIH] Cochlear Implantation: Surgical insertion of an electronic device implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Implants: Electronic devices implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Nerve: The cochlear part of the 8th cranial nerve (vestibulocochlear nerve). The cochlear nerve fibers originate from neurons of the spiral ganglion and project peripherally to cochlear hair cells and centrally to the cochlear nuclei (cochlear nucleus) of the brain stem. They mediate the sense of hearing. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make

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biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contusion: A bruise; an injury of a part without a break in the skin. [EU] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH]

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Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Counterimmunoelectrophoresis: Immunoelectrophoresis in which immunoprecipitation occurs when antigen at the cathode is caused to migrate in an electric field through a suitable medium of diffusion against a stream of antibody migrating from the anode as a result of endosmotic flow. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH]

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Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis,

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polyneuritis, and other systemic toxic effects. [NIH] Diphtheria Toxin: A 60 kD single chain protein elaborated by Corynebacterium diphtheriae that causes the sign and symptoms of diphtheria; it can be broken into two unequal fragments, the smaller (A fragment) inhibits protein synthesis and is the lethal moiety that needs the larger (B fragment) for entry into cells. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dispenser: Glass, metal or plastic shell fitted with valve from which a pressurized formulation is dispensed; an instrument for atomizing. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Dose-limiting: Describes side effects of a drug or other treatment that are serious enough to prevent an increase in dose or level of that treatment. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH]

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Eardrum: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual

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defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]

Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enhancers: Transcriptional element in the virus genome. [NIH] Enterovirus: A genus of the family Picornaviridae whose members preferentially inhabit the intestinal tract of a variety of hosts. The genus contains many species. Newly described members of human enteroviruses are assigned continuous numbers with the species designated "human enterovirus". [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme-Linked Immunosorbent Assay: An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidemiology, Molecular: The application of molecular biology to the answering of epidemiological questions. The examination of patterns of changes in DNA to implicate particular carcinogens and the use of molecular markers to predict which individuals are at highest risk for a disease are common examples. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord.

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An epidural injection is given into this space. [NIH] Epidural Space: Space between the dura mater and the walls of the vertebral canal. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitatory Amino Acids: Endogenous amino acids released by neurons as excitatory neurotransmitters. Glutamic acid is the most common excitatory neurotransmitter in the brain. Aspartic acid has been regarded as an excitatory transmitter for many years, but the extent of its role as a transmitter is unclear. [NIH] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH]

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Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH]

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Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]

Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU]

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Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemophilus: A genus of Pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gram-negative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Hematogenous: Originating in the blood or spread through the bloodstream. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells,

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cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Heterodimer: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histamine Release: The secretion of histamine from mast cell and basophil granules by exocytosis. This can be initiated by a number of factors, all of which involve binding of IgE, cross-linked by antigen, to the mast cell or basophil's Fc receptors. Once released, histamine binds to a number of different target cell receptors and exerts a wide variety of effects. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Horseradish Peroxidase: An enzyme isolated from horseradish which is able to act as an antigen. It is frequently used as a histochemical tracer for light and electron microscopy. Its antigenicity has permitted its use as a combined antigen and marker in experimental immunology. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH]

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Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolases: Any member of the class of enzymes that catalyze the cleavage of the substrate and the addition of water to the resulting molecules, e.g., esterases, glycosidases (glycoside hydrolases), lipases, nucleotidases, peptidases (peptide hydrolases), and phosphatases (phosphoric monoester hydrolases). EC 3. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hysteria: Historical term for a chronic, but fluctuating, disorder beginning in early life and characterized by recurrent and multiple somatic complaints not apparently due to physical illness. This diagnosis is not used in contemporary practice. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Imipenem: Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with cilastatin, a renal dipeptidase inhibitor. [NIH]

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Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodiffusion: Technique involving the diffusion of antigen or antibody through a semisolid medium, usually agar or agarose gel, with the result being a precipitin reaction. [NIH]

Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators

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or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Initiator: A chemically reactive substance which may cause cell changes if ingested, inhaled or absorbed into the body; the substance may thus initiate a carcinogenic process. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and

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B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-12: A heterodimeric cytokine that stimulates the production of interferon gamma from T-cells and natural killer cells, and also induces differentiation of Th1 helper cells. It is an initiator of cell-mediated immunity. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interneurons: Most generally any neurons which are not motor or sensory. Interneurons may also refer to neurons whose axons remain within a particular brain region as contrasted with projection neurons which have axons projecting to other brain regions. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction

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of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kanamycin: Antibiotic complex produced by Streptomyces kanamyceticus from Japanese soil. Comprises 3 components: kanamycin A, the major component, and kanamycins B and C, the minor components. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthine: A vestibular nystagmus resulting from stimulation, injury, or disease of the labyrinth. [NIH] Labyrinthitis: Inflammation of the inner ear. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leptospirosis: Infections with bacteria of the genus Leptospira. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukemia: Cancer of blood-forming tissue. [NIH] Leukocyte Count: A count of the number of white blood cells per unit volume in venous blood. A differential leukocyte count measures the relative numbers of the different types of white cells. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levofloxacin: A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU]

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Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Fat. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoblastic: One of the most aggressive types of non-Hodgkin lymphoma. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Subsets: A classification of lymphocytes based on structurally or functionally different populations of cells. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysosome: A sac-like compartment inside a cell that has enzymes that can break down cellular components that need to be destroyed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes

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dead cells, and stimulates the action of other immune system cells. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meningeal: Refers to the meninges, the tissue covering the brain and spinal cord. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Meningococcal Vaccines: Vaccines or candidate vaccines used to prevent infection with Neisseria meningitidis. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with

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application chiefly in the areas of research and medicine. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microfilaments: The smallest of the cytoskeletal filaments. They are composed chiefly of actin. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microvilli: Minute projections of cell membranes which greatly increase the surface area of the cell. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH]

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Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Motility: The ability to move spontaneously. [EU] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Multivalent: Pertaining to a group of 5 or more homologous or partly homologous chromosomes during the zygotene stage of prophase to first metaphasis in meiosis. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mutilation: Injuries to the body. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH] Mycoplasma Infections: Infections with species of the genus Mycoplasma. [NIH] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelitis: Inflammation of the spinal cord. Relatively common etiologies include infections; autoimmune diseases; spinal cord; and ischemia (see also spinal cord vascular diseases). Clinical features generally include weakness, sensory loss, localized pain, incontinence, and other signs of autonomic dysfunction. [NIH] Myeloid Cells: Cells which include the monocytes and the granulocytes. [NIH] Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU]

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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Natural killer cells: NK cells. A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called large granular lymphocytes (LGL). [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurogenic Inflammation: Inflammation caused by an injurious stimulus of peripheral neurons and resulting in release of neuropeptides which affect vascular permeability and help initiate proinflammatory and immune reactions at the site of injury. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH]

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Neutrophil: A type of white blood cell. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleotidases: A class of enzymes that catalyze the conversion of a nucleotide and water to a nucleoside and orthophosphate. EC 3.1.3.-. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otitis Media with Effusion: Inflammation of the middle ear with a clear pale yellowcolored transudate. [NIH] Ototoxic: Having a deleterious effect upon the eighth nerve, or upon the organs of hearing and balance. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the

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increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Particle: A tiny mass of material. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Hydrolases: A subclass of enzymes from the hydrolase class that catalyze the hydrolysis of peptide bonds. Exopeptidases and endopeptidases make up the sub-subclasses for this group. EC 3.4. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU]

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Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perilymph: The fluid contained within the space separating the membranous from the osseous labyrinth of the ear. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphoric Monoester Hydrolases: A group of hydrolases which catalyze the hydrolysis of monophosphoric esters with the production of one mole of orthophosphate. EC 3.1.3. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Phosphorylcholine: Calcium and magnesium salts used therapeutically in hepatobiliary dysfunction. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized

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regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Platelet Activating Factor: A phospholipid derivative formed by platelets, basophils, neutrophils, monocytes, and macrophages. It is a potent platelet aggregating agent and inducer of systemic anaphylactic symptoms, including hypotension, thrombocytopenia, neutropenia, and bronchoconstriction. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Pneumococcal Infections: Infections with bacteria of the species Streptococcus pneumoniae. [NIH]

Pneumococcal Vaccines: Vaccines or candidate vaccines used to prevent infections with Streptococcus pneumoniae. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or

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mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prion: Small proteinaceous infectious particles that resist inactivation by procedures modifying nucleic acids and contain an abnormal isoform of a cellular protein which is a major and necessary component. [NIH]

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Progeny: The offspring produced in any generation. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH]

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Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoan Infections: Infections with unicellular organisms of the subkingdom Protozoa. [NIH]

Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by headaches; nausea; papilledema, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile tinnitus. Obesity is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic papilledema may lead to optic nerve injury (optic nerve diseases) and visual loss (blindness). [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis,

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caused by hemorrhage into the tissues. [NIH] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Pyramidal Cells: Projection neurons in the cerebral cortex and the hippocampus. Pyramidal cells have a pyramid-shaped soma with the apex and an apical dendrite pointed toward the pial surface and other dendrites and an axon emerging from the base. The axons may have local collaterals but also project outside their cortical region. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process,

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such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU]

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Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH] Rocky Mountain Spotted Fever: An acute febrile illness caused by Rickettsia rickettsii. It is transmitted to humans by bites of infected ticks and occurs only in North and South America. Characteristics include a sudden onset with headache and chills and fever lasting about two to three weeks. A cutaneous rash commonly appears on the extremities and trunk about the fourth day of illness. [NIH] Rod: A reception for vision, located in the retina. [NIH] Sanatorium: This category applies to all those institutions partially or wholly devoted to the diagnosis and treatment of tuberculosis. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH]

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Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of

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dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Cord Vascular Diseases: Hypoxic-ischemic and hemorrhagic disorders of the spinal cord. Arteriosclerosis, emboli, and vascular malformations are potential causes of these conditions. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spiral Ganglion: The sensory ganglion of the cochlear nerve. The cells of the spiral ganglion send fibers peripherally to the cochlear hair cells and centrally to the cochlear nuclei of the brain stem. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the

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skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Stabilization: The creation of a stable state. [EU] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptococcal: Caused by infection due to any species of streptococcus. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Streptococcus pneumoniae: A gram-positive organism found in the upper respiratory tract, inflammatory exudates, and various body fluids of normal and/or diseased humans and, rarely, domestic animals. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stria: 1. A streak, or line. 2. A narrow bandlike structure; a general term for such longitudinal collections of nerve fibres in the brain. [EU] Stria Vascularis: A layer of highly vascular pigmented granular cells on the outer wall of the cochlear duct. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally

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conditioned by geographical and/or ecological occurrence. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Superinfection: A frequent complication of drug therapy for microbial infection. It may result from opportunistic colonization following immunosuppression by the primary pathogen and can be influenced by the time interval between infections, microbial physiology, or host resistance. Experimental challenge and in vitro models are sometimes used in virulence and infectivity studies. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Teichoic Acids: Bacterial polysaccharides that are rich in phosphodiester linkages. They are the major components of the cell walls and membranes of many bacteria. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tetani: Causal agent of tetanus. [NIH] Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a non-barbiturate hypnotic,

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but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Ticks: Blood-sucking arachnids of the order Acarina. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic

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proteases. EC 3.4.21.68. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoid: The material resulting from the treatment of toxin in such a way that the toxic properties are inactivated whilst the antigenic potency remains intact. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transposons: Discrete genetic elements capable of inserting, in a non-permuted fashion, into

Dictionary 169

the chromosomes of many bacteria. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Triad: Trivalent. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urbanization: The process whereby a society changes from a rural to an urban way of life. It refers also to the gradual increase in the proportion of people living in urban areas. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [NIH]

Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the

170

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inner ear. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vinorelbine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH]

Dictionary 171

Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

173

INDEX A Abdomen, 121, 127, 146, 148, 155, 167 Abscess, 25, 87, 121 Acatalasia, 121, 128 Acetylcholine, 121, 153 Acremonium, 121, 129 Actin, 8, 9, 11, 121, 150 Acute renal, 121, 142 Adaptability, 121, 129 Adenine, 121 Adenocarcinoma, 121, 153 Adenoma, 53, 121 Adenosine, 19, 121, 155 Adjunctive Therapy, 21, 66, 121 Adolescence, 4, 121 Adverse Effect, 121, 163 Aerobic, 121, 128, 143, 154, 159 Aerobic Metabolism, 121, 154 Aerobic Respiration, 121, 154 Affinity, 4, 11, 121, 122 Affinity Chromatography, 11, 122 Agar, 122, 144, 156 Agarose, 122, 144 Airway, 91, 122 Algorithms, 122, 126 Alimentary, 122, 154 Allograft, 91, 122 Alpha-Defensins, 122, 134 Alternative medicine, 99, 122 Alveoli, 122, 170 Amikacin, 18, 41, 122 Amine, 122, 142 Amino Acid Sequence, 122, 123 Amino Acids, 122, 123, 138, 154, 159, 161, 162, 167, 168 Ampicillin, 18, 36, 123 Amyloid, 47, 123 Anaerobic, 11, 12, 123, 128, 141, 143, 151 Anaesthesia, 59, 123, 145 Anal, 123 Anaphylactic, 123, 156 Anaphylatoxins, 123, 131 Anatomical, 123, 125, 144, 148, 162 Anesthesia, 42, 60, 122, 123 Animal model, 74, 123 Annealing, 123, 157 Anode, 123, 133 Antibacterial, 5, 37, 123, 128, 143, 164, 169

Antibodies, 4, 36, 59, 81, 83, 84, 88, 89, 123, 141, 142, 144, 148, 151, 156, 160 Anticoagulant, 123, 158 Antigen, 5, 6, 73, 76, 81, 122, 123, 124, 131, 133, 137, 142, 144, 145, 149 Antigen-Antibody Complex, 124, 131 Anti-infective, 124, 143, 146 Anti-inflammatory, 9, 17, 21, 60, 91, 124, 134, 140, 147 Anti-Inflammatory Agents, 124, 147 Antimicrobial, 5, 9, 16, 24, 28, 29, 33, 35, 36, 42, 52, 83, 124, 130, 134 Antioxidant, 35, 66, 124 Antiviral, 124, 145, 154 Anus, 123, 124 Aorta, 124, 128, 170 Aperture, 87, 124 Aponeurosis, 124, 139 Apoptosis, 7, 14, 18, 39, 124, 128 Aqueous, 124, 125, 133, 136, 143, 147, 148 Arachidonic Acid, 124, 158 Arginine, 37, 123, 124, 153, 169 Arterial, 124, 143, 159, 166 Arteries, 124, 126, 133, 150 Ascites, 124, 153 Aseptic, 22, 56, 63, 81, 82, 87, 124, 165 Assay, 7, 12, 21, 55, 67, 73, 124, 144, 162 Asymptomatic, 4, 121, 124 Atmospheric Pressure, 124, 143 Atrium, 125, 128, 170 Auditory, 9, 67, 98, 125, 136, 141, 149 Autoimmune disease, 90, 125, 151 Autonomic, 121, 125, 151, 164, 166 Autoradiography, 9, 125 Axons, 125, 134, 146, 160, 164 Aztreonam, 19, 125 B Bacteremia, 5, 13, 15, 43, 80, 89, 125 Bacterial Infections, 13, 88, 110, 125, 129, 147 Bactericidal, 4, 5, 6, 9, 17, 18, 20, 125 Bacteriolysis, 88, 125 Bacteriophage, 125, 156, 168 Bacteriostatic, 9, 125 Bacterium, 71, 72, 80, 89, 125, 132, 142 Barbiturate, 125, 166 Basal Ganglia, 125, 139 Base, 91, 121, 125, 147, 160, 166

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Basophil, 125, 142 Benign, 121, 126, 139, 141, 152, 160 Beta-Defensins, 126, 134 Beta-Lactamases, 125, 126, 128, 143 Beta-pleated, 123, 126 Bewilderment, 126, 132 Bile, 126, 142, 148 Binding Sites, 91, 126 Biochemical, 6, 15, 126, 147 Biological response modifier, 126, 145 Biosynthesis, 14, 124, 126, 162 Biotechnology, 10, 17, 21, 99, 105, 126 Bioterrorism, 6, 126 Biotransformation, 126 Bladder, 125, 126, 144, 151, 152, 169 Blood pressure, 126, 143, 151 Blood vessel, 126, 129, 130, 137, 141, 147, 155, 159, 163, 165, 167, 170 Blood-Brain Barrier, 8, 9, 11, 49, 66, 67, 126 Blot, 67, 126 Body Fluids, 126, 127, 165 Bone Marrow, 127, 144, 148, 151 Bowel, 123, 127, 146 Bradykinin, 127, 153 Brain Stem, 127, 131, 164 Branch, 117, 127, 149, 154, 159, 164, 167 Breakdown, 127, 134, 139 Broad-spectrum, 90, 122, 123, 127, 128, 129 Bronchial, 127, 142 Bronchoconstriction, 127, 156 Buccal, 127, 148 Bypass, 127 C Calcium, 127, 131, 155, 163 Capsular, 6, 14, 15, 76, 80, 81, 84, 88, 89, 127 Capsules, 14, 81, 127 Carbohydrate, 84, 89, 127, 140, 157 Carbon Dioxide, 27, 127, 134, 139, 143, 161, 170 Carcinogenic, 127, 145 Carcinogens, 127, 137 Carcinoma, 40, 127, 153, 164, 165 Cardiopulmonary, 91, 128 Cardiopulmonary Bypass, 91, 128 Carrier Proteins, 80, 84, 89, 128 Case report, 51, 56, 72, 128 Caspase, 52, 128 Catalase, 73, 121, 128 Cathode, 123, 128, 133, 136 Causal, 128, 162, 166 Cefoperazone, 18, 128

Cefotaxime, 18, 20, 41, 98, 128 Cefoxitin, 20, 128 Ceftazidime, 20, 128 Ceftizoxime, 21, 42, 128 Ceftriaxone, 18, 20, 43, 57, 59, 128 Cefuroxime, 18, 20, 128 Cell Adhesion, 91, 128 Cell Adhesion Molecules, 91, 128 Cell Cycle, 128, 130, 138 Cell Death, 14, 124, 129, 138, 152 Cell Differentiation, 129, 163 Cell Division, 125, 128, 129, 138, 149, 150, 156, 158 Cell membrane, 128, 129, 134, 138, 150, 155 Cell proliferation, 129, 163 Cell Respiration, 121, 129, 154, 161 Central Nervous System, 8, 16, 19, 35, 53, 68, 82, 121, 129, 130, 134, 139, 141, 143, 150, 151 Central Nervous System Infections, 35, 129, 141, 143 Cephaloridine, 128, 129 Cephalosporins, 83, 126, 129 Cerebral, 27, 30, 33, 36, 61, 66, 73, 82, 125, 126, 127, 129, 136, 139, 143, 159, 160 Cerebrospinal fluid, 17, 18, 19, 20, 22, 27, 28, 33, 34, 36, 38, 40, 41, 42, 43, 44, 46, 47, 48, 49, 50, 52, 55, 56, 60, 61, 62, 63, 66, 72, 73, 80, 81, 82, 83, 90, 129, 143, 148, 163, 164 Cerebrovascular, 27, 129 Cerebrum, 129 Chemotactic Factors, 129, 131 Chemotaxis, 13, 129 Chemotherapy, 9, 24, 33, 38, 42, 52, 93, 129 Chickenpox, 21, 129 Chlamydia, 85, 129 Cholera, 130, 163 Cholesteatoma, 95, 130 Chromatin, 124, 130, 137 Chromosome, 130, 132 Chronic, 94, 130, 135, 143, 145, 159, 165, 166 Cilastatin, 42, 66, 130, 143 Ciprofloxacin, 20, 130 Circulatory system, 130, 146 Cisplatin, 26, 72, 130 Clinical Medicine, 83, 130, 157 Clinical trial, 4, 6, 66, 105, 130, 159, 160 Cloning, 126, 130 Coagulation, 6, 127, 130, 162, 167

Index 175

Cochlea, 8, 130, 131, 145 Cochlear, 8, 25, 58, 94, 97, 98, 130, 131, 164, 165, 167 Cochlear Duct, 131, 165 Cochlear Implantation, 8, 131 Cochlear Implants, 25, 58, 94, 98, 131 Cochlear Nerve, 131, 164 Cofactor, 131, 159, 167 Combination Therapy, 98, 131 Complement, 5, 17, 36, 68, 82, 83, 88, 123, 131 Complementary and alternative medicine, 71, 77, 131 Complementary medicine, 71, 131 Computational Biology, 105, 131 Computed tomography, 44, 132 Computerized axial tomography, 132 Computerized tomography, 132 Conception, 132, 165 Confusion, 71, 132, 135 Conjugated, 80, 88, 132 Conjugation, 84, 89, 126, 132 Connective Tissue, 127, 132, 139, 166 Consciousness, 82, 132, 135 Constriction, 132, 146, 159 Consumption, 38, 132, 134, 161 Contamination, 86, 87, 132 Contraindications, ii, 132 Contusion, 64, 132 Coordination, 15, 132, 151 Coronary, 133, 150 Coronary Thrombosis, 133, 150 Cortex, 133, 137, 139, 160 Cortical, 11, 133, 138, 160, 162 Corticosteroids, 30, 61, 66, 68, 133, 140 Cortisone, 133, 134 Counterimmunoelectrophoresis, 18, 20, 72, 133 Cranial, 30, 131, 133, 141, 146 Craniocerebral Trauma, 133, 141, 143, 167 Critical Care, 25, 33, 50, 56, 133 Curative, 133, 167 Cutaneous, 133, 148, 162 Cyclic, 19, 133, 141, 153, 158 Cysteine, 133, 134 Cytokine, 6, 17, 98, 99, 133, 146, 167 Cytoplasm, 124, 129, 133, 137, 141, 151, 161 Cytoskeleton, 9, 11, 133 Cytotoxic, 133, 160, 163 Cytotoxicity, 130, 133

D Databases, Bibliographic, 105, 133 Decarboxylation, 134, 142 Defensins, 85, 122, 126, 134 Deletion, 124, 134 Denaturation, 134, 157 Dendrites, 134, 152, 160 Dentate Gyrus, 14, 18, 134, 142 Depolarization, 134, 163 Developing Countries, 38, 88, 90, 134 Dexamethasone, 6, 19, 23, 30, 31, 32, 33, 45, 53, 58, 75, 98, 99, 134 Dextroamphetamine, 134, 150 Diagnostic Imaging, 134, 159 Diagnostic procedure, 79, 99, 134 Diarrhea, 75, 134 Diastolic, 134, 143 Diffusion, 33, 133, 134, 144 Digestion, 122, 126, 127, 134, 146, 148 Diphtheria, 80, 84, 89, 134, 135 Diphtheria Toxin, 80, 135 Direct, iii, 5, 15, 16, 81, 87, 130, 135, 161 Disease Progression, 7, 135 Disorientation, 132, 135 Dispenser, 86, 87, 135 Dissociation, 122, 135 Distal, 87, 135, 159 Dorsal, 25, 135, 157, 164 Dorsum, 135, 139 Dose-limiting, 26, 72, 135 Drug Interactions, 135 Drug Resistance, 34, 135 Drug Tolerance, 135 Dura mater, 87, 135, 138, 149, 154 Dyes, 123, 135 E Eardrum, 95, 136 Edema, 73, 136, 146, 153 Effector, 121, 131, 136, 152 Efficacy, 8, 88, 136, 143 Effusion, 136 Electrocoagulation, 130, 136 Electrons, 124, 125, 128, 136, 146, 154, 160 Electrophoresis, 136, 144 Embolus, 136, 145 Embryo, 129, 136, 144 Emollient, 136, 140 Emulsion, 125, 136 Encephalitis, 35, 52, 73, 82, 136 Encephalitis, Viral, 136 Encephalocele, 26, 136 Endemic, 4, 10, 73, 88, 130, 137

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Bacterial Meningitis

Endothelial cell, 6, 8, 9, 11, 74, 126, 137, 167 Endothelium, 137, 153, 156 Endothelium-derived, 137, 153 Endotoxin, 21, 81, 137, 169 Enhancers, 91, 137 Enterovirus, 21, 137 Entorhinal Cortex, 137, 142 Environmental Health, 104, 106, 137 Enzymatic, 4, 80, 127, 131, 137, 142, 157 Enzyme, 16, 74, 80, 86, 128, 136, 137, 141, 142, 156, 157, 158, 159, 163, 166, 167, 169, 170, 171 Enzyme-Linked Immunosorbent Assay, 74, 137 Eosinophils, 137, 141, 147 Epidemic, 10, 73, 88, 99, 137 Epidemiological, 10, 137 Epidemiology, Molecular, 10, 137 Epidermis, 137, 159 Epidural, 25, 60, 72, 86, 87, 137, 138 Epidural Space, 87, 138 Epithelial, 5, 6, 121, 126, 138 Epithelial Cells, 5, 6, 126, 138 Epitope, 84, 89, 138 Etoposide, 73, 138 Eukaryotic Cells, 6, 138 Excitatory, 14, 138, 140 Excitatory Amino Acids, 14, 138 Exocytosis, 11, 138, 142 Exogenous, 34, 126, 138 Extracellular, 8, 123, 132, 138, 139, 153 Extracellular Matrix, 132, 138, 139, 153 Extravasation, 16, 138, 141 F Family Planning, 105, 138 Fat, 124, 127, 136, 138, 148, 151 Fatty acids, 138, 140, 158 Febrile, 43, 81, 138, 162 Femoral, 128, 138 Femoral Artery, 128, 138 Fibrin, 138, 156, 167 Fibrinogen, 138, 156, 167 Fibroblasts, 139, 146 Fibrosis, 8, 139, 162 Fissure, 134, 139 Fistula, 95, 139 Flatus, 139 Foramen, 139, 142, 149, 155 Fungi, 132, 139, 150, 171 Fungus, 129, 139

G Gamma Rays, 139, 160 Ganglia, 121, 139, 152, 164, 166 Ganglion, 139, 164 Gangrenous, 139, 163 Gas, 21, 127, 134, 139, 143, 153, 159, 170 Gas exchange, 139, 170 Gastric, 139, 142 Gastrointestinal, 127, 130, 139 Gene, 11, 15, 91, 126, 139, 146, 153, 168 Gene Expression, 11, 15, 139 Genetic testing, 139, 157 Genetics, 12, 132, 140 Genital, 130, 140, 169 Genomics, 12, 13, 140 Genotype, 140, 155 Geriatric, 89, 140 Gestation, 140, 155 Glucocorticoid, 134, 140 Glucose, 11, 27, 38, 81, 140 Glutamate, 33, 36, 56, 98, 140 Glycerol, 39, 53, 140, 155 Glycerophospholipids, 140, 155 Glycogen, 130, 140 Glycoprotein, 8, 138, 140, 167, 169 Glycoside, 140, 143 Glycosidic, 140, 153 Gonorrhea, 85, 128, 140 Governing Board, 140, 157 Gp120, 140, 154 Graft, 140, 142 Grafting, 140, 144 Gram-negative, 9, 11, 18, 21, 30, 40, 71, 81, 82, 98, 125, 128, 130, 140, 141, 143, 151, 159 Gram-Negative Bacteria, 18, 21, 30, 141 Gram-positive, 12, 30, 82, 89, 125, 128, 141, 143, 165 Granule, 14, 36, 134, 141, 161 Granulocytes, 39, 125, 141, 147, 151, 163, 171 Guanylate Cyclase, 141, 153 H Haematoma, 141 Haemophilus, 5, 26, 32, 34, 50, 51, 56, 74, 80, 82, 84, 89, 128, 141 Haemorrhage, 59, 141 Hair Cells, 131, 141, 164 Half-Life, 128, 141 Haptens, 122, 141 Headache, 50, 66, 82, 141, 143, 162 Headache Disorders, 141

Index 177

Heart failure, 141, 153 Helminthiasis, 129, 141 Hematogenous, 8, 9, 141 Hematoma, 72, 141 Hemolytic, 12, 141 Hemorrhage, 133, 136, 141, 142, 160, 165 Hepatobiliary, 142, 155 Heredity, 139, 140, 142 Heritability, 12, 142 Herniated, 87, 142 Heterodimer, 91, 142 Heterogeneity, 122, 142 Hippocampus, 14, 134, 142, 160, 165 Histamine, 16, 123, 142 Histamine Release, 16, 123, 142 Histidine, 142 Homodimer, 142, 168 Homogeneous, 17, 142 Homologous, 142, 151, 166 Hormone, 133, 142, 146, 149, 163, 167, 168 Horseradish Peroxidase, 137, 142 Host, 5, 6, 10, 15, 57, 83, 125, 134, 142, 144, 166, 169, 170 Hybridomas, 142, 146 Hydrocephalus, 143, 146 Hydrogen, 122, 125, 127, 128, 134, 143, 150, 154 Hydrogen Peroxide, 128, 143 Hydrolases, 43, 143, 155 Hydrolysis, 126, 130, 143, 154, 155, 159 Hyperbaric, 74, 143 Hyperbaric oxygen, 74, 143 Hypertension, 143, 146 Hyperventilation, 33, 143 Hypnotic, 125, 143, 166 Hypotension, 143, 156 Hysteria, 73, 143 I Id, 69, 76, 111, 116, 118, 143 Imipenem, 42, 66, 130, 143 Immune function, 144, 168 Immune response, 12, 13, 88, 124, 125, 133, 141, 144, 169, 170 Immune Sera, 144 Immune system, 5, 90, 144, 148, 149, 151, 169, 171 Immunity, 5, 6, 44, 134, 144, 146, 168 Immunization, 88, 144 Immunoassay, 137, 144 Immunodeficiency, 43, 144 Immunodiffusion, 122, 144 Immunoelectrophoresis, 81, 122, 133, 144

Immunogen, 4, 144 Immunogenic, 4, 16, 84, 88, 89, 144 Immunoglobulin, 46, 123, 144, 151 Immunologic, 129, 144, 160 Immunology, 11, 22, 27, 38, 72, 88, 122, 142, 144 Impairment, 3, 29, 39, 54, 75, 83, 90, 94, 126, 144 Implantation, 132, 144 In vitro, 6, 8, 9, 11, 13, 16, 19, 43, 144, 157, 162, 166 In vivo, 5, 9, 11, 13, 16, 144 Incision, 144, 146, 159 Incontinence, 143, 144, 151 Indicative, 93, 144, 154, 170 Induction, 8, 12, 144 Infancy, 4, 33, 45, 145 Infarction, 27, 133, 143, 145, 150 Infusion, 83, 145 Initiation, 81, 145, 168 Initiator, 145, 146 Inner ear, 94, 95, 128, 145, 147, 170 Inorganic, 130, 145 Insulator, 145, 151 Intensive Care, 23, 145 Interferon, 19, 44, 145, 146 Interferon-alpha, 145 Interleukin-1, 19, 44, 46, 145, 146 Interleukin-10, 46, 145 Interleukin-12, 19, 44, 146 Interleukin-2, 145, 146 Interleukin-6, 40, 146 Internal Medicine, 24, 67, 68, 146 Interneurons, 14, 146 Intervertebral, 87, 142, 146, 160 Intestinal, 122, 137, 146 Intestine, 127, 142, 146, 161, 165 Intracellular, 7, 8, 13, 145, 146, 149, 153, 158, 163 Intracellular Membranes, 146, 149 Intracranial Hypertension, 61, 141, 143, 146, 167 Intracranial Pressure, 57, 146, 159 Intramuscular, 146, 154 Intrathecal, 19, 36, 40, 44, 146 Intravenous, 18, 53, 83, 145, 146, 154 Intrinsic, 122, 146 Invasive, 6, 9, 15, 53, 60, 74, 81, 85, 144, 146 Iodine, 87, 146 Ionizing, 146, 160 Ions, 125, 135, 143, 146

178

Bacterial Meningitis

Ischemia, 14, 91, 146, 151 J Joint, 10, 130, 147, 166 K Kanamycin, 122, 147 Kb, 104, 147 Ketorolac, 75, 147 Kinetic, 146, 147 L Labile, 131, 147 Labyrinth, 9, 130, 145, 147, 155, 162, 170 Labyrinthine, 8, 147 Labyrinthitis, 8, 147 Laceration, 147, 166 Latent, 147, 157 Lectin, 147, 149 Lens, 127, 147 Leptospirosis, 10, 147 Lesion, 147, 148 Lethal, 125, 135, 147 Leucocyte, 24, 147 Leukemia, 71, 147 Leukocyte Count, 90, 147 Leukocytes, 38, 90, 127, 129, 137, 141, 145, 147, 151, 169 Levofloxacin, 28, 147 Library Services, 116, 147 Ligament, 9, 147 Ligands, 5, 128, 148 Ligation, 17, 148 Lipid, 15, 140, 148, 151 Lipopolysaccharide, 75, 140, 148 Lipoprotein, 47, 140, 148 Liquor, 148, 160 Liver, 30, 55, 60, 124, 126, 136, 140, 142, 148 Localization, 63, 148 Localized, 47, 88, 121, 134, 141, 145, 148, 151, 153, 155, 156, 166 Longitudinal Studies, 10, 148 Lumbar, 22, 48, 59, 61, 72, 99, 148, 164 Lumbar puncture, 22, 48, 59, 148, 164 Lumen, 8, 148 Lupus, 148, 166 Lymph, 130, 137, 148 Lymphatic, 137, 145, 148, 153, 167 Lymphoblastic, 71, 148 Lymphocyte, 56, 124, 148, 149 Lymphocyte Subsets, 56, 148 Lymphocytic, 82, 148 Lymphoid, 123, 133, 147, 148 Lymphoma, 148

Lysosome, 11, 148 Lytic, 86, 125, 148 M Macrophage, 16, 19, 145, 148 Malaise, 82, 149 Malignant, 121, 149, 152, 160 Malnutrition, 24, 149 Mastitis, 149, 163 Meatus, 136, 149 Mediate, 12, 13, 128, 131, 149 Mediator, 16, 146, 149 Medical Records, 149, 161 MEDLINE, 105, 149 Meiosis, 149, 151, 166 Membrane Proteins, 6, 84, 89, 149 Memory, 14, 149 Meningeal, 20, 38, 59, 63, 67, 81, 149 Meninges, 9, 82, 125, 128, 129, 130, 133, 135, 149 Meningococcal Vaccines, 15, 80, 88, 149 Mental Health, iv, 4, 104, 106, 149, 159 Mentors, 10, 149 Meta-Analysis, 54, 66, 67, 149 Metastasis, 128, 150 Metastatic, 73, 150 Methylphenidate, 73, 150 MI, 119, 150 Microbe, 6, 150, 168 Microfilaments, 11, 150 Microorganism, 131, 150, 154, 170 Micro-organism, 150, 162 Microscopy, 9, 142, 150 Microvilli, 11, 150 Migration, 90, 150 Mitochondrial Swelling, 150, 152 Mitosis, 124, 150 Mitotic, 138, 150 Modeling, 8, 150 Modification, 150, 160 Modulator, 91, 150 Monitor, 151, 153 Monoclonal, 4, 8, 83, 142, 151, 160 Monoclonal antibodies, 8, 83, 151 Monocytes, 145, 146, 147, 151, 156, 167 Mononuclear, 151, 169 Monophosphate, 19, 151 Morphogenesis, 14, 151 Motility, 11, 151 Mucinous, 139, 151 Mucosa, 148, 151 Multiple sclerosis, 49, 68, 151 Multivalent, 84, 89, 151

Index 179

Mutagenesis, 8, 13, 151 Mutagens, 151 Mutilation, 58, 151 Mycoplasma, 5, 36, 129, 151 Mycoplasma Infections, 129, 151 Myelin, 151, 162 Myelitis, 23, 151 Myeloid Cells, 68, 151 Myocarditis, 134, 151 Myocardium, 150, 151, 152 N Narcolepsy, 134, 150, 152 Natural killer cells, 146, 152 Necrosis, 14, 24, 124, 145, 150, 152 Need, 3, 46, 51, 82, 85, 94, 112, 121, 140, 148, 152 Neonatal, 6, 8, 9, 11, 13, 14, 35, 41, 45, 51, 55, 63, 99, 152 Neonatal period, 9, 152 Neoplasm, 152, 169 Neoplastic, 130, 142, 148, 152 Nervous System, 44, 129, 141, 149, 152, 166 Neural, 123, 136, 152 Neurogenic, 16, 51, 152 Neurogenic Inflammation, 16, 152 Neurologic, 7, 14, 30, 51, 53, 67, 136, 143, 152 Neuronal, 7, 52, 55, 152 Neurons, 14, 18, 131, 134, 138, 139, 146, 152, 160, 164, 166 Neuropeptides, 152 Neurosurgery, 29, 33, 43, 44, 45, 53, 152 Neurotransmitters, 138, 151, 152 Neutropenia, 152, 156 Neutrophil, 19, 22, 85, 90, 153 Nitric Oxide, 16, 20, 46, 153 Non-small cell lung cancer, 26, 72, 153 Nuclear, 50, 91, 125, 132, 136, 138, 139, 152, 153 Nuclei, 131, 132, 136, 150, 153, 164 Nucleotidases, 143, 153 Nucleus, 124, 130, 131, 133, 137, 138, 139, 149, 151, 153, 158, 165 Nystagmus, 147, 153 O Oedema, 51, 153 Oligosaccharides, 80, 84, 89, 153 Operon, 15, 153, 161 Ossification, 8, 153 Osteoblasts, 9, 153 Otitis, 5, 15, 22, 89, 94, 153

Otitis Media, 5, 15, 22, 89, 94, 153 Otitis Media with Effusion, 94, 153 Ototoxic, 122, 153 Oxidation, 124, 126, 153 Oxidative metabolism, 27, 121, 154 Oxygenator, 128, 154 P Pachymeningitis, 149, 154 Paediatric, 54, 60, 154 Palliative, 154, 167 Parasite, 154, 169 Parenteral, 48, 154 Particle, 81, 154, 164, 168 Pathogen, 5, 6, 14, 154, 166 Pathogenesis, 7, 8, 9, 10, 11, 12, 13, 16, 90, 94, 154 Pathologic, 8, 14, 91, 124, 133, 154 Pathologic Processes, 124, 154 Pathophysiology, 8, 9, 16, 20, 21, 55, 95, 154 Penicillin, 86, 123, 154 Peptide, 5, 143, 154, 158, 159 Peptide Hydrolases, 143, 154 Peptide T, 5, 154 Perception, 55, 154 Perforation, 95, 124, 139, 154 Pericardium, 155, 166 Perilymph, 95, 155 Perinatal, 27, 155 Peritoneal, 124, 153, 155 Peritoneal Cavity, 124, 153, 155 Petechiae, 141, 155 Phagocytosis, 84, 89, 155 Pharmacokinetic, 155 Pharmacologic, 123, 141, 155, 168 Phenotype, 5, 155 Phospholipases, 155, 163 Phospholipids, 16, 138, 148, 155 Phosphoric Monoester Hydrolases, 143, 155 Phosphorus, 127, 155 Phosphorylated, 8, 155 Phosphorylation, 13, 155 Phosphorylcholine, 5, 155 Photocoagulation, 130, 155 Physiologic, 126, 134, 141, 155, 158, 161 Plants, 126, 127, 134, 140, 147, 155, 159, 168 Plaque, 11, 156 Plasma, 11, 16, 17, 22, 76, 123, 129, 138, 151, 156 Plasma cells, 123, 156

180

Bacterial Meningitis

Plasmin, 156, 167, 169 Plasminogen, 58, 156, 167, 169 Plasminogen Activators, 156 Platelet Activating Factor, 5, 156 Platelet Activation, 156, 163 Platelet Aggregation, 123, 153, 156 Platelets, 153, 156, 167 Platinum, 130, 156 Pleural, 153, 156 Pleural cavity, 153, 156 Pneumococcal Infections, 89, 156 Pneumococcal Vaccines, 84, 89, 156 Podophyllotoxin, 138, 156 Poisoning, 157, 162 Polymerase, 27, 55, 157, 161 Polymerase Chain Reaction, 27, 157 Polymers, 15, 157, 159 Polymorphic, 134, 157 Polysaccharide, 6, 14, 73, 76, 80, 81, 84, 88, 89, 122, 124, 157 Posterior, 123, 135, 157 Postsynaptic, 157, 163 Potentiates, 145, 157 Potentiation, 157, 163 Practice Guidelines, 106, 157 Precursor, 124, 136, 137, 156, 157, 168 Predictive factor, 3, 157 Predisposition, 38, 157 Prion, 129, 157 Progeny, 14, 132, 158 Prognostic factor, 23, 29, 158 Progression, 7, 8, 123, 158 Progressive, 129, 135, 141, 152, 156, 158, 169 Projection, 87, 146, 158, 160 Prophase, 151, 158, 166 Prophylaxis, 86, 158, 169 Proportional, 137, 158 Prospective study, 56, 158 Prostaglandin, 67, 158 Prostaglandins A, 158 Protease, 131, 158, 167 Protein C, 6, 30, 82, 88, 122, 125, 148, 158 Protein S, 4, 126, 135, 159, 161 Proteolytic, 131, 138, 156, 159, 167, 169 Protocol, 73, 159 Protozoa, 132, 150, 159 Protozoan Infections, 129, 159 Proximal, 87, 91, 135, 159 Pseudomonas, 75, 82, 128, 159 Pseudotumor Cerebri, 146, 159 Psychiatry, 22, 43, 53, 66, 159, 170

Psychic, 159, 162 Psychomotor, 137, 159 Public Health, 10, 13, 29, 106, 159 Public Policy, 105, 159 Publishing, 17, 94, 159 Pulmonary, 51, 91, 126, 132, 143, 159, 170 Pulmonary Ventilation, 143, 159 Punctures, 159 Purpura, 74, 141, 159 Pyogenic, 67, 160, 162 Pyramidal Cells, 134, 160 Q Quality of Life, 8, 160, 166 R Race, 150, 160 Radiation, 125, 139, 143, 146, 160, 171 Radiation therapy, 143, 160 Radicular, 160 Radiculopathy, 87, 160 Radioactive, 125, 141, 143, 144, 151, 153, 160 Radioimmunotherapy, 160 Radiologist, 94, 160 Radiotherapy, 26, 72, 160 Randomized, 20, 28, 136, 160 Randomized Controlled Trials, 28, 160 Reagent, 62, 161 Receptor, 5, 7, 11, 13, 16, 18, 37, 68, 124, 140, 154, 161, 163 Recombinant, 8, 16, 161, 170 Recombination, 132, 161 Rectum, 124, 139, 144, 161 Red blood cells, 141, 161 Refer, 1, 81, 127, 131, 139, 146, 148, 160, 161, 170 Refraction, 161, 164 Regimen, 74, 136, 161 Repressor, 153, 161 Respiration, 127, 151, 161 Respiratory Physiology, 161, 170 Retreatment, 161 Retrospective, 19, 28, 161 Retrospective study, 19, 28, 161 Rhinitis, 161, 163 Ribose, 121, 161 Ribosome, 161, 168 Rigidity, 146, 156, 161 Risk factor, 58, 158, 162 Ristocetin, 162, 169 Rocky Mountain Spotted Fever, 21, 162 Rod, 125, 141, 159, 162

Index 181

S Sanatorium, 73, 162 Sclerosis, 7, 151, 162 Screening, 7, 54, 85, 94, 130, 162 Secretion, 142, 162, 168 Secretory, 5, 122, 162 Seizures, 18, 33, 43, 82, 162 Semicircular canal, 145, 162 Semisynthetic, 128, 138, 143, 162 Sensory loss, 151, 160, 162 Sepsis, 6, 12, 13, 16, 75, 88, 162 Septic, 17, 91, 124, 162 Septicaemia, 33, 162, 163 Septicemia, 74, 80, 86, 162 Sequence Homology, 154, 162 Sequencing, 12, 157, 162 Serine, 162, 167 Serotypes, 4, 6, 13, 80, 81, 84, 89, 90, 163 Serous, 94, 137, 163 Serum, 35, 41, 43, 46, 47, 59, 60, 72, 123, 131, 144, 163, 169 Sex Characteristics, 121, 163 Sexually Transmitted Diseases, 85, 163 Shock, 91, 163, 169 Shunt, 53, 163 Side effect, 121, 128, 135, 163, 166, 168 Signal Transduction, 10, 13, 163 Signs and Symptoms, 85, 163 Skeleton, 121, 147, 158, 163 Skull, 130, 133, 136, 146, 163, 166 Small cell lung cancer, 163 Smooth muscle, 123, 142, 163 Social Environment, 160, 163 Solvent, 140, 163 Somatic, 121, 143, 149, 150, 164 Sound wave, 160, 164 Specialist, 111, 164 Specificity, 41, 88, 122, 164 Spectrum, 35, 59, 128, 143, 164 Spinal cord, 7, 16, 23, 56, 87, 127, 129, 135, 137, 139, 146, 149, 151, 152, 154, 160, 164, 166 Spinal Cord Injuries, 160, 164 Spinal Cord Vascular Diseases, 151, 164 Spinal Nerve Roots, 160, 164 Spinal tap, 148, 164 Spinous, 87, 137, 164 Spiral Ganglion, 8, 131, 164 Squamous, 130, 153, 164, 165 Squamous cell carcinoma, 153, 164 Squamous Epithelium, 130, 165 Stabilization, 34, 165

Sterile, 87, 124, 165 Sterility, 86, 165 Steroids, 59, 133, 140, 165 Stimulant, 134, 142, 150, 165 Stimulus, 152, 165, 167 Strand, 157, 165 Streptococcal, 42, 86, 110, 165 Streptococci, 12, 13, 165 Streptococcus, 5, 6, 12, 15, 17, 18, 80, 84, 86, 88, 89, 156, 165 Streptococcus pneumoniae, 5, 15, 17, 18, 81, 84, 86, 88, 89, 156, 165 Stress, 54, 67, 94, 157, 165 Stria, 9, 165 Stria Vascularis, 9, 165 Stroke, 33, 36, 40, 104, 165 Subacute, 145, 165 Subarachnoid, 6, 8, 39, 59, 141, 165 Subclinical, 145, 162, 165 Subcutaneous, 136, 139, 153, 154, 165 Subiculum, 142, 165 Subspecies, 164, 165 Substrate, 11, 137, 143, 166 Superinfection, 125, 166 Supportive care, 9, 166 Suppurative, 9, 139, 166 Sympathetic Nervous System, 152, 166 Symptomatic, 7, 166 Synaptic, 163, 166 Systemic, 9, 44, 84, 89, 124, 126, 135, 145, 146, 153, 156, 160, 162, 166, 168 Systemic lupus erythematosus, 44, 166 Systolic, 143, 166 T Tachycardia, 125, 166 Tachypnea, 125, 166 Teichoic Acids, 141, 166 Temporal, 8, 141, 142, 149, 166 Tetani, 166 Tetanic, 166 Tetanus, 84, 89, 166 Thalidomide, 98, 166 Therapeutics, 167 Thermal, 135, 157, 167 Thoracic, 26, 72, 167 Thorax, 121, 148, 167 Threonine, 154, 162, 167 Threshold, 143, 167 Thrombin, 138, 156, 158, 167 Thrombocytopenia, 156, 167 Thrombolytic, 156, 167 Thrombomodulin, 158, 167

182

Bacterial Meningitis

Thrombosis, 159, 165, 167 Thrombus, 133, 145, 156, 167 Thymus, 144, 148, 167 Thyroid, 146, 167 Ticks, 162, 167 Tidal Volume, 143, 167 Tinnitus, 153, 159, 167 Tissue Plasminogen Activator, 43, 167 Tomography, 168 Torsion, 145, 168 Toxic, iv, 13, 80, 132, 133, 135, 144, 157, 168, 169 Toxicity, 26, 72, 135, 162, 168 Toxicokinetics, 168 Toxicology, 106, 168 Toxins, 124, 126, 136, 145, 151, 160, 162, 168 Toxoid, 84, 89, 168 Transcription Factors, 15, 91, 168 Transduction, 13, 163, 168 Transfection, 126, 168 Transfer Factor, 144, 168 Transforming Growth Factor beta, 46, 168 Translation, 12, 168 Translational, 13, 168 Translocation, 7, 15, 91, 168 Transmitter, 121, 138, 149, 168 Transplantation, 54, 55, 60, 144, 168 Transposons, 13, 168 Trauma, 90, 152, 169 Triad, 26, 169 Trichomoniasis, 85, 169 Tuberculosis, 132, 148, 162, 169 Tumor Necrosis Factor, 41, 44, 46, 83, 167, 169 Tumour, 24, 139, 169 U Ultrasonography, 30, 169 Unconscious, 143, 169 Urbanization, 10, 169 Ureters, 169 Urethra, 169 Urinary, 43, 128, 130, 143, 144, 167, 169 Urinary Plasminogen Activator, 167, 169 Urinary tract, 43, 128, 169 Urinary tract infection, 43, 169

Urine, 72, 126, 144, 169 Urogenital, 140, 169 Urokinase, 58, 169 V Vaccination, 4, 26, 51, 88, 169 Vaccine, 4, 6, 10, 15, 30, 32, 80, 84, 88, 89, 159, 169 Vancomycin, 18, 57, 63, 169 Vascular, 9, 63, 137, 141, 145, 152, 153, 156, 164, 165, 167, 170 Vasoactive, 16, 170 Vasodilatation, 16, 170 Vasodilator, 127, 142, 170 Vector, 168, 170 Vein, 146, 153, 170 Venous, 147, 153, 159, 170 Venous blood, 147, 170 Ventilation, 94, 170 Ventricle, 142, 166, 170 Vertebrae, 87, 146, 164, 170 Vertebral, 87, 138, 170 Vertigo, 153, 170 Vestibular, 95, 141, 147, 170 Vestibule, 130, 145, 162, 170 Veterinary Medicine, 105, 170 Vinca Alkaloids, 170 Vinorelbine, 26, 72, 170 Viral, 52, 64, 81, 83, 94, 98, 136, 168, 170 Virulence, 6, 11, 13, 14, 15, 55, 81, 166, 168, 170 Virus, 43, 125, 129, 137, 140, 145, 146, 156, 168, 170 Vitro, 9, 16, 170 Vivo, 9, 16, 171 W White blood cell, 123, 125, 147, 148, 152, 153, 156, 171 Wound Healing, 128, 171 X Xenograft, 123, 171 X-ray, 128, 132, 139, 153, 160, 171 Y Yeasts, 139, 155, 171 Z Zygote, 132, 171 Zymogen, 158, 171

Index 183

184

Bacterial Meningitis