BLACK COHOSH 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 2003 by ICON Group International, Inc. Copyright 2003 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., 1960Black Cohosh: 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: 0-597-83789-9 1. Black Cohosh-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.
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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 black cohosh. 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 BLACK COHOSH........................................................................................ 3 Overview........................................................................................................................................ 3 Federally Funded Research on Black Cohosh ................................................................................. 3 The National Library of Medicine: PubMed .................................................................................. 9 CHAPTER 2. NUTRITION AND BLACK COHOSH .............................................................................. 11 Overview...................................................................................................................................... 11 Finding Nutrition Studies on Black Cohosh................................................................................ 11 Federal Resources on Nutrition ................................................................................................... 14 Additional Web Resources ........................................................................................................... 14 CHAPTER 3. ALTERNATIVE MEDICINE AND BLACK COHOSH ....................................................... 15 Overview...................................................................................................................................... 15 National Center for Complementary and Alternative Medicine.................................................. 15 Additional Web Resources ........................................................................................................... 22 General References ....................................................................................................................... 27 CHAPTER 4. CLINICAL TRIALS AND BLACK COHOSH .................................................................... 29 Overview...................................................................................................................................... 29 Recent Trials on Black Cohosh..................................................................................................... 29 Keeping Current on Clinical Trials ............................................................................................. 31 CHAPTER 5. PATENTS ON BLACK COHOSH .................................................................................... 33 Overview...................................................................................................................................... 33 Patents on Black Cohosh .............................................................................................................. 33 Patent Applications on Black Cohosh .......................................................................................... 37 Keeping Current .......................................................................................................................... 38 CHAPTER 6. BOOKS ON BLACK COHOSH ........................................................................................ 39 Overview...................................................................................................................................... 39 Book Summaries: Online Booksellers........................................................................................... 39 The National Library of Medicine Book Index ............................................................................. 39 Chapters on Black Cohosh............................................................................................................ 40 CHAPTER 7. PERIODICALS AND NEWS ON BLACK COHOSH .......................................................... 41 Overview...................................................................................................................................... 41 News Services and Press Releases................................................................................................ 41 Academic Periodicals covering Black Cohosh .............................................................................. 42 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 47 Overview...................................................................................................................................... 47 NIH Guidelines............................................................................................................................ 47 NIH Databases............................................................................................................................. 49 Other Commercial Databases....................................................................................................... 51 APPENDIX B. PATIENT RESOURCES ................................................................................................. 53 Overview...................................................................................................................................... 53 Patient Guideline Sources............................................................................................................ 53 Finding Associations.................................................................................................................... 55 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 57 Overview...................................................................................................................................... 57 Preparation................................................................................................................................... 57 Finding a Local Medical Library.................................................................................................. 57 Medical Libraries in the U.S. and Canada ................................................................................... 57 ONLINE GLOSSARIES.................................................................................................................. 63 Online Dictionary Directories ..................................................................................................... 63
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BLACK COHOSH DICTIONARY................................................................................................ 65 INDEX ................................................................................................................................................ 87
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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 black cohosh 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 black cohosh, 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 black cohosh, 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 black cohosh. 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 black cohosh, 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 black cohosh. 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 BLACK COHOSH Overview In this chapter, we will show you how to locate peer-reviewed references and studies on black cohosh.
Federally Funded Research on Black Cohosh The U.S. Government supports a variety of research studies relating to black cohosh. 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 black cohosh. 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 black cohosh. The following is typical of the type of information found when searching the CRISP database for black cohosh: •
Project Title: A NEW CULTIVATION SYSTEM FOR CLEAN CONSISTENT ROOT CROPS Principal Investigator & Institution: Hayden, Anita L.; Native American Botanics Corporation 531 E Muriel Pl Tucson, Az 85733 Timing: Fiscal Year 2002; Project Start 15-AUG-2000; Project End 31-JUL-2005
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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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Summary: (provided by applicant): In order to accurately assess the efficacy of botanical products, consistent materials are needed for clinical studies, as well as a guarantee of sustainable access to commercial volumes of those materials should the products prove useful. This proposal addresses exactly that by developing a sustainable horticultural production method that can provide clean, unadulterated, and consistent raw materials for the herbal dietary supplement and phytopharmaceutical industries. The technology investigated is an innovative type of hydroponics called aeroponics, with engineering modifications and crop management practices specifically designed to maximize the biomass production and phytochemistry of crops, with an emphasis on root crops. The SBIR Phase I research demonstrated the feasibility of using aeroponics for biomass and phytochemical yields of burdock, the Phase II research will explore the universality and appropriateness of the aeroponic technology for various medicinal root crops, developing improved prototype aeroponic systems and testing those systems with different model crops: stinging nettles (Urtica dioica), purple coneflower (Echinacea purpurea), yerba mansa (Anemopsis califomica), and black cohosh (Cimicifuga racemosa). Various experiments will be conducted in the aeroponic systems, examining the flexibility and control the grower has over the crop environment and measuring the effects of those parameters on biomass and phytochemical yields. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ALTERNATIVE THERAPIES FOR MENOPAUSE: A RANDOMIZED TRIAL Principal Investigator & Institution: Newton, Katherine M.; Associate Investigator; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-NOV-2004 Summary: (Adapted from Investigator's Abstract) Hormone replacement therapy (HRT: estrogen and progestin) remains the treatment of choice for women with vasomotor symptoms, and long-term HRT has been recommended for prevention purposes. The demand for alternatives to HRT, and the availability and use of over-the-counter products including dietary phytoestrogen supplements and naturopathic medicines, has grown dramatically. Few of these products have faced the rigors of randomized trials and none have been tested to evaluate their effects on long-term outcomes. The purpose of this four-year randomized controlled trial is to evaluate the efficacy and safety of three alternative approaches utilizing phytoestrogens to treat vasomotor symptoms in peri- and postmenopausal women. The treatments were chosen because of the scientific evidence supporting a possible benefit, the availability of products with adequate quality control their frequency of use in naturopathic medicine, and our ability to blind participants to the intervention. The five proposed treatment arms are as follow: 1) esterified estrogen and micronized progesterone: 9) a single herbal product, black cohosh; 3) a multibotanical preparation; 4) a combination regimen that includes the same multibotanical preparation plus soy diet counseling; and 5) placebo. The primary aim is to compare the effects of three alternative treatments, HRT, and placebo on the frequency and intensity of vasomotor symptoms measured by The Wiklund Menopause Symptom Checklist and a daily Vasomotor Symptom Diary. The secondary aims are to compare the effects of three alternative treatments, HRT, and placebo on the following: 1) vaginal cytology (vaginal maturation index); 2) serum lipids (total cholesterol, HDL and LDL cholesterol, triglycerides); 3) bone mineral density (hip and spine dual energy x-ray absorptiometry scan); 4) glucose metabolism (insulin, fasting blood glucose); and 5) coagulation factors (fibrinogen, PAI-1). The hypotheses are that compared to placebo the three alternative treatments tested in this study will have the following effects:
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reduce frequency of hot flashes and night sweats, improve vaginal maturation and decrease vagina atrophy as measured by maturation index, lower total cholesterol and LDL with no effect on HDL, reduce the rate of decline in bone mineral density (BMD), and have no effect on glucose metabolism or clotting factors. To accomplish the specific aims the investigators propose to do the following: 1) recruit and randomize 400 periand post-menopausal women to one of five treatment arms for one year; 2) collect measurements of primary and secondary outcomes at baseline, three, six, and 12 months; and 3) compare changes in outcomes in the groups taking alternative treatments to those in the HRT and placebo groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BOTANICAL DIETARY SUPPLEMENTS FOR WOMEN'S HEALTH Principal Investigator & Institution: Farnsworth, Norman R.; Research Professor; Prog/Collab Res/Pharmactl Scis; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-JUL-2004 Summary: (verbatim from the applicant's abstract) The Center for Dietary Supplements Research on botanicals will consist of a multidisciplinary team of investigators who will focus their initial efforts on the study of the clinical safety and efficacy of botanicals used to treat women's health with particular emphasis on therapies for menopause. Additional studies will address mechanisms of action, identification of active compounds, and characterization of metabolism, bioavailability and pharmacokinetics of active species contained in these botanicals. The research component will consist of four projects, which will be supported by three cores as follows: Project 1. This pharmacognosy project will carry out standardization of botanical dietary supplements and structure elucidation of active compounds using bioassay-guided fractionation in collaboration with Project 2. Project 2 will use bioassay-guided fractionation to isolate active compounds for structure elucidation, and then will carry out biochemical studies to determine the mechanism(s) of botanicals used for women's health. Project 3. Novel in vitro methods for the study of metabolism, absorption and toxicity of active compounds in botanicals will be developed and applied during this project. Immunotoxicity of botanical preparations will be evaluated. Project 4. This Clinical Project will carry out Phase I and Phase II clinical trials of black cohosh (Cimicifugae racemosa) and red clover (Trifolium pratense). Phase I studies will focus on human toxicity, absorption, distribution, metabolism and elimination of active compounds, and in Phase II, efficacy for the relief of menopausal symptoms will be evaluated. Core A. This Administrative Core will facilitate the exchange of data between investigators, coordinate data archiving, will provide administrative assistance and statistical support, and will coordinate meetings with the Advisory Committee. Core B. The Education and Information Core will be responsible for pharmacognosy curriculum development and the implementation of graduate and post-doctoral training programs, for the implementation of interactive on-line learning and continuing education programs, phone-in services for the public, and botanical information database searches. Core C. The LC-MS-MS Core will provide analytical support including: identification/dereplication and quantitative analysis of active compounds; bioavailability and pharmacokinetic profiles, and identification of urinary metabolites. With these research facilities in place, the Center will be positioned to expand its efforts in the future to include studies on other botanicals used for a wider range of human health issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CENTER FOR CAM RESEARCH IN AGING Principal Investigator & Institution: Kronenberg, Fredi; Rehabilitation Medicine; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-JUL-2004 Summary: In recent years increasing numbers of Americans are using alternative approaches to conventional medicine. This includes 39% of people age 50 and older. Aging does not begin at age 65 but occurs across our life span. Physiological, social and psychological changes that occur during midlife can have major effects on health and thereby, the quality and duration of the rest of life. Such changes are particularly significant for women, where declining estrogen levels result in changes in the physiologic profile. Although estrogen therapy is widely recommended to midlife women with long term protection against heart disease, osteoporosis and Alzheimer's disease in mind, estrogen therapy is also associated with increased cancer risk and has side effects and most women choose not to take it. The initial focus of our proposed Center for CAM Research in Aging at Columbia University is on botanical and dietary approaches to clinical concerns of post menopausal women with the goal of rigorous evaluation of the efficacy, mechanisms of action, and possible risks of these approaches. The proposed Center contains three highly interactive clinical research projects and one basic science project, supported by administrative, biostatistical, and clinical research cores. Project One examines the influence of a macrobiotic diet, as compared to the addition of a single food to a typical diet, on various biochemical and cardiovascular parameters that may be influenced by estrogens. Project Two assesses whether these natural, dietary sources of estrogen prevent postmenopausal bone loss, one of the most important current public health challenges. State-of-the-art approaches to measurement of markers of bone formation and bone resorption will be combined with highly sensitive quantitation of bone mass. Project Three is designed to determine whether treatment with herb black cohosh is effective in reducing the frequency and intensity of menopausal host flashes. Project Four examines the bioactivity, mechanisms of action, and potential risks of a widely-used Chinese Herbal formula in cell culture and in vivo. All of the Program Projects are led by Principal Investigators with an active interest in complementary and alternative medicine and extensive experience with both clinical populations and basic research. While the proposed Center for CAM in Aging will initially evaluate dietary and herbal treatments in postmenopausal women, the score of work will be expanded through the Developmental Research Program to include other CAM modalities. In addition, a strong Career Development Program is proposed that will provide a critical link between researchers with an interest in CAM at Columbia and the larger CAM community. The proposed Center will take advantage of the unique institutional resources available at Columbia, will develop an interdisciplinary research program that targets significant health problems of aging, and will conduct the timely education and training of future CAM researchers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CLINICAL EVALUATION OF BOTANICAL DIETARY SUPPLEMENT Principal Investigator & Institution: Derman, Richard J.; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: The overall objectives of this project are to conduct Phase I and II clinical trials of black cohosh (Cimicifuga racemosa) and red clover (Trifolium pratense), to be used for women's health problems-for menopausal hot flashes (primarily) and other
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somatic symptoms. Observational and epidemiological studies demonstrated that black cohosh is effective for menopausal women, and safe (at least in short-term). Phase I: The aims of this study is to determine safe doses (acute toxicity) of extracts of both botanicals, to be used in the subsequent Phase II clinical trial. Three doses will be tested over a one-week period in an attempt to determine symptoms of acute toxicity. There will be 5 subjects for each of 3 dosages (1X, 2X, 3X) of the 2 botanicals. (N=30) The goal is a sample size large enough to estimate unknown parameters Also studied will be pharmacokinetics (hourly bloods) absorption, distribution, metabolism, elimination, and pharmacological mode of action and side effects in healthy menopausal women. Phase II: This is a one year, randomized, controlled, double-blind efficacy study, the primary aim of which is to evaluate the efficacy of black cohosh and red clover, over a "safe dose range," for menopausal hot flashes. Additional goals are to assess these botanicals for other menopausal symptoms such as insomnia, joint pain, vaginal dryness, and dyspareunia (using Kupperman Index, bleeding scales and index of sexual function). They will also assess longer-term risks and safety issues and to determine changes in biomarkers (such as bone turnover and lipids) associated with use of these botanicals. Most previous studies of black cohosh lasted at most 6 months. Longer-term (1-year) safety data will be evaluated. In particular, incidence of endometrial hyperplasia, breakthrough bleeding, and other side effects will be determined. Subjects (n=112) will be randomized into one of 4 treatment groups (28/gr): placebo, Prempro 0.625/2.5, black cohosh and red clover. Also they will take blood samples to measure DNA oxidation products for measurements of DNA strand breaks using the comet assay to determine if DNA in peripheral blood leukocytes is being protected from damage through the antioxidant properties of the 'active' compounds or whether DNA damage is being produced (indicator of toxicity). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INTERACTIONS BETWEEN SERMS, SOY AND BLACK COHOSH Principal Investigator & Institution: Shaw, Heather S.; Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Tamoxifen is the most commonly used selective estrogen receptor modulator (SERM) in the treatment and prevention of breast cancer. Raloxifene, a newer SERM, is currently widely used for treatment of osteoporosis and is in trials for breast cancer prevention. A new health awareness is growing among women, resulting in the use of natural supplements such as soy and black cohosh for the treatment and prevention of menopausal symptoms. Each of these substances has also been shown to contain phytoestrogens, plant derived substances, which interact functionally with ER. Therefore, there is a potential for competition between soy or black cohosh and SERMs, which may result in decreased efficacy of the prescribed medication. It is essential to know whether this interaction exists and what ramifications it may have in order to properly counsel patients about the combined use of SERMs and phytoestrogen containing natural supplements. We hypothesize that the natural products soy and black cohosh and/or their metabolites will alter the effects of tamoxifen and raloxifene on 1) ER-dependent transcription and cellular proliferation in vitro and 2) anti-tumor efficacy in a human breast cancer xenograft model in nude mice. The ultimate objective of this study is to determine the safety of combined use of SERMs and natural product dietary supplements. To begin to address this long-term goal, we plan to: 1) Determine effects of addition of genistein, daidzein, equol, and 27deoxyactein to tamoxifen, its metabolites, and raloxifene on ER-signaling of MCF-7
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human breast cancer cells and proliferation of MCF-7 and MDA-MB-231 ceils in vitro. 2) Determine effects of addition of soy and black cohosh to tamoxifen and raloxifene on ER-signaling of MCF-7 cells and proliferation of MCF-7 and MDA-MB-231 cells in vitro in a simulated system of human colonic fermentation and hepatic metabolism. 3) Determine pharmacokinetics of black cohosh in female volunteers. 4) Determine pharmacokinetics of black cohosh and soy in immunocompetent mice. 5) Determine interactions between ingested standardized soy or black cohosh and tamoxifen on MCF-7 breast cancer growth in an in vivo nude mouse model. The sponsors of the proposed study and the laboratories in which the candidate is working have extensive experience in isolation and characterization of natural products and in cancer research, which is essential to accomplishing the scientific goals outlined here as well as facilitating the development of the candidate into a productive independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE EFFECT OF BLACK COHOSH EXTRACT ON THE HUMAN BREAST Principal Investigator & Institution: Sauter, Edward R.; Surgery; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211 Timing: Fiscal Year 2003; Project Start 15-JUN-2003; Project End 28-FEB-2005 Summary: (provided by applicant): Over 40 million women in the US have reached menopause, and 40% will experience symptoms significant enough to seek medical attention. Hormone replacement therapy, prescribed to ameliorate menopausal symptoms, has been associated with an increased risk of developing breast cancer. Many women use herbal preparations for menopausal complaints, believing them to be safe. Black cohosh extract (BCE) is the largest selling herbal dietary supplement in the United States used to alleviate menopausal symptoms. The mechanism of action by which BCE acts to treat menopausal symptoms of estrogen deficiency is not clear, with some data supporting a central nervous system effect, while other studies demonstrate a proestrogenic effect. The primary aim of this study is to determine if BCE administered to symptomatic postmenopausal women results in estrogenic stimulation of the breast as measured by changes in nipple aspirate fluid (NAF) levels of estradiol, pS2, follicle stimulating hormone (FSH), leutenizing hormone (LH) and prostate-specific antigen (PSA), as well as NAF cytology. Secondary aims are to 1) evaluate if BCE saponins, the proposed active constituents in BCE, are detectable in the NAF of women receiving BCE, 2) determine if BCE leads to a reduction in clinical symptoms of menopause, and 3) determine if the biomarker effects persist after stopping BCE. As the American population ages there are an increasing number of menopausal women. Interest in herbal therapies is rapidly growing among these women, including breast cancer survivors, to treat the disruptive symptoms associated with menopause. BCE binds to the estrogen receptor and in some studies stimulates breast cells. It is therefore important to demonstrate that BCE does not increase the risk of estrogen-related cancers. We have chosen biomarkers proven to be estrogen responsive proteins which are readily measured in both NAF and blood. Although prior studies failed to correlate clinical response to BCE with changes in serum levels of LH, FSH, or estradiol, it is critical to measure these markers in the breast itself, not diluted by the contribution from other organs. The findings should allow us to design a high quality R01 submission involving a larger, randomized study of longer duration which should provide some answers on the potential role of BCE in breast cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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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.3 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 black cohosh, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “black cohosh” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for black cohosh (hyperlinks lead to article summaries): •
Antiestrogenic activities of Cimicifuga racemosa extracts. Author(s): Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G. Source: The Journal of Steroid Biochemistry and Molecular Biology. 2002 January; 80(1): 125-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867271&dopt=Abstract
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Antimalarial activity and nucleoside transport inhibitory activity of the triterpenic constituents of Cimicifuga spp. Author(s): Takahira M, Kusano A, Shibano M, Kusano G, Koizumi K, Suzuki R, Kim HS, Wataya Y, Takahara M. Source: Biological & Pharmaceutical Bulletin. 1998 August; 21(8): 823-8. Erratum In: Biol Pharm Bull 1998 December; 21(12): 1396. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9743250&dopt=Abstract
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Cimicifuga racemosa: a systematic review of its clinical efficacy. Author(s): Borrelli F, Ernst E. Source: European Journal of Clinical Pharmacology. 2002 July; 58(4): 235-41. Epub 2002 June 07. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12136368&dopt=Abstract
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Cycloartane glycosides from the rhizomes of Cimicifuga racemosa and their cytotoxic activities. Author(s): Watanabe K, Mimaki Y, Sakagami H, Sashida Y. Source: Chemical & Pharmaceutical Bulletin. 2002 January; 50(1): 121-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11824572&dopt=Abstract
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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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Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Author(s): Duker EM, Kopanski L, Jarry H, Wuttke W. Source: Planta Medica. 1991 October; 57(5): 420-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1798794&dopt=Abstract
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Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Author(s): Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A. Source: Planta Medica. 1999 December; 65(8): 763-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10630125&dopt=Abstract
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Homeopathic induction. Beyond cimicifuga and caulophyllum. Author(s): Martin P. Source: Midwifery Today Int Midwife. 2002 Fall; (63): 28-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12298384&dopt=Abstract
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Inhibition of neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga racemosa. Author(s): Loser B, Kruse SO, Melzig MF, Nahrstedt A. Source: Planta Medica. 2000 December; 66(8): 751-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11199135&dopt=Abstract
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Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Author(s): Liske E. Source: Adv Ther. 1998 January-February; 15(1): 45-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10178637&dopt=Abstract
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CHAPTER 2. NUTRITION AND BLACK COHOSH Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and black cohosh.
Finding Nutrition Studies on Black Cohosh 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.4 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 “black cohosh” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
4
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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Black Cohosh
The following information is typical of that found when using the “Full IBIDS Database” to search for “black cohosh” (or a synonym): •
A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. Author(s): University of Bridgeport, Connecticut, USA. Source: Lieberman, S J-Womens-Health. 1998 June; 7(5): 525-9 1059-7115
•
Analysis of thirteen populations of black cohosh for formononetin. Author(s): Department of Biological Sciences, Lehman College and The Center for Graduate Studies, The City University of New York, Bronx, NY 10468, USA.
[email protected] Source: Kennelly, E J Baggett, S Nuntanakorn, P Ososki, A L Mori, S A Duke, J Coleton, M Kronenberg, F Phytomedicine. 2002 July; 9(5): 461-7 0944-7113
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Antiestrogenic activities of Cimicifuga racemosa extracts. Author(s): Molecular Cell Physiology and Endocrinology, Technical University Dresden, Mommsen street 13, 01062 Dresden, Germany. Source: Zierau, Oliver Bodinet, Claudia Kolba, Susanne Wulf, Marina Vollmer, Gunter JSteroid-Biochem-Mol-Biol. 2002 January; 80(1): 125-30 0960-0760
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Black cohosh (Cimicifuga racemosa L.) protects against menadione-induced DNA damage through scavenging of reactive oxygen species: bioassay-directed isolation and characterization of active principles. Author(s): Department of Medicinal Chemistry and Pharmacognosy and UIC/NIH Center for Botanical and Dietary Supplements Research, College of Pharmacy, 833 South Wood Street, University of Illinois at Chicago, Chicago, Illinois 60612, USA. Source: Burdette, J E Chen, S N Lu, Z Z Xu, H White, B E Fabricant, D S Liu, J Fong, H H Farnsworth, N R Constantinou, A I Van Breemen, R B Pezzuto, J M Bolton, J L J-AgricFood-Chem. 2002 November 20; 50(24): 7022-8 0021-8561
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Black cohosh and other herbal remedies associated with acute hepatitis. Author(s): Princess Alexandra Hospital, Woolloongabba, QLD, Australia. Source: Whiting, P W Clouston, A Kerlin, P Med-J-Aust. 2002 October 21; 177(8): 440-3 0025-729X
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Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Author(s): Institute for Natural Products Research in Marine, St. Croix, Minn., USA. Source: McKenna, D J Jones, K Humphrey, S Hughes, K Altern-Ther-Health-Med. 2001 May-June; 7(3): 93-100 1078-6791
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Direct analaysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products. Source: He, K. Zheng, B. Kim, C.H. Rogers, L. Zheng, Q. Planta-med. Stuttgart : Georg Thieme Verlag,. October 2000. volume 66 (7) page 635-640. 0032-0943
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Direct analysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products. Author(s): Department of Research & Development, Pure World Botanicals, Inc., South Hackensack, New Jersey, USA. Source: He, K Zheng, B Kim, C H Rogers, L Zheng, Q Planta-Med. 2000 October; 66(7): 635-40 0032-0943
Nutrition
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Estrogenic effects of Cimicifuga racemosa (black cohosh) in mice and on estrogen receptors in MCF-7 cells. Source: Liu, Z.P. Yu, B. Huo, J.S. Lu, C.Q. Chen, J.S. J-med-food. Larchmont, NY : Mary Ann Liebert, Inc., c1998-. Fall 2001. volume 4 (3) page 171-179. 1096-620X
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Herbal medicine. Black cohosh: the woman's herb? Source: Anonymous Harv-Womens-Health-Watch. 2000 April; 7(8): 6 1070-910X
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Herbal treatments for menopause. Black cohosh, soy and micronized progesterone. Author(s): Women to Women, Yarmouth, Maine, USA. Source: Pick, M Adv-Nurse-Pract. 2000 May; 8(5): 29-30 1096-6293
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In vitro plant regeneration from leaf-derived callus of Cimicifuga racemosa. Author(s): National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, 38677, USA. Source: Lata, H Bedir, E Hosick, A Ganzera, M Khan, I Moraes, R M Planta-Med. 2002 October; 68(10): 912-5 0032-0943
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Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells. Author(s): Research and Development Department, Schaper & Brummer GmbH & Co. KG, Salzgitter, Germany. Source: Bodinet, C Freudenstein, J Breast-Cancer-Res-Treat. 2002 November; 76(1): 1-10 0167-6806
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Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. Author(s): Schaper & Brummer GmbH & Co. KG, Salzgitter, Germany. Source: Liske, E Hanggi, W Henneicke von Zepelin, H H Boblitz, N Wustenberg, P Rahlfs, V W J-Womens-Health-Gend-Based-Med. 2002 March; 11(2): 163-74 1524-6094
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Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. Author(s): Herbert Irving Comprehensive Cancer Center and Joseph L. Mailman School of Public Health, Columbia University, and Weill-Cornell Medical College, New York, NY 10032, USA. Source: Jacobson, J S Troxel, A B Evans, J Klaus, L Vahdat, L Kinne, D Lo, K M Moore, A Rosenman, P J Kaufman, E L Neugut, A I Grann, V R J-Clin-Oncol. 2001 May 15; 19(10): 2739-45 0732-183X
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Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Author(s): Schaper & Brummer GmbH & Co. KG, International Sales Division, Salzgitter-Ringelheim, Germany. Source: Liske, E Adv-Ther. 1998 Jan-February; 15(1): 45-53 0741-238X
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Triterpene glycosides from Cimicifuga racemosa. Author(s): Solgar Research Center for Excellence, Solgar Vitamin and Herb Company, 1211 Sherwood Avenue, Richmond, Virginia 23220, USA.
[email protected] Source: Shao, Y Harris, A Wang, M Zhang, H Cordell, G A Bowman, M Lemmo, E J-NatProd. 2000 July; 63(7): 905-10 0163-3864
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Black Cohosh
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/
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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WebMDHealth: 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. COHOSH
ALTERNATIVE MEDICINE AND BLACK
Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to black cohosh. 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 black cohosh 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 “black cohosh” (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 black cohosh: •
“Bust enhancing” herbal products. Author(s): Fugh-Berman A. Source: Obstetrics and Gynecology. 2003 June; 101(6): 1345-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798545&dopt=Abstract
•
A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. Author(s): McFarlin BL, Gibson MH, O'Rear J, Harman P. Source: Journal of Nurse-Midwifery. 1999 May-June; 44(3): 205-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10380441&dopt=Abstract
•
A preliminary RAPD-PCR analysis of Cimicifuga species and other botanicals used for women's health.
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Author(s): Xu H, Fabricant DS, Piersen CE, Bolton JL, Pezzuto JM, Fong H, Totura S, Farnsworth NR, Constantinou AI. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 December; 9(8): 757-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587700&dopt=Abstract •
A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. Author(s): Lieberman S. Source: Journal of Women's Health / the Official Publication of the Society for the Advancement of Women's Health Research. 1998 June; 7(5): 525-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9650153&dopt=Abstract
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A systematic review of herbal medicinal products for the treatment of menopausal symptoms. Author(s): Huntley AL, Ernst E. Source: Menopause (New York, N.Y.). 2003 September-October; 10(5): 465-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501609&dopt=Abstract
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A systematic review of the safety of black cohosh. Author(s): Huntley A, Ernst E. Source: Menopause (New York, N.Y.). 2003 January-February; 10(1): 58-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544678&dopt=Abstract
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Activation of the Ah receptor by extracts of dietary herbal supplements, vegetables, and fruits. Author(s): Jeuken A, Keser BJ, Khan E, Brouwer A, Koeman J, Denison MS. Source: Journal of Agricultural and Food Chemistry. 2003 August 27; 51(18): 5478-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926901&dopt=Abstract
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Acute liver failure associated with the use of herbal preparations containing black cohosh. Author(s): Lontos S, Jones RM, Angus PW, Gow PJ. Source: The Medical Journal of Australia. 2003 October 6; 179(7): 390-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14503910&dopt=Abstract
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Alternative therapies for traditional disease states: menopause. Author(s): Morelli V, Naquin C. Source: American Family Physician. 2002 July 1; 66(1): 129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12126027&dopt=Abstract
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Alternatives to HRT: an evidence-based review. Author(s): Taylor M.
Alternative Medicine 17
Source: Int J Fertil Womens Med. 2003 March-April; 48(2): 64-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779291&dopt=Abstract •
Analysis of thirteen populations of black cohosh for formononetin. Author(s): Kennelly EJ, Baggett S, Nuntanakorn P, Ososki AL, Mori SA, Duke J, Coleton M, Kronenberg F. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 July; 9(5): 461-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222669&dopt=Abstract
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Antiestrogenic activities of Cimicifuga racemosa extracts. Author(s): Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G. Source: The Journal of Steroid Biochemistry and Molecular Biology. 2002 January; 80(1): 125-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867271&dopt=Abstract
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Black cohosh (Cimicifuga racemosa L.) protects against menadione-induced DNA damage through scavenging of reactive oxygen species: bioassay-directed isolation and characterization of active principles. Author(s): Burdette JE, Chen SN, Lu ZZ, Xu H, White BE, Fabricant DS, Liu J, Fong HH, Farnsworth NR, Constantinou AI, Van Breemen RB, Pezzuto JM, Bolton JL. Source: Journal of Agricultural and Food Chemistry. 2002 November 20; 50(24): 7022-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12428954&dopt=Abstract
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Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. Author(s): Burdette JE, Liu J, Chen SN, Fabricant DS, Piersen CE, Barker EL, Pezzuto JM, Mesecar A, Van Breemen RB, Farnsworth NR, Bolton JL. Source: Journal of Agricultural and Food Chemistry. 2003 September 10; 51(19): 5661-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12952416&dopt=Abstract
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Black cohosh and other herbal remedies associated with acute hepatitis. Author(s): Vitetta L, Thomsen M, Sali A. Source: The Medical Journal of Australia. 2003 April 21; 178(8): 411-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697018&dopt=Abstract
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Black cohosh and other herbal remedies associated with acute hepatitis. Author(s): Whiting PW, Clouston A, Kerlin P. Source: The Medical Journal of Australia. 2002 October 21; 177(8): 440-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381254&dopt=Abstract
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Black cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth.
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Author(s): Lupu R, Mehmi I, Atlas E, Tsai MS, Pisha E, Oketch-Rabah HA, Nuntanakorn P, Kennelly EJ, Kronenberg F. Source: International Journal of Oncology. 2003 November; 23(5): 1407-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532983&dopt=Abstract •
Black cohosh. Author(s): Kligler B. Source: American Family Physician. 2003 July 1; 68(1): 114-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887117&dopt=Abstract
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Black cohosh: an alternative therapy for menopause? Author(s): Mahady GB, Fabricant D, Chadwick LR, Dietz B. Source: Nutrition in Clinical Care : an Official Publication of Tufts University. 2002 November-December; 5(6): 283-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557811&dopt=Abstract
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Black cohosh: Cimicifuga racemosa. Author(s): Pepping J. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1999 July 15; 56(14): 1400-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10428447&dopt=Abstract
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Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Author(s): McKenna DJ, Jones K, Humphrey S, Hughes K. Source: Alternative Therapies in Health and Medicine. 2001 May-June; 7(3): 93-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11347288&dopt=Abstract
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Cimicifuga extract BNO 1055: reduction of hot flushes and hints on antidepressant activity. Author(s): Winterhoff H, Spengler B, Christoffel V, Butterweck V, Lohning A. Source: Maturitas. 2003 March 14; 44 Suppl 1: S51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609559&dopt=Abstract
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Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Author(s): Hernandez Munoz G, Pluchino S. Source: Maturitas. 2003 March 14; 44 Suppl 1: S59-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609560&dopt=Abstract
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Cimicifuga racemosa: a systematic review of its clinical efficacy. Author(s): Borrelli F, Ernst E.
Alternative Medicine 19
Source: European Journal of Clinical Pharmacology. 2002 July; 58(4): 235-41. Epub 2002 June 07. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12136368&dopt=Abstract •
Cimidahuside 1 and 2, two new cyclolanostanol xylosides from the aerial parts of Cimicifuga dahurica. Author(s): Liu Y, Chen D, Si J, Tu G, An D. Source: Natural Product Research. 2003 August; 17(4): 243-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822901&dopt=Abstract
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Cimiracemates A-D, phenylpropanoid esters from the rhizomes of Cimicifuga racemosa. Author(s): Chen SN, Fabricant DS, Lu ZZ, Zhang H, Fong HH, Farnsworth NR. Source: Phytochemistry. 2002 October; 61(4): 409-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377235&dopt=Abstract
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Cimiracemosides I-P, new 9,19-cyclolanostane triterpene glycosides from Cimicifuga racemosa. Author(s): Chen SN, Fabricant DS, Lu ZZ, Fong HH, Farnsworth NR. Source: Journal of Natural Products. 2002 October; 65(10): 1391-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398533&dopt=Abstract
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Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Author(s): Dog TL, Powell KL, Weisman SM. Source: Menopause (New York, N.Y.). 2003 July-August; 10(4): 299-313. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851513&dopt=Abstract
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Cultivation of Cimicifuga racemosa (L.) nuttal and quality of CR extract BNO 1055. Author(s): Popp M, Schenk R, Abel G. Source: Maturitas. 2003 March 14; 44 Suppl 1: S1-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609554&dopt=Abstract
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Direct analysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products. Author(s): He K, Zheng B, Kim CH, Rogers L, Zheng Q. Source: Planta Medica. 2000 October; 66(7): 635-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11105569&dopt=Abstract
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Effects of an isopropanolic extract of Cimicifuga racemosa on urinary crosslinks and other parameters of bone quality in an ovariectomized rat model of osteoporosis. Author(s): Nisslein T, Freudenstein J.
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Source: Journal of Bone and Mineral Metabolism. 2003; 21(6): 370-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14586793&dopt=Abstract •
Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Author(s): Seidlova-Wuttke D, Hesse O, Jarry H, Christoffel V, Spengler B, Becker T, Wuttke W. Source: European Journal of Endocrinology / European Federation of Endocrine Societies. 2003 October; 149(4): 351-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514351&dopt=Abstract
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Hepatotoxicity from Cimicifuga racemosa? Recent Australian case report not sufficiently substantiated. Author(s): Thomsen M, Schmidt M. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2003 June; 9(3): 337-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816621&dopt=Abstract
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Herbal treatments for menopause. Black cohosh, soy and micronized progesterone. Author(s): Pick M. Source: Adv Nurse Pract. 2000 May; 8(5): 29-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11235332&dopt=Abstract
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Identification of caffeic acid derivatives in Actea racemosa (Cimicifuga racemosa, black cohosh) by liquid chromatography/tandem mass spectrometry. Author(s): Li W, Sun Y, Liang W, Fitzloff JF, van Breemen RB. Source: Rapid Communications in Mass Spectrometry : Rcm. 2003; 17(9): 978-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717772&dopt=Abstract
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In vitro effects of the Cimicifuga racemosa extract BNO 1055. Author(s): Jarry H, Metten M, Spengler B, Christoffel V, Wuttke W. Source: Maturitas. 2003 March 14; 44 Suppl 1: S31-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609557&dopt=Abstract
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In vitro formation of quinoid metabolites of the dietary supplement Cimicifuga racemosa (black cohosh). Author(s): Johnson BM, van Breemen RB. Source: Chemical Research in Toxicology. 2003 July; 16(7): 838-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870886&dopt=Abstract
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In vitro plant regeneration from leaf-derived callus of Cimicifuga racemosa. Author(s): Lata H, Bedir E, Hosick A, Ganzera M, Khan I, Moraes RM.
Alternative Medicine 21
Source: Planta Medica. 2002 October; 68(10): 912-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12391555&dopt=Abstract •
Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells. Author(s): Bodinet C, Freudenstein J. Source: Breast Cancer Research and Treatment. 2002 November; 76(1): 1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408370&dopt=Abstract
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Is black cohosh estrogenic? Author(s): Mahady GB. Source: Nutrition Reviews. 2003 May; 61(5 Pt 1): 183-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822708&dopt=Abstract
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Pharmacological effects of Cimicifuga racemosa. Author(s): Borrelli F, Izzo AA, Ernst E. Source: Life Sciences. 2003 July 25; 73(10): 1215-29. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850238&dopt=Abstract
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Pharmacology of Cimicifuga racemosa extract BNO 1055 in rats: bone, fat and uterus. Author(s): Seidlova-Wuttke D, Jarry H, Becker T, Christoffel V, Wuttke W. Source: Maturitas. 2003 March 14; 44 Suppl 1: S39-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609558&dopt=Abstract
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Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. Author(s): Liske E, Hanggi W, Henneicke-von Zepelin HH, Boblitz N, Wustenberg P, Rahlfs VW. Source: Journal of Women's Health & Gender-Based Medicine. 2002 March; 11(2): 16374. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975864&dopt=Abstract
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Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. Author(s): Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VR. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2001 May 15; 19(10): 2739-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11352967&dopt=Abstract
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The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Author(s): Wuttke W, Seidlova-Wuttke D, Gorkow C. Source: Maturitas. 2003 March 14; 44 Suppl 1: S67-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609561&dopt=Abstract
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Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Author(s): Liske E. Source: Adv Ther. 1998 January-February; 15(1): 45-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10178637&dopt=Abstract
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Triterpene glycosides from Cimicifuga racemosa. Author(s): Shao Y, Harris A, Wang M, Zhang H, Cordell GA, Bowman M, Lemmo E. Source: Journal of Natural Products. 2000 July; 63(7): 905-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10924163&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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WebMDHealth: 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/
Alternative Medicine 23
The following is a specific Web list relating to black cohosh; 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 Alopecia Source: Integrative Medicine Communications; www.drkoop.com Amenorrhea Source: Integrative Medicine Communications; www.drkoop.com Arthritis Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Breast Cancer Source: Integrative Medicine Communications; www.drkoop.com Cervical Dysplasia Source: Prima Communications, Inc.www.personalhealthzone.com Common Cold Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Source: Healthnotes, Inc.; www.healthnotes.com Dysmenorrhea Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Alternative names: Painful Menstruation Source: Prima Communications, Inc.www.personalhealthzone.com Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Endometriosis Source: Integrative Medicine Communications; www.drkoop.com Fibromyalgia Source: Integrative Medicine Communications; www.drkoop.com Hair Loss Source: Integrative Medicine Communications; www.drkoop.com Headache Source: Integrative Medicine Communications; www.drkoop.com
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Black Cohosh
Heart Palpitations Source: Integrative Medicine Communications; www.drkoop.com Hirsuitism Source: Integrative Medicine Communications; www.drkoop.com Hot Flashes Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Integrative Medicine Communications; www.drkoop.com Infection Source: Integrative Medicine Communications; www.drkoop.com Irritability Source: Integrative Medicine Communications; www.drkoop.com Menopausal Symptoms (other Than Osteoporosis) Source: Prima Communications, Inc.www.personalhealthzone.com Menopause Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Menstrual Pain Source: Integrative Medicine Communications; www.drkoop.com Muscular Dystrophy Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Osteoarthritis Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Healthnotes, Inc.; www.healthnotes.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com PMS Source: Integrative Medicine Communications; www.drkoop.com
Alternative Medicine 25
Premenstrual Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Psychological Conditions and Disorders Source: Integrative Medicine Communications; www.drkoop.com Rheumatoid Arthritis Source: Healthnotes, Inc.; www.healthnotes.com Rheumatoid Arthritis Source: Integrative Medicine Communications; www.drkoop.com Sprains and Strains Source: Integrative Medicine Communications; www.drkoop.com •
Alternative Therapy Herbal Medicine Source: Integrative Medicine Communications; www.drkoop.com
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Chinese Medicine Shengma Alternative names: Largetrifoliolious Bugbane Rhizome; Rhizoma Cimicifugae Source: Chinese Materia Medica
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Homeopathy Cimicifuga Source: Healthnotes, Inc.; www.healthnotes.com
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Herbs and Supplements Angelica Sinensis Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Alternative names: Cimicifuga racemosa Source: Healthnotes, Inc.; www.healthnotes.com Black Cohosh Alternative names: Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Source: Prima Communications, Inc.www.personalhealthzone.com
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Black Cohosh
Black Cohosh Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Black Cohosh Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10009,00.html Black Snakeroot Alternative names: Black Cohosh Source: Integrative Medicine Communications; www.drkoop.com Blessed Thistle Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Chasteberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,767,00.html Chinese Angelica Source: Integrative Medicine Communications; www.drkoop.com Cimicifuga Alternative names: Black Cohosh; Cimicifuga racemosa (NUTT.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Cimicifuga Racemosa (actea) Alternative names: Black Cohosh Source: Integrative Medicine Communications; www.drkoop.com Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Dong Quai (angelica) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,774,00.html
Alternative Medicine 27
Meadowsweet Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Menopause Herbal Combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10096,00.html Oral Contraceptives Source: Prima Communications, Inc.www.personalhealthzone.com Pollen Source: Healthnotes, Inc.; www.healthnotes.com Royal Jelly Source: Healthnotes, Inc.; www.healthnotes.com Skullcap Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Tang Kuei Source: Integrative Medicine Communications; www.drkoop.com Vitex Alternative names: Chaste; Vitex agnus-castus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Wild Yam Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Women's Herbal Combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10100,00.html
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. CLINICAL TRIALS AND BLACK COHOSH Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning black cohosh.
Recent Trials on Black Cohosh The following is a list of recent trials dedicated to black cohosh.5 Further information on a trial is available at the Web site indicated. •
Black cohosh and red clover efficacy for the relief of menopausal symptoms Condition(s): Hot Flashes; Menopause Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM); National Institute of General Medical Sciences (NIGMS); Office of Dietary Supplements (ODS); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This Phase II study, a follow-up to a Phase I trial in normal volunteers, will determine the efficacy of black cohosh and red clover for the relief of menopausal symptoms. It will also assess the safety of chronic dosing (1 year) by evaluating uterine (endometrial biopsies), breast (mammography), and hematology parameters (CBC and chemistry lab values) at baseline and 1 year. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066144
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Black Cohosh Extract in Postmenopausal Breast Health Condition(s): Menopause; Hot Flashes Study Status: This study is currently recruiting patients.
5
These are listed at www.ClinicalTrials.gov.
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Black Cohosh
Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of the study is to determine if black cohosh extract (BCE) administration in symptomatic postmenopausal women results in estrogenic stimulation of the breast, as determined by estradiol, pS2, FSH, LH, and PSA levels in nipple aspirate fluid. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00064831 •
Effects of Black Cohosh on Menopausal Hot Flashes Condition(s): Postmenopause; Hot Flashes; Osteoporosis, Postmenopausal Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will assess whether treatment with black cohosh is effective in reducing the frequency and intensity of menopausal hot flashes. In addition, it will determine whether or not black cohosh reduces the frequency of other menopausal symptoms and improves quality of life. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010712
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Single-Dose Study of Black Cohosh and Red Clover Condition(s): Menopause Study Status: This study is no longer recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM); National Institute of General Medical Sciences (NIGMS); Office of Dietary Supplements (ODS); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This Phase I study will assess the pharmacokinetics of two botanicals, Trifolium pratense (red clover) and Cimicifuga racemosa (black cohosh). Participants will receive a single dose of one botanical preparation. The observation period will be one week. Drug toxicity, absorption, distribution, metabolism and elimination data will be collected, and dosages to be utilized in a Phase II clinical trial will be determined. The Phase II trial will examine the efficacies of red clover and black cohosh for the reduction of menopausal symptoms in healthy menopausal women. The study will be randomized, double-blinded, and placebo-controlled. Study duration will be one year. Phase(s): Phase I; MEDLINEplus consumer health information Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010959
Clinical Trials 31
•
A Study of the Pharmocokinetics of Black Cohosh Condition(s): Hot Flashes Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Black cohosh is a natural supplement that has been used to treat and prevent menopausal symptoms. Remifemin is a standardized form of black cohosh. The purpose of this study is to determine the levels of components of black cohosh obtained in the blood of healthy women taking Remifemin. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00068185
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Black Cohosh in Treating Hot Flashes in Women Who Have or Who Are At Risk of Developing Breast Cancer Condition(s): Breast Cancer; Hot Flashes Study Status: This study is not yet open for patient recruitment. Sponsor(s): North Central Cancer Treatment Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: The herbal supplement black cohosh may be effective in relieving hot flashes in women. PURPOSE: Randomized phase III trial to determine the effectiveness of black cohosh in relieving hot flashes in women who have breast cancer or who are at risk of developing breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00060320
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “black cohosh” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials:
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•
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
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CHAPTER 5. PATENTS ON BLACK COHOSH 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.6 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 “black cohosh” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on black cohosh, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Black Cohosh By performing a patent search focusing on black cohosh, 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. The following is an 6Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Black Cohosh
example of the type of information that you can expect to obtain from a patent search on black cohosh: •
Breast-enhancing, herbal compositions and methods of using saMen Inventor(s): Ernest; Joseph Michael (Oceanside, CA), Smith; Allen (Encino, CA) Assignee(s): Vital Dynamics, Inc. (Canoga Park, CA) Patent Number: 6,200,594 Date filed: December 29, 1999 Abstract: Topical and oral compositions containing unique blends of certain herbs effectively enhance breasts in human females by strengthening connective tissues and encouraging the growth of new cells. The topical composition contains Saw Palmetto berry extract, Chaste Tree berry extract, Fenugreek seed extract, Fennel seed extract, Comfrey extract, White Willow Bark extract, Ma Huang extract, Black Cohosh extract, Guarana extract, Passion Flower extract, Bilberry extract, Horsetail extract and Cayenne extract. The oral composition is a dietary supplement system containing two diet supplement compositions. The first composition contains extracts of Blessed Thistle, Hops, Wild Yam, Fenugreek seed, Saw Palmetto berry, Chaste Tree berry, Fennel seed, Black Cohosh, Damiana, Dong Quai, Lycium Chinese Herb, Scullcap Concentrate, and Curcubita Pepo Pumpkin seed, as well as Methyl Sulfonyl Methane and Royal Jelly. The second composition contains extracts of Saw Palmetto berry, Chaste Tree berry, Black Cohosh, Fennel seed, Fenugreek seed, Lycium Chinese Herb, Scullcap Concentrate, and Curcubita Pepo Pumpkin seed, as well as Methyl Sulfonyl Methane and Royal Jelly. The topical composition, which is preferably in cream form, is topically applied to the breast area daily for a sufficient period of time. The oral system, preferably in the form of a plurality of capsules taken separately, is orally administered on a daily basis for a sufficient period, wherein capsules of the first composition are taken for a first period and capsules of the second composition are taken for a subsequent second period. Most preferably, the topical and oral compositions are administered concurrently in a treatment regimen. The latter regimen provides a synergistic breast enhancement relative to the individual topical and oral treatments. Excerpt(s): The present invention relates to compositions and methods for enhancing breasts. More particularly, this invention relates to herbal topical and oral compositions and methods of using same to enhance breast appearance in women. An attractive bustline is important to many women. Unfortunately, as women age, lose weight or become inactive, their bustlines tend to become less firm and, therefore, less attractive. The strengthening or building up of biological tissue in the female human breast is a well known problem in physiotherapy. One medical approach uses surgical techniques, such as breast implant operations. Such approach has numerous disadvantages. For example, surgical operations are inherently dangerous and relatively expensive. Opting for use of a surgical breast implant carries with it not only the danger and expense involved in any surgical operation but also potential health dangers that may be associated with using a particular type of breast implant, namely, the silicone breast implant. Web site: http://www.delphion.com/details?pn=US06200594__
Patents 35
•
Hair care formulations Inventor(s): McCullough; John E. (Indianapolis, IN) Assignee(s): Hair Associates, LLC (Carmel, IN) Patent Number: 6,139,828 Date filed: June 2, 1999 Abstract: Hair care formulations for cleansing the scalp and hair follicle openings are disclosed which comprises black cohosh extract, and a surfactant selected from the group consisting of sodium C.sub.14-16 olefin sulfonate, sodium lauryl sulfoacetate, disodium laureth sulfosuccinate and combinations thereof Excerpt(s): The present invention relates to formulations useful as hair care and beauty products. Each hair originates in a germinative cell at the bottom of a hair follicle, a tube-like pocket in the scalp. The follicle directs the hair to the surface of the scalp. Each follicle has attached sebaceous glands. The oil produced by the sebaceous glands combines with other debris creates sebum, a substance that can form a plug, which blocks the opening of the hair follicle and traps the hair in the follicle. It is believed that accumulated sebum within the follicles and on the scalp surrounding the follicles is an important factor in hair loss and baldness. Sebum cannot be dissolved and removed from the hair follicles and scalp by regular shampoos. Therefore, several hair care products have been developed to cleanse the sebum from the follicle opening and release the entrapped hair. Two of these products are Foli-Kleen.TM., Sable Laboratories, Pompano Beach, Fla., described in U.S. Pat. No. 5,610,071; and Nioxin.TM., Nioxin Research Laboratories, Inc., Lithia Springs, Ga. Web site: http://www.delphion.com/details?pn=US06139828__
•
Herbal composition Inventor(s): Fasano; Sabina (1306 Perico Point Cir., Bradenton, FL 34209) Assignee(s): none reported Patent Number: 6,586,018 Date filed: August 31, 2001 Abstract: An herbal composition is disclosed and claimed. One of the compositions disclosed includes the combination of sage leaf, red raspberry leaf, bayberry bark, capsicum pepper, damiana leaf, ginger root, licorice root, vaierian root, black cohosh root, red clover extract and kudzu root. Other compositions of the herbs are disclosed and claimed. The composition is bound in tablet form and administered orally. Alternatively, the composition is applied to the skin of the user as a cream, a patch or spray. Excerpt(s): The invention is an herbal composition for women for the treatment of premenstrual syndrome, perimenopausal symptoms, menopausal symptoms and postmenopausal symptoms. Menopause is defined as the cessation of menstruation in women. Six to twelve months without a period is the commonly accepted rule for diagnosing menopause. The follicle stimulating hormone ("FSH") laboratory test is used by physicians in diagnosing menopause. Most women experience menopause between the ages of 40 and 55. Menopause is characterized by hot flashes, headaches, night sweats, atrophic vaginitis, frequent urinary tract infections, cold hands and feet, forgetfulness and an inability to concentrate. Emotional indicators of menopause
36
Black Cohosh
include distress, irritability, mood swings, depression and decreased sex drive. There are many undesirable symptoms too numerous to articulate which are attributed to premenstrual, perimenstrual and premenopause changes in the female body. Hot flashes are common in menopausal women. Dilation of peripheral blood vessels leads to a rise in skin temperature and flushing of the skin. The skin of a menopausal women during a hot flash becomes red and warm for a period of a few seconds up to two minutes. During a hot flash, the skin on the head and neck of a menopausal woman is particularly affected and becomes red and warm. Other symptoms such as increased heart rate, headaches, dizziness, weight gain, fatigue and insomnia may be associated with a hot flash. Sixty-five (65) to eighty (80) percent of the menopausal women in the United States experience hot flashes. Hot flashes may appear prior to the cessation of the menses and may be the first sign that menopause is approaching. Web site: http://www.delphion.com/details?pn=US06586018__ •
Herbal composition for promoting hormonal balance in women and methods of using saMen Inventor(s): Newmark; Thomas (704 Cordell Ct., St. Louis, MO 63132), Schulick; Paul (222 Kipling Rd., Brattleboro, VT 05301) Assignee(s): none reported Patent Number: 6,242,012 Date filed: February 25, 2000 Abstract: An herbal composition which can be used to alleviate the symptoms associated with hormonal imbalance in women contains supercritical extracts of ginger, rosemary and evening primrose oil, and either regular or supercritical (preferably regular) extracts of black cohosh, dong quai, schizandra berry, chaste tree berry and rosemary. The herbal composition can be administered orally, topically or parenterally. In addition to promoting hormonal balance, the herbal composition also promotes normal bone growth by inhibiting the 5-lipoxygenase enzyme and sustains warmth and normal fluids for healthy sexual functioning. Furthermore, the herbal composition contains organic anti-aging constituents that inactivate free radicals, thereby providing antioxidant activity. Excerpt(s): This invention relates to herbal compositions. More particularly, this invention relates to an herbal composition which can promote pre- and postmenopausal hormonal balance in women. The present invention further relates to methods of using such composition to promote hormonal balance. From the commencement of menstruation until the termination of menopause, the female body can experience wide fluctuations in baseline hormonal levels. When such fluctuations cause an imbalance in the hormonal composition, certain chemical reactions occur which cause what are commonly referred to as PMS and/or menopausal symptoms. These symptoms include headaches, cramping, nausea, inflammation, increased agitation, anxiety, tension, restlessness, decreased digestive tract activity, depression, moodiness and severe mood swings. Hormone Replacement Therapy (RWI) and conventional treatments for hormonal imbalance conditions like PMS in women are the subject of countless articles and controversy. Few would question that the treatment protocols are fraught with acute side effects and potential long term health concerns. A search for historically safe and effective hormonal health/balance programs with a basis in modern science is of great need for women today.
Patents 37
Web site: http://www.delphion.com/details?pn=US06242012__
Patent Applications on Black Cohosh As of December 2000, U.S. patent applications are open to public viewing.7 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 black cohosh: •
Feminine care products for the delivery of therapeutic substances Inventor(s): Dvoracek, Barbara Jo; (Appleton, WI), Geiser, Kimberly Marie; (Appleton, WI), Koenig, David William; (Menasha, WI), Krzysik, Duane Gerard; (Appleton, WI), Minerath, Bernard Joseph; (Oshkosh, WI), Tyrrell, David John; (Appleton, WI) Correspondence: Kimberly-clark Worldwide, INC.; 401 North Lake Street; Neenah; WI; 54956 Patent Application Number: 20030120224 Date filed: December 21, 2001 Abstract: An absorbent personal care device, such as an interlabial pad, tampon, sanitary pad or liner, or incontinence product adapted to deliver a therapeutic agent to the vaginal epithelium for systemic and topical treatment, the tampon including absorbent material and a formulation including a therapeutic agent, wherein the therapeutic agent is a botanical. The botanical may be, but is not limited to, Agnus castus, aloe vera, comfrey, calendula, dong quai, black cohosh, chamomile, evening primrose, Hypericum perforatum, licorice root, black currant seed oil, St. John's wort, tea extracts, lemon balm, capsicum, rosemary, Areca catechu, mung bean, borage seed oil, witch hazel, fenugreek, lavender, soy, heath, cranberries, blueberries, azaleas, red onion skin, short red bell peppers, long red bell peppers, beet root extract, capsanthin, whortleberry, lingenberry, chokeberry, sweet rowan, rowanberry, seabuckhrouberry, crowberry, strawberries, or gooseberries. Excerpt(s): Many disease states and physiological conditions can occur in a woman, including symptoms associated with premenstrual syndrome, menstruation, and menopause. These symptoms may include dysmenorrhea (menstrual cramping), irritability, water retention, moodiness, depression, anxiety, skin changes, headaches, breast tenderness, tension, weight gain, cravings, fatigue, and hot flashes. Symptoms of conditions can include itching and other associated sensory maladies. Many of these symptoms are due to changes in hormonal levels throughout the menstrual cycle. Menstrual cramping is associated with increased levels of prostaglandin F2.alpha., prostaglandin E2, and in some cases leukotrienes in the endometrium and menstrual fluid. These eicosinoids lead to restricted blood flow to the uterus and increased uterine contractions, causing pain. One example is dysmenorrhea, which is the occurrence of painful uterine cramps during menstruation that affects a large number of postpubescent women. The pain of dysmenorrhea originates in the uterus. Various analgesics can be effective in limiting the pain from dysmenorrhea; some have used orally-delivered analgesics, while others have searched for alternative analgesic delivery methods. Attempts have been made to deliver analgesics in the vicinity of the cervix and
7
This has been a common practice outside the United States prior to December 2000.
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Black Cohosh
the vaginal mucosa using various vaginally-inserted devices and methods. A similar situation exists with many other disease states and physiological conditions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Use of a preparation of cimicifuga racemosa Inventor(s): Gessler, Andrea C; (Gleichen-Reinhausen, DE), Nisslein, Thomas; (Gottingen, DE) Correspondence: Whitham, Curtis & Christofferson, P.C.; 11491 Sunset Hills Road; Suite 340; Reston; VA; 20190; US Patent Application Number: 20030049340 Date filed: September 26, 2002 Abstract: A preparation of Cimicifuga racemosa can be used to successfully treat urinary incontinence in female mammals following an ovariohysterectomy. Positive results can be expected for the treatment of women following a hysterectomy or after the menopause. Excerpt(s): The invention relates to the use of a preparation of Cimicifuga racemosa (Black Snakeroot), in particular an extract thereof, and more particularly an extract of the rhizome (Rhizoma cimicifugae racemosae). Extracts of Cimicifuga racemosa are used in gyniatrics for the treatment of menopause complaints, such as hot flushes, sweating, sleep disorders, irritability, and depressive disgruntlement. The extract is regarded as a phytosubstitute for oestrogen replacement therapy. Extracts of Cimicifuga racemosa play no significant role in allopathic veterinary medicine. It has been found, surprisingly, that preparations of Cimicifuga racemosa are therapeutically effective against urinary incontinence. 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 black cohosh, 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 “black cohosh” (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 black cohosh. You can also use this procedure to view pending patent applications concerning black cohosh. 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 6. BOOKS ON BLACK COHOSH Overview This chapter provides bibliographic book references relating to black cohosh. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on black cohosh 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 “black cohosh” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “black cohosh” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “black cohosh” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Black Cohosh: Nature's Versatile Healer by James R.,Ph., N.D. Lavalle, James B. La Valle, James B. LaValle, Ernest B. Hawkins (Contributor); ISBN: 0895299259; http://www.amazon.com/exec/obidos/ASIN/0895299259/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “black cohosh” (or synonyms) into the search box, and select “books
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Black Cohosh
only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 •
Black cohosh: Cimicifuga racemosa Author: Foster, Steven,; Year: 1998; Austin, TX: American Botanical Council, c1998
•
Black cohosh rhizome: Actaea racemosa L., syn. Cimicifuga racemosa (L.) Nutt.: standards of analysis, quality control, and therapeutics. Author: American Herbal Pharmacopoeia.; Year: 2002; Santa Cruz, CA: American Herbal Pharmacopoeia, 2002; ISBN: 1929425147
Chapters on Black Cohosh In order to find chapters that specifically relate to black cohosh, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and black cohosh 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 “black cohosh” (or synonyms) into the “For these words:” box.
8
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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CHAPTER 7. PERIODICALS AND NEWS ON BLACK COHOSH Overview In this chapter, we suggest a number of news sources and present various periodicals that cover black cohosh.
News Services and Press Releases One of the simplest ways of tracking press releases on black cohosh 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 “black cohosh” (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 black cohosh. 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 “black cohosh” (or synonyms). The following was recently listed in this archive for black cohosh: •
Black cohosh used for menopausal symptoms may promote metastasis Source: Reuters Medical News Date: July 14, 2003
•
Black cohosh may make breast cancer drug more toxic Source: Reuters Health eLine Date: April 07, 2003
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Black Cohosh
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 “black cohosh” (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. 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 “black cohosh” (or synonyms). If you know the name of a company that is relevant to black cohosh, 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 “black cohosh” (or synonyms).
Academic Periodicals covering Black Cohosh Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to black cohosh. In addition to
Periodicals and News
43
these sources, you can search for articles covering black cohosh 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
47
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 Institute9: •
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
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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/
9
These publications are typically written by one or more of the various NIH Institutes.
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Black Cohosh
•
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/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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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
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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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.10 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:11 •
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
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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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/
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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
10
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). 11 See http://www.nlm.nih.gov/databases/databases.html.
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Black Cohosh
•
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 Gateway12 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.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “black cohosh” (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 90 4 466 0 0 560
HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 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.16 Simply search by “black cohosh” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
12
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
13
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). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16
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 Biologists17 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.18 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.19 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/.
17 Adapted 18
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. 19 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 black cohosh can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based 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 black cohosh. 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 black cohosh. 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 “black cohosh”:
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Black Cohosh
•
Other guides Dietary Supplements http://www.nlm.nih.gov/medlineplus/dietarysupplements.html Female Sexual Dysfunction http://www.nlm.nih.gov/medlineplus/femalesexualdysfunction.html Herbal Medicine http://www.nlm.nih.gov/medlineplus/herbalmedicine.html Menopause http://www.nlm.nih.gov/medlineplus/menopause.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. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on black cohosh. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Questions and Answers About Black Cohosh and the Symptoms of Menopause Source: Bethesda, MD: Office of Dietary Supplements, National Institutes of Health. 2001. 7 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; INTERNATIONAL PHONE: (301) 519-3153; TTY: (866) 464-3615; FAX: (866) 464-3616; EMAIL:
[email protected]. PRICE: Free. Publication Number: D176. Summary: This fact sheet from the National Institutes of Health Office of Dietary Supplements and the National Center for Complementary and Alternative Medicine provides an overview of the use of black cohosh for menopausal symptoms. It lists key points about black cohosh and menopause, followed by a series of questions and answers on the topic. The information provided in the fact sheet includes an explanation of what black cohosh is, a description of its preparations, the history of its use, details about clinical studies on black cohosh and its effect on menopausal symptoms, how black cohosh works, and the possible side effects of, and drug interactions with, black cohosh. The fact sheet offers additional sources of information on black cohosh. 24 references.
Patient Resources
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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 black cohosh. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information 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. 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/
•
WebMDHealth: 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 black cohosh. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with black cohosh. 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 black cohosh. 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. The Directory of Health Organizations database can be accessed via the Internet at
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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 “black cohosh” (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 “black cohosh”. 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 “black cohosh” (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 “black cohosh” (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.20
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
20
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)21: •
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
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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/
21
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
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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
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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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
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
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/
Finding Medical Libraries
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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
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
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
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
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
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
63
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
•
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
65
BLACK COHOSH 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] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [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 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] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [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] 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] 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] 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
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pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Antidepressant: A drug used to treat depression. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [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] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Arachidonate 12-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 12-hydroperoxyarachidonate (12-HPETE) which is itself rapidly converted by a peroxidase to 12-hydroxy-5,8,10,14-eicosatetraenoate (12-HETE). The 12-hydroperoxides are preferentially formed in platelets. EC 1.13.11.31. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [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] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [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] 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] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH]
Dictionary 67
Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [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] Bioassay: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biomass: Total mass of all the organisms of a given type and/or in a given area. (From Concise Dictionary of Biology, 1990) It includes the yield of vegetative mass produced from any given crop. [NIH] 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] Bladder: The organ that stores urine. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [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] Body Fluids: Liquid components of living organisms. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [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] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Calendula: Genus of annuals in the family Asteraceae that contains carotenoids, essential oils (oils, volatile), flavonoids, mucilage, saponins, and sterols. It is used both topically and internally. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed
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round the edges and fragments of broken bone. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [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] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chamomile: Common name for several daisy-like species native to Europe and Western Asia, now naturalized in the United States and Australia. The dried flower-heads of two species, Anthemis nobilis (Chamaemelum nobile) and Matricaria recutita, have specific use as herbs. They are administered as tea, extracts, tinctures, or ointments. Chamomile contains choline, coumarins, cyanogenic glycosides, flavonoids, salicylate derivatives, tannins, and volatile oils. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [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]
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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] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Comet Assay: A genotoxicological technique for measuring DNA damage in an individual cell using single-cell gel electrophoresis. Cell DNA fragments assume a "comet with tail" formation on electrophoresis and are detected with an image analysis system. Alkaline assay conditions facilitate sensitive detection of single-strand damage. [NIH] Comfrey: Perennial herb Symphytum officinale, in the family Boraginaceae, used topically for wound healing. It contains allantoin, carotene, essential oils (oils, volatile), glycosides, mucilage, resin, saponins, tannins, triterpenoids, vitamin B12, and zinc. Comfrey also contains pyrrolizidine alkaloids and is hepatotoxic if ingested. [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,
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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 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] Conjugated: Acting or operating as if joined; simultaneous. [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] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] 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] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]
Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] 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] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] 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] Cyst: A sac or capsule filled with fluid. [NIH] Cytotoxic: Cell-killing. [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.
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The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [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] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] 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.
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[NIH]
Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometrium: The layer of tissue that lines the uterus. [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]
Enzyme: A protein that speeds up chemical reactions in the body. [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] Epidemiological: Relating to, or involving epidemiology. [EU] 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] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]
Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] 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] 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] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place
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in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [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] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Follicles: Shafts through which hair grows. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: 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]
Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [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] 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] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to
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replace diseased or injured tissue removed from another part of the body. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [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] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatotoxic: Toxic to liver cells. [EU] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hormonal: Pertaining to or of the nature of a hormone. [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] Host: Any animal that receives a transplanted graft. [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] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and
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disposal of foreign ("non-self") material which enters the body. [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] 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 or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] 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] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intracellular: Inside a cell. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction 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] 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] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins
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and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [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] Lipid: Fat. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] 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]
Mammary: Pertaining to the mamma, or breast. [EU] Mammography: Radiographic examination of the breast. [NIH] 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 Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH]
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Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [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] 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] 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] 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] 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] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mung bean: A type of bean grown in warm climates. It is usually used for its seed and for bean sprouts. Mung bean may have anticancer effects. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit.
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Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [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] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neutrophil: A type of white blood cell. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]
Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the 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]
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Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Peripheral blood: Blood circulating throughout the body. [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] 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] 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]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [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 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] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for
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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] Preclinical: Before a disease becomes clinically recognizable. [EU] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] 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] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate-Specific Antigen: Kallikrein-like serine proteinase produced by epithelial cells of both benign and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. EC 3.4.21.77. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein
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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] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [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] 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] Pulmonary: Relating to the lungs. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyrrolizidine Alkaloids: Alkaloids found in various species of Senecio and other plants. There are at least ten different chemicals, many of them hepatotoxic, teratogenic, and carcinogenic. The plants may cause damage in grazing herds, but no longer have medical use. [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] 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] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [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] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] 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]
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Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [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] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [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] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino
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acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [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] 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] 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] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [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] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] 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] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic
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hydrocarbons. [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] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [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] 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] 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 conditioned by geographical and/or ecological occurrence. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]
Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Topical: On the surface of the body. [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] 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] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH]
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Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [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 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] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning involuntarily or unconsciously, as the vegetative nervous system. 3. Resting; denoting the portion of a cell cycle during which the cell is not involved in replication. 4. Of, pertaining to, or characteristic of plants. [EU] Venous: Of or pertaining to the veins. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] 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] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [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] Vivo: Outside of or removed from the body of a living organism. [NIH]
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Weight Gain: Increase in body weight over existing weight. [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]
Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [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]
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INDEX A Abdomen, 69, 71, 80, 88, 89 Abdominal, 69, 83, 84 Acceptor, 69, 82 Adrenal Cortex, 69, 76, 82, 84 Adverse Effect, 69, 87 Affinity, 69, 87 Agonist, 19, 69, 85, 88 Algorithms, 69, 71 Aloe, 39, 69 Alternative medicine, 46, 69 Amino Acids, 69, 83, 85, 86 Anaesthesia, 69, 79 Analgesic, 40, 70 Antidepressant, 20, 70 Antineoplastic, 70, 74, 77 Antioxidant, 7, 38, 70 Anxiety, 39, 70 Arachidonate 12-Lipoxygenase, 70, 80 Arachidonate 15-Lipoxygenase, 70, 80 Arachidonate Lipoxygenases, 70, 80 Arachidonic Acid, 70, 80, 84 Arterial, 70, 85 Arteries, 70, 71, 74, 81 Aspirate, 9, 32, 70 Assay, 70, 73 ATP, 70, 75, 77, 85 Atrophy, 5, 70 B Bacteria, 70, 81, 85, 89 Base, 70, 75, 79 Basophils, 70, 80 Benign, 71, 78, 84 Bile, 71, 77, 80, 87 Bioassay, 5, 14, 19, 71 Bioavailability, 5, 71 Biochemical, 5, 6, 71, 86 Biomarkers, 7, 9, 71 Biomass, 4, 71 Biotechnology, 9, 44, 46, 53, 71 Bladder, 71, 79, 84, 89 Blood Glucose, 5, 71, 79 Blood Platelets, 71, 87 Blood pressure, 71, 87 Blood vessel, 71, 72, 79, 83, 88, 89 Body Fluids, 71, 87, 89 Bone Resorption, 6, 71 Bowel, 71, 75, 88
Bowel Movement, 71, 75, 88 Branch, 65, 71, 85, 87, 88 C Calendula, 39, 71 Callus, 15, 22, 71 Capsaicin, 72 Capsicum, 37, 39, 72 Capsules, 36, 72 Cardiovascular, 6, 72, 80, 87 Carotene, 72, 73 Carotenoids, 71, 72 Case report, 22, 72 Case series, 72 Cell, 6, 14, 19, 37, 69, 70, 71, 72, 73, 74, 76, 77, 79, 82, 83, 84, 85, 86, 89, 90 Central Nervous System, 8, 72, 78, 80, 87 Cervix, 40, 72 Chamomile, 39, 72 Cholesterol, 4, 71, 72, 85, 87, 88 Choline, 72 Chronic, 31, 72, 79 Clinical study, 15, 23, 72 Clinical trial, 3, 5, 7, 31, 32, 33, 53, 72, 74, 75, 85 Cloning, 71, 73 Coagulation, 5, 71, 73, 78 Cofactor, 73, 84 Comet Assay, 7, 73 Comfrey, 36, 39, 73 Complement, 73 Complementary and alternative medicine, 6, 17, 29, 73 Complementary medicine, 17, 73 Computational Biology, 53, 74 Conjugated, 24, 74 Connective Tissue, 36, 74 Connective Tissue Cells, 74 Consciousness, 70, 74 Contraindications, ii, 74 Controlled study, 24, 74 Conventional therapy, 74 Conventional treatment, 39, 74 Coronary, 74, 81 Coronary Thrombosis, 74, 81 Corpus, 74, 84 Corpus Luteum, 74, 84 Cortex, 74 Coumarins, 72, 74
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Curative, 74, 88 Cyclic, 74, 84 Cyst, 70, 74 Cytotoxic, 10, 72, 74 D Databases, Bibliographic, 53, 74 Degenerative, 75, 78 Density, 5, 75, 82 Diagnostic procedure, 35, 46, 75 Digestion, 71, 75, 80, 88 Digestive system, 34, 75 Digestive tract, 39, 75, 87 Direct, iii, 14, 21, 75, 86 Dizziness, 38, 75 DNA Topoisomerase, 75, 77 Double-blinded, 32, 75 Drive, ii, vi, 13, 38, 75 Drug Interactions, 58, 75 Dysmenorrhea, 25, 39, 75 Dyspareunia, 7, 75 E Efficacy, 4, 5, 6, 7, 8, 10, 11, 14, 15, 20, 24, 31, 75 Electrocoagulation, 73, 75 Electrolyte, 75, 87 Electrons, 70, 75, 82, 85 Electrophoresis, 73, 75 Embryo, 76, 79, 82 Emodin, 69, 76 Endometrial, 7, 31, 76 Endometrium, 39, 76, 81 Environmental Health, 52, 54, 76 Enzyme, 38, 70, 75, 76, 80, 85, 88, 89 Eosinophils, 76, 80 Epidemiological, 7, 76 Epithelial, 76, 78, 84 Epithelial Cells, 76, 78, 84 Epithelium, 39, 76 Esophagus, 75, 76, 88 Estradiol, 9, 22, 32, 76 Estrogen, 4, 6, 8, 15, 23, 76, 85, 86, 88 Estrogen receptor, 9, 15, 23, 76 Ethanol, 76, 77 Extracellular, 74, 76, 87 Extracellular Matrix, 74, 76 F Family Planning, 53, 76 Fat, 23, 70, 72, 76, 80, 86, 88 Fatigue, 38, 39, 76 Fatty acids, 76, 80, 84 Fermentation, 8, 76 Fetus, 77, 83, 89
Fibrinogen, 5, 77, 88 Flushing, 38, 77 Foetoplacental, 77, 82 Follicles, 37, 77 Fractionation, 5, 77 G Gallbladder, 69, 75, 77 Gastrin, 77, 78 Gastrointestinal, 76, 77, 80, 87, 89 Gastrointestinal tract, 76, 77, 80, 87, 89 Gene, 44, 71, 77 Genistein, 8, 77 Ginger, 37, 38, 77 Gland, 69, 77, 83, 84, 85, 86, 88 Glucose, 5, 71, 77, 79, 86 Glycoprotein, 77 Glycoside, 77, 86 Gonadotropin, 10, 77 Governing Board, 77, 84 Graft, 77, 78 Growth, 8, 19, 36, 38, 78, 80, 83, 86, 89 H Hair follicles, 37, 78 Headache, 25, 78, 84 Hematology, 31, 78 Hemorrhage, 75, 78, 88 Hemostasis, 78, 87 Hepatic, 8, 78 Hepatitis, 14, 19, 78 Hepatocytes, 78 Hepatotoxic, 73, 78, 85 Heredity, 77, 78 Hormonal, 38, 39, 70, 78 Hormone, 4, 8, 37, 39, 71, 76, 77, 78, 79, 84 Host, 6, 78, 80, 89 Hydrogen, 69, 70, 78, 81, 82 Hyperplasia, 7, 78 Hypersensitivity, 78, 80 Hypertrophy, 78 Hysterectomy, 40, 78 I Id, 16, 24, 59, 64, 66, 78 Immune system, 78, 80, 90 Impairment, 79, 81 Implantation, 79, 82 In vitro, 5, 8, 10, 15, 22, 79 In vivo, 6, 8, 79 Incontinence, 39, 40, 79 Indicative, 43, 79 Induction, 10, 79 Infarction, 74, 79, 81 Infection, 26, 79, 90
Index 89
Inflammation, 38, 78, 79, 80, 89 Insomnia, 7, 38, 79, 84 Insulin, 5, 79 Insulin-dependent diabetes mellitus, 79 Internal Medicine, 78, 79 Intracellular, 79, 84, 86 Ischemia, 70, 79 J Joint, 7, 79, 88 K Kb, 52, 79 Keratin, 79, 86 L Lactation, 80, 82 Large Intestine, 75, 80, 86, 87 Leukocytes, 7, 70, 76, 80, 81 Leukotrienes, 39, 70, 80 Library Services, 64, 80 Ligament, 80, 84 Lipid, 72, 79, 80 Lipoxygenase, 38, 70, 80 Liver, 18, 69, 70, 71, 75, 77, 78, 80 M Malignant, 70, 80, 84 Malnutrition, 70, 80 Mammary, 80, 85, 88 Mammography, 31, 80 Mediator, 80, 87 Medical Staff, 75, 80 MEDLINE, 53, 80 Membrane, 73, 76, 80, 81, 83 Meninges, 72, 81 Menopause, 4, 5, 8, 14, 15, 18, 20, 21, 22, 24, 26, 29, 31, 32, 37, 38, 39, 40, 58, 81, 82, 83 Menstrual Cycle, 39, 81, 82, 84 Menstruation, 25, 37, 38, 39, 75, 81, 84 Mental Disorders, 34, 81 Mental Health, iv, 3, 34, 52, 54, 81, 85 Metastasis, 45, 81 MI, 67, 81 Microbe, 81, 88 Microorganism, 73, 81, 89 Modification, 81, 85 Modulator, 81 Molecular, 9, 14, 19, 53, 55, 71, 74, 77, 81, 86 Molecule, 70, 73, 77, 81, 82, 85 Monocytes, 80, 81 Morphology, 78, 81 Motility, 81, 87 Motion Sickness, 81, 82
Mucosa, 40, 81 Mung bean, 39, 81 Myocardium, 81 N Nausea, 38, 81, 84 NCI, 1, 33, 34, 51, 82 Necrosis, 79, 81, 82 Need, 39, 44, 60, 82 Nervous System, 72, 80, 82, 89 Neutrophil, 10, 82 Nucleus, 70, 74, 76, 81, 82, 88 O Oestrogen, 40, 82 Ointments, 72, 82 On-line, 5, 67, 82 Opacity, 75, 82 Osteoporosis, 6, 8, 21, 26, 32, 82, 85 Ovary, 74, 76, 82 Ovum, 74, 82, 84, 90 Oxidation, 7, 69, 70, 82 Oxidative metabolism, 80, 82 P Palliative, 82, 83, 88 Pancreas, 69, 71, 75, 79, 83, 89 Patch, 37, 83 Patient Education, 58, 62, 64, 67, 83 Pelvic, 83, 84 Peptide, 80, 83, 85 Perimenopausal, 37, 83 Peripheral blood, 7, 38, 83 Pharmacokinetic, 6, 83 Pharmacologic, 83, 88 Phospholipids, 76, 83 Photocoagulation, 73, 83 Physiologic, 6, 69, 81, 83, 84, 85 Physiology, 14, 78, 83 Placenta, 76, 77, 83, 84 Plants, 72, 76, 77, 81, 83, 85, 86, 87, 89 Poisoning, 82, 83 Polypeptide, 77, 83 Postmenopausal, 4, 6, 9, 31, 32, 37, 38, 82, 83, 85 Practice Guidelines, 54, 83 Preclinical, 14, 20, 84 Premenstrual, 27, 37, 39, 84 Premenstrual Syndrome, 27, 37, 39, 84 Progesterone, 4, 15, 22, 84, 87 Progressive, 78, 82, 84 Prostaglandin, 39, 84 Prostaglandins A, 84 Prostate, 9, 71, 82, 84, 89 Prostate-Specific Antigen, 9, 84
90
Black Cohosh
Protein S, 44, 71, 84 Proteins, 9, 69, 73, 79, 81, 83, 85, 86, 87 Protein-Tyrosine Kinase, 77, 85 Proteolytic, 73, 77, 85 Public Health, 6, 15, 54, 85 Public Policy, 53, 85 Pulmonary, 71, 80, 85, 88 Purulent, 85, 89 Pyrrolizidine Alkaloids, 73, 85 Q Quality of Life, 32, 85 R Radiation, 77, 85, 90 Radiation therapy, 77, 85 Raloxifene, 8, 85, 86 Randomized, 4, 7, 9, 15, 23, 32, 33, 75, 85 Reactive Oxygen Species, 14, 19, 85 Receptor, 18, 19, 85, 87 Receptors, Serotonin, 86, 87 Rectum, 71, 75, 79, 80, 84, 86 Red blood cells, 86 Refer, 1, 73, 75, 86 Regeneration, 15, 22, 86 Regimen, 4, 36, 75, 86 Restoration, 86, 90 S Salicylate, 72, 86 Salivary, 75, 86 Salivary glands, 75, 86 Sanitary, 39, 86 Saponins, 9, 71, 73, 86, 87 Screening, 72, 86 Sebaceous, 37, 86 Sebaceous gland, 37, 86 Sebum, 37, 86 Secondary tumor, 81, 86 Selective estrogen receptor modulator, 7, 22, 85, 86, 88 Semen, 84, 86 Senile, 82, 86 Serine, 84, 86 Serotonin, 19, 86, 89 Serum, 4, 9, 73, 77, 87 Sex Characteristics, 82, 87 Side effect, 6, 7, 39, 58, 69, 87, 88 Skeleton, 79, 84, 87 Small intestine, 78, 87 Social Environment, 85, 87 Sodium, 37, 87 Soma, 87 Somatic, 7, 87 Spatial disorientation, 75, 87
Specialist, 59, 87 Species, 5, 17, 72, 85, 87, 88, 89, 90 Spices, 72, 87 Spinal cord, 72, 81, 82, 87 Steroid, 9, 14, 19, 82, 86, 87 Stimulus, 75, 88 Stomach, 69, 75, 76, 77, 78, 81, 87, 88 Stool, 79, 80, 88 Strand, 7, 73, 88 Stress, 77, 82, 88 Stroke, 34, 52, 88 Subspecies, 87, 88 Surfactant, 37, 88 Symphysis, 84, 88 Symptomatic, 9, 32, 88 Synergistic, 36, 88 Systemic, 15, 23, 39, 71, 79, 85, 88 T Tamoxifen, 7, 86, 88 Testis, 76, 82, 88 Therapeutics, 44, 88 Thrombin, 77, 88 Thrombosis, 85, 88 Tissue, 36, 70, 71, 73, 74, 76, 77, 78, 80, 81, 84, 85, 86, 87, 88, 90 Topical, 36, 39, 76, 88 Toxic, iv, 45, 78, 88 Toxicity, 5, 7, 32, 75, 76, 88 Toxicology, 22, 54, 88 Transfection, 71, 88 Tryptophan, 87, 89 Tumor marker, 71, 89 U Unconscious, 78, 89 Ureters, 89 Urethra, 84, 89 Urinary, 6, 21, 38, 40, 79, 89 Urinary tract, 38, 89 Urinary tract infection, 38, 89 Urine, 71, 79, 89 Uterine Contraction, 40, 89 Uterus, 23, 40, 72, 74, 76, 78, 81, 84, 89 V Vagina, 5, 72, 81, 89 Vaginal, 4, 7, 39, 40, 89 Vaginitis, 38, 89 Vasomotor, 4, 89 Vegetative, 71, 89 Venous, 85, 89 Veterinary Medicine, 40, 53, 89 Virulence, 88, 89 Viscera, 87, 89
Index 91
Vitro, 8, 89 Vivo, 89 W Weight Gain, 38, 39, 90 White blood cell, 80, 82, 90
Womb, 89, 90 Wound Healing, 73, 90 X Xenograft, 8, 90 X-ray, 5, 85, 90
92
Black Cohosh
