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

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 , ...

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Feet: 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: 0-597-84280-9 1. Feet-Popular works. I. Title.

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

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

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on feet. 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 FEET .......................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Feet................................................................................................ 8 E-Journals: PubMed Central ....................................................................................................... 16 The National Library of Medicine: PubMed ................................................................................ 17 Academic Periodicals covering Feet ............................................................................................. 26 Dissertations on Feet.................................................................................................................... 26 CHAPTER 2. NUTRITION AND FEET ................................................................................................. 27 Overview...................................................................................................................................... 27 Finding Nutrition Studies on Feet............................................................................................... 27 Federal Resources on Nutrition ................................................................................................... 29 Additional Web Resources ........................................................................................................... 29 CHAPTER 3. ALTERNATIVE MEDICINE AND FEET .......................................................................... 33 Overview...................................................................................................................................... 33 National Center for Complementary and Alternative Medicine.................................................. 33 Additional Web Resources ........................................................................................................... 36 General References ....................................................................................................................... 49 CHAPTER 4. PATENTS ON FEET ....................................................................................................... 51 Overview...................................................................................................................................... 51 Patents on Feet............................................................................................................................. 51 Patent Applications on Feet ......................................................................................................... 54 Keeping Current .......................................................................................................................... 56 CHAPTER 5. BOOKS ON FEET ........................................................................................................... 57 Overview...................................................................................................................................... 57 Book Summaries: Federal Agencies.............................................................................................. 57 Book Summaries: Online Booksellers........................................................................................... 58 Chapters on Feet........................................................................................................................... 58 CHAPTER 6. MULTIMEDIA ON FEET ................................................................................................ 61 Overview...................................................................................................................................... 61 Video Recordings ......................................................................................................................... 61 Audio Recordings......................................................................................................................... 62 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 63 Overview...................................................................................................................................... 63 U.S. Pharmacopeia....................................................................................................................... 63 Commercial Databases ................................................................................................................. 65 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 69 Overview...................................................................................................................................... 69 NIH Guidelines............................................................................................................................ 69 NIH Databases............................................................................................................................. 71 Other Commercial Databases....................................................................................................... 74 APPENDIX B. PATIENT RESOURCES ................................................................................................. 75 Overview...................................................................................................................................... 75 Patient Guideline Sources............................................................................................................ 75 News Services and Press Releases................................................................................................ 88 Newsletters on Feet ...................................................................................................................... 89 Newsletter Articles ...................................................................................................................... 90 Finding Associations.................................................................................................................... 91 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 93 Overview...................................................................................................................................... 93

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Preparation................................................................................................................................... 93 Finding a Local Medical Library.................................................................................................. 93 Medical Libraries in the U.S. and Canada ................................................................................... 93 ONLINE GLOSSARIES.................................................................................................................. 99 Online Dictionary Directories ..................................................................................................... 99 FEET DICTIONARY...................................................................................................................... 101 INDEX .............................................................................................................................................. 159

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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 feet is indexed in search engines, such as www.google.com or others, a nonsystematic 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 feet, 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 feet, 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 feet. 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 feet, 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 feet. 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 FEET Overview In this chapter, we will show you how to locate peer-reviewed references and studies on feet.

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

Your Feet Are Made for Walking Source: Health. p.110-115. October 2000. Summary: Keeping feet pain free and healthy can help maintain physical fitness. This article gives an overview of common foot ailments and their home treatments. Home remedies begin with aspirin or ibuprofen and continue with RICE -- rest, ice, compression, and elevation. Fortunately, most people who suffer from foot or leg overuse injuries get some relief from wearing orthotic inserts. Studies have found that about 70 to 80 percent of those treated with orthotic devices improve.

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Four-Wheel Drive for Feet Source: Cooking Light. 12(8):50,54,56. October 1998.

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Summary: Shaffer discusses what is needed in a shoe used for walking and running on trails rather than pavement. She notes that a lugged sole, to improve the sole's grip on the running surface, is very important. Other useful features include toe guards, more ankle support and protection, less padding, and water protection. Reviews of several shoe models are provided. •

Keeping Your Feet on a Firm Footing Source: Diabetes Self-Management. 14(3): 46, 48, 50, 52. May-June 1997. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article explores ways for readers with diabetes to ward off the effects of many foot complications by protecting the feet's health. The author emphasizes that the foot is a complex structure that plays many roles, including shock absorber, stabilizer, and a method of mobility. The author reviews the four major longterm complications that can affect the feet: sensory peripheral neuropathy, which affects the sensation in the feet; autonomic neuropathy, which affects the moisturization of the skin on the feet; motor neuropathy, which affects the muscles in and the shape of the feet; and peripheral vascular disease, which affects the circulation to the feet. The author discusses the importance of keeping blood glucose levels in control, not smoking, and to follow guidelines of proper foot care. These include inspecting the feet, washing and drying the feet daily, protecting feet from trauma, cutting toenails safely, choosing suitable socks and shoes, and moisturizing dry feet. The remainder of the article presents suggestions for treating common foot problems, including sores, blisters, minor scratches, athlete's foot, thick toenails, ingrown toenails, bunions, flat feet, hammertoes (claw toes), corns, and calluses. The author concludes by encouraging readers to remind their health care providers of the importance of including the feet in any regular checkups. One sidebar provides information on where to get additional information and assistive supplies.

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Simple Test Saves Feet Source: Diabetes Forecast. 49(4): 28-31. April 1996. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article familiarizes readers with the use of a nylon filament, referred to as a monofilament, to test whether a person still has normal feeling in his or her feet. The author stresses that the test is important because if the filament shows that the person has lost some feeling, and therefore is at risk for developing a foot ulcer, that person and his or her health care team can take steps to avoid an ulcer. The author describes the Lower Extremity Amputation Prevention (LEAP) program of the U.S. Department of Health and Human Services, a program in which monofilament testing plays a prominent role. The article describes how monofilament testing is performed and the meaning of the different categories of results; for each category, recommendations for foot care are provided. One sidebar provides information for doctors, nurses, and diabetes educators who are interested in obtaining a LEAP package from the National Diabetes Outreach Program. 2 figures.

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Pain-Free Feet: Helpful Hints for Runners Source: The Physician and Sportsmedicine. 26(12):73-74,52. December 1998.

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Contact: The Physician and Sportsmedicine, 4530 W. 77th St., Minneapolis, MN 55435. (612) 835-3222. FAX (612) 835-3460. Summary: This article is intended for physicians to share with their patients who run. Topics covered include shoe selection, use of special insoles and other shoe inserts, and stretching before and after a run. •

Caring for Feet Source: Diabetes Forecast. Resource Guide 2000: 10-12. January 2000. Contact: Available from American Diabetes Association (ADA). 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article offers guidelines for foot care for people who have diabetes. Diabetes is hard on feet because it can cause nerve damage and poor blood flow. For people who have diabetes, shoes and socks are medical devices, so the article presents suggestions for buying proper shoes and socks. The article outlines other steps people can take to keep their feet healthy, including washing and examining feet daily, moisturizing feet after bathing, avoiding going barefoot or using heating pads or hot water bottles on the feet, avoiding smoking, exercising, and having a doctor treat foot injuries or problems. In addition, the article explains what people should do if they develop a foot ulcer.

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Feet First Source: Diabetes Forecast. 50(6): 27-30. June 1997. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reminds readers with diabetes of the importance of regular foot care to prevent foot complications and amputations. The author stresses that many people with diabetes simply don't care for their feet properly. Diabetic neuropathy, vascular disease, and altered responses to infection make people with diabetes particularly susceptible to developing the foot ulcers that so often lead to amputation. The author outlines the causes of foot complications, then discusses the loss of protective sensation (LOPS) and how it is diagnosed with a monofilament. The role of footwear is also stressed. The author notes that Medicare now provides 80 percent reimbursement to patients with diabetes for one pair of doctor prescribed, customized shoes each year and two additional pairs of insoles. One sidebar summarizes nine steps to better foot care.

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Influence of Shoe Design on Plantar Pressures in Neuropathic Feet Source: Diabetes Care. 26(2): 441-445. February 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study undertaken to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy (nerve disease associated with diabetes) during walking. Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured. Shoes with a rocker bottom principle reduced pressure 35 to 65 percent underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics

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underneath the heel and medial forefoot (first metatarsal head and hallus) on average showed no significant differences among the different shoes with a cushioning insole. The authors conclude that the most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, inshoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individuals cases. 2 figures. 1 table. 18 references. •

How to Treat Your Feet Source: Diabetes Forecast. 43(2): 17-20. February 1990. Summary: This article reviews the importance of foot care for people who have diabetes. The author stresses that most of the foot problems and complications stemming from diabetes are preventable. When complications first develop, they are often treatable and conservative treatments are available that may help prevent more serious damage. A list of ten selfcare tips for feet is included.

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Feet Treats: Buying a Shoe That Fits Right! Source: Living Well With Diabetes. 7(1): 17-18. Winter 1992. Summary: This article stresses the importance of buying shoes that fit correctly, in order to prevent some of the foot problems that can cause major trouble for people with diabetes. Topics include determining the proper shoe size, how feet change as people age, and choosing the type of shoe to buy. The author also makes some recommendations about which brands of shoes to buy.

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Healthy Feet in Diabetes Source: World Health. May-June 1991. p. 13-15. Summary: This article, from a magazine of international health, reviews the problems and prevention of foot problems for people with diabetes. Topics include the complications of diabetes, particularly in the developing world, the physiological and psychological effects of amputation, prevention of foot problems, choosing shoes, the importance of regular foot inspection, the cost-effectiveness of foot disease prevention, the role of health care practitioners in regular examination of the feet, and the vital role of all members of an interdisciplinary health care team working with the patient to prevent the foot problems of diabetes. The author also briefly discusses the role of the World Health Organization in this area.

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Treat Your Feet With Loving Care While You're Traveling Source: Diabetes in the News. 11(4): 40-42. July-August 1992. Summary: This article, written by a podiatrist, discusses the importance of good foot care while traveling. The author discusses ways to take extra care of the feet both before leaving and during the trip in order to prevent painful foot problems. The article covers different footwear for different activities; socks; and daily foot inspections. One sidebar discusses first aid for feet, including a toll-free referral service for locating a podiatrist.

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Feet First: Diabetes Care Source: AJN. American Journal of Nursing. 99(2): 26-34. February 1999.

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Summary: This journal article provides nurses with information on the care of foot problems among people who have diabetes. Foot problems are the most common cause of hospitalization for people who have diabetes. People who have diabetes have many complications that can cause chronic skin ulcers. The main etiologic mechanisms involved in the formation of diabetic ulcers are ischemia, neuropathy, and infection. Ischemia occurs when inadequate perfusion leads to cellular death. Neuropathy occurs when a disturbance in metabolism caused by hyperglycemia results in reduced blood flow and subsequent nerve damage. Infections occur as the neuropathy and vascular disease associated with diabetes create opportunities for microbial invasion. Infections on the skin surface usually result from aerobic Gram-positive cocci, nail infections may be caused by fungi, and deeper infections may involve aerobic Gram-negative bacilli and anaerobic organisms. Superficial foot ulcers usually do not threaten the limb, but deep ulcers with polymicrobial infections extending into the subcutaneous tissue are limb threatening. Mechanisms of injury include mechanical stress and shearing. Charcot foot, a form of diabetic osteoarthropathy, is usually limited to people who have moderate to severe neuropathy and is believed to be triggered by an incidental trauma. A foot ulceration risk profile includes both external and internal factors. Tests for assessing risk for ulcer development include the Semmes Weinstein monofilament esthesiometer and neuropathy classification. Wound management involves classifying the ulcer, relieving pressure on the ulcerated foot with total contact casting, removing necrotic tissue and exudate, cleansing and dressing the wound with the appropriate products, and providing followup care. Other treatment methods include taking the drug pentoxifylline and undergoing arterial reconstruction surgery. Patient education is an important part of foot ulcer prevention. 2 tables and 8 references. •

Get Square With Your Feet Source: Arthritis Today. 15(5): 58-60. September-October 2001. Summary: This journal article provides people who have arthritis with information on foot care. Orthopedic problems, including foot problems, are a leading cause of inactivity and disability in the United States. As people age, their feet spread out, their muscles weaken, and their skin gets thin. Feet also change size because of fluid retention. Years of wearing the wrong shoes can cause problems such as bunions, hammertoes, or neuromas. Joints inflamed and distorted by arthritis are made worse by a day's pounding in ill fitting shoes or by feet whose padding has grown thin. People who neglect foot problems are much more likely to develop osteoarthritis in their feet. In addition, pain changes the way a person walks. Once this happens, ankles, knees, hips, and spine are affected. Although people do tend to ignore their feet, most problems can be avoided or corrected with the proper attention. People who have arthritis should have their feet checked by a rheumatologist, an orthopaedic surgeon, or a podiatrist. Shoes that fit well and feel good are important for people who have arthritis. Another key to foot health is exercise. Self massage will help relieve sore feet. Nonsteroidal antiinflammatory drugs, heat, and ultrasound can help relieve pain. The article includes tips on buying shoes and suggests exercises to help keep feet fit.

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Federally Funded Research on Feet The U.S. Government supports a variety of research studies relating to feet. 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 feet. 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 feet. The following is typical of the type of information found when searching the CRISP database for feet: •

Project Title: CAD-CAM TECHNOLOGY FOR DIABETIC FOOTWEAR Principal Investigator & Institution: Loomis, Joseph L.; Diapedia, Llc 200 Innovation Blvd, Ste 240 State College, Pa 16803 Timing: Fiscal Year 2003; Project Start 15-JUN-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Over 15% of diabetic patients will experience a foot ulcer. Foot ulcers are expensive both in terms of cost of care and work productivity lost. Foot ulcers are also the dominant contributory cause to the more than 80,000 amputations performed in the US each year in diabetic patients. In order to prevent ulcerations and amputations, at-risk patients must use special footwear for life as part of a comprehensive care and self-care program. Currently the design and manufacture of therapeutic footwear is largely based on subjective criteria. Successful shoes are usually made by experienced craftspeople and much iteration is often required. Several attempts have been made to put the design process for the critical shoe-foot interface (insole) on a quantitative basis. These products appear to have not been particularly successful because of the lack of a well-defined algorithm to translate patient attributes into insole design. We will develop an entire therapeutic shoe system for at risk DM patients that will incorporate: data collection; automatic algorithm for insole design; CAD-CAM system for manufacture; and system for shoe selection including outsole modifications. The final product will also include a means for provider and patient education and products to promote appropriate care and self-care. Phase I preliminary studies have demonstrated success in data acquisition in the areas of plantar pressure, foot shape and arch shape. Algorithms for shoe sizing and alignment of the pressure and shape data with the shoe template have been developed. A method for reproducible design of insole modifications on the computer screen, based on the shape and pressure data, now exists and virtually designed insoles can now be milled using the CAD-CAM system. A data set from patients staying healed has been acquired that for the first time provides guidance for the identification of an in-shoe pressure ulceration threshold. We have also demonstrated feasibility of the whole process by utilizing the method to reduce in-shoe pressure below threshold in a group of neuropathic high-risk feet with high pressure at

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

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the first metatarsal head. We now see a clear path toward further automation of the system and to a consideration of other "at-risk" regions of the foot. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LEARNING TO REACH: CONTROL OF LIMB DYNAMICS IN INFANCY Principal Investigator & Institution: Galloway, James C.; Physical Therapy; University of Delaware Newark, De 19716 Timing: Fiscal Year 2004; Project Start 15-DEC-2003; Project End 30-NOV-2005 Summary: (provided by applicant): The long-term goal of this research is to develop diagnostic and treatment options for infants under 6 months of age who are at risk for coordination disorders. Clinically, infants are often first diagnosed as 'at risk' at 6-12 months of age when they show delay in several skills such as reaching or walking. Early arm movements (i.e., movements before the development of reaching) offer the potential to detect movement impairments within the first 12 weeks of postnatal life. This project involves the systematic, longitudinal study of joint coordination starting when infants are 4 weeks of age and continuing through successful reaching at 24 weeks. This project is a necessary precursor to the study of young infants at risk for coordination disorders and ultimately to treatments specific to enhancing reaching development. The first aim of this project is to determine the pattern of shoulder-elbow-wrist dynamics from early arm movements through successful reaching. In adults, the appropriate combination of muscular and non-muscular moments at a joint are less complex at the shoulder than at distal points. Shoulder and elbow motion in pre-reaching infants suggests that this dynamic pattern may be present in early movements. If so, this could be an important early marker of typical development. The second aim is to determine the pattern of hipknee-ankle dynamics from early leg movements up to successful feet reaching, and compare this pattern with that of the arms. Recent work suggests that infants are able to control their legs for reaching weeks before they can control their arms for reaching. Patterns of dynamics underlying feet reaching could help identify atypical development weeks earlier than hand reaching. This project will provide the foundation data for a larger study of the effects of early training on the development of reaching in very young infants at risk for developing coordination disorders such as cerebral palsy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MUSCLE LOCOMOTION

ACTIVITY

INITIATION

DURING

HEMIPARETIC

Principal Investigator & Institution: Brown, David A.; Programs in Physical Therapy; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 10-SEP-2000; Project End 31-MAY-2004 Summary: (adapted from Investigator's abstract) During locomotion in persons with post-stroke hemiparesis, muscle activity is initiated at inappropriate points in the cycle. As a consequence, movements are less-forceful and are slower, and movement function is impaired. The investigators propose that an interaction between two key underlying mechanisms, heightened motoneuron excitability and abnormal position-dependent modulation of motoneuron excitability, result in inappropriately-timed muscle activity. With their earlier work, the investigators have shown that paretic uniarticular knee muscles and biarticular hip and knee muscles are inappropriately activated at an earlier phase in the pedaling cycle. Since these muscles are lengthening at these points in the cycle and, since this effect is speed-dependent, they first propose that heightened

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motoneuron excitability results in muscle being activated when it is stretched at a specific threshold length and velocity. They will systematically vary the ranges of length and velocity of uniarticular knee muscles during cyclical leg motion to identify threshold muscle stretch parameters that trigger inappropriate initiation of uniarticular muscle activity. They will also systematically vary the ranges of length and velocity of uni- and biarticular muscles crossing the hip to identify muscle stretch parameters that, secondarily, contribute to inappropriate initiation of uniarticular knee muscle activity. They will use a computer model of the musculoskeletal system to calculate each muscle's length and velocity characteristics from kinematic patterns and develop a comprehensive statistical model of the relative contributions from multiple muscle stretch parameters. Also, normally during cycling, uniarticular knee extensors are activated during knee extension, regardless of hip position. However, preliminary work in post-stroke subjects has demonstrated abnormal activation that is dependent on hip position. They propose that the position of the hip can abnormally modulate motoneuron excitability and, hence, influence timing of muscle activity in uniarticular knee extensor muscles. They will systematically vary the relative position of the hip versus knee using a unique linkage attached to the feet. This experiment will result in kinematic patterns that generate more appropriate timings of uniarticlar knee extensors. The intent is that the experimental apparatus and principles developed within this study will form the basis of a new therapeutic modality that targets deficits in locomotor control, post-stroke, and with other neurologic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOCICEPTION ENDOTHELINS

IN

DIABETIC

NEUROPATHY:

ROLE

OF

Principal Investigator & Institution: Berti-Mattera, Liliana N.; Associate Professor; Pathology; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Diabetic neuropathy is one of the major complications of diabetes mellitus. Two distinct clinical manifestations of: the diabetic neuropathy include patients suffering from painful symmetrical polyneuropathy and those with insensitive, painless, feet. Morphometrical analysis shows that small sensory fiber neurons degenerate early and prominently during the course of diabetic neuropathy. Signs and symptoms associated with degeneration of small fibers vary from hyperalgesia to loss of pain and temperature sensation. The endothelins (lETs) constitute a family of vasoactive peptides interacting with different receptor subtypes to regulate blood flow, cell proliferation, muscle contraction or relaxation. Recent observations in normal rats have demonstrated the predominant localization of type A and type B endotbelin receptors (ETAR and ETBR, respectively) in small nonmyelinated sensory fibers and their satellite Schwann cells (SC), where they appear to regulate neuropathic and inflammatory pain. The regulation of pain by these receptors seems to be reciprocal, since administration of ETBR agonists counteracts ETARmediated excitation of nociceptors. We have recently demonstrated that ETs, acting through the ETBR, modulate the proliferation and phenotype of cultured SC, and have observed a decreased expression of ETBR in diabetic nerves. Based on this information, we hypothesize that in experimental diabetes, the development of mechanical hyperalgesia and tactile allodynia reflects a decreased expression of ETBR in glial cells and/or an increased expression of ETAR in neurons from nociceptive fibers. To test this hypothesis we propose: 1) To compare the expression and localization of ET-1 and ETR in nerves and dorsal root ganglia cells isolated from normal and diabetic rats 2) To study

Studies 11

the effect of ETBR agonists and ETAR antagonists on the nociceptive responses in normal and diabetic rats, and to compare the nociceptive responses in control rats with those observed in rats lacking expression of ETBR This short-term exploratory project (R21) is expected to significantly advance our understanding of the role of ETs in diabetic pain, which is currently in early stages of development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NONLINEAR DYNAMICS AND ENHANCED SENSORIMOTOR FUNCTION Principal Investigator & Institution: Collins, James J.; University Professor; Biomedical Engineering; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2004; Project Start 27-SEP-1999; Project End 31-DEC-2007 Summary: (provided by applicant): The long-term goal of this project is to develop a non-invasive, noise-based technique for enhancing somatosensation and thereby improving balance control in elderly individuals and patients with somatosensory deficits. In previous studies, we have shown that sub-sensory mechanical noise (i.e., random vibration with a small intensity) can enhance somatosensory function in healthy individuals and older adults with somatosensory deficits. Moreover, we have shown that the postural sway of both healthy young and healthy elderly individuals during quiet standing can be significantly reduced by applying sub-sensory mechanical noise to the feet using vibrating shoe insoles. Despite these promising results, we still need to determine whether the intervention is effective in improving dynamic balance control and clinical measures of balance in addition to quiet-standing balance control, whether subjects adapt to the input noise that is used as part of the intervention, and in which types of patients this intervention is effective. Thus, in this project, we plan to build upon this work and explore the effects of our noise-based technique on biomechanical and clinical measures of balance in healthy elderly individuals, diabetic patients with somatosensory deficits, and stroke patients with somatosensory deficits. The specific aims of this project are: (1) to determine the effects of noise-enhanced somatosensation at the feet on balance performance in healthy elderly individuals; (2) to assess whether adaptation occurs in noise-enhanced balance control in healthy elderly individuals; (3) to determine the effects of noise-enhanced somatosensation at the feet on balance performance in diabetic patients with somatosensory deficits; (4) to assess whether adaptation occurs in noise-enhanced balance control in diabetic patients with somatosensory deficits; (5) to determine the effects of noise-enhanced somatosensation at the feet on balance performance in stroke patients with somatosensory deficits; and (6) to assess whether adaptation occurs in noise-enhanced balance control in stroke patients with somatosensory deficits. To accomplish these aims, we will conduct quietstanding and dynamic posture experiments and clinical balance assessments on healthy elderly individual, diabetic patients with somatosensory deficits, and stroke patients with somatosensory deficits. This project could lead to the development of a novel bioengineering technique for improving balance control in older adults and patients with somatosensory deficits. The proposed work could thus serve to reduce the frequency, morbidity and cost of falling, and assist aged individuals and patients with somatosensory deficits in achieving maximal independence in activities of daily living and mobility. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ORGANIZATION OF EXTRASTRIATE VISUAL CORTEX Principal Investigator & Institution: Sherk, Helen A.; Biological Structure; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-JUL-1983; Project End 31-MAY-2007 Summary: (provided by applicant): Vision plays an essential role during normal locomotion. Visual guidance is of particular clinical importance in elderly people, among whom decreased visual function is a major contributing factor to falls that often result in serious injury. The present proposal has two aims. The first is to explore the neural mechanisms underlying visual guidance during locomotion. The second is to investigate how visual information is transmitted to the motor system to guide locomotion. Cats are better suited than monkeys for this project because it is both feasible to record from single neurons in locomoting cats, and to do behavioral studies on unrestrained cats. Moreover, the areas of visual cortex most directly involved in visual guidance are similar in cats and monkeys.To explore how neurons in visual cortex analyze and transmit information during locomotion, electrodes will be placed in two key visual cortical areas. Responses will be recorded while cats walk down a long test alley, and the cat's gaze will also be monitored. We will correlate responses with several factors: the presence or absence of small objects cluttering the alley floor, the gaze behavior of the cat, and the direction selectivity of the neurons under study.To investigate the link between visual and motor systems during locomotion, the relay from visual cortex to cerebellum will be reversibly blocked in cats that are walking down a test alley. When the alley is cluttered, cats rely on vision to accurately place their feet. The hypothesis is that interruption of transmission of visual cortical information to cerebellum will cause a substantial increase in visually-guided stepping errors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OTOLITHIC TRAJECTORIES

CONTROL

OF

HUMAN

POSTURAL

SWAY

Principal Investigator & Institution: Black, Franklin O.; Director; Emanuel Hospital and Health Center Portland, or 97208 Timing: Fiscal Year 2002; Project Start 01-JUL-1982; Project End 31-MAR-2004 Summary: This project will continue studies on the contributions of vestibular otolith and semicircular canal inputs to normal and abnormal human balance control, but will be expanded to study visual contributions to postural control sensory interactions. The specific aims are to: 1) determine sources of variability of otolith-vestibulo-ocular reflexes and vestibular evoked myogenic potentials in patients with vestibular deficiencies and in an existing normal population cross-sectioned by age decade and gender, 2) determine otolith and canal contributions to postural control in normals and patients with vestibular deficits, 3) determine the role of altered otolith inputs to adaptive postural control in normal and vestibular deficient subjects, 4) determine the role of macular and peripheral retinal contributions to the sensory interaction controlling posture, and 5) study gait initiation in normals, and patients with vestibular or visual disorders under controlled head and gaze position. Studies will be performed on computer controlled rotation devices and dynamic platform systems. Vestibuloocular responses to angular, linear or combined angular and linear accelerations will be used as independent estimates of vestibular function. Eye movement responses will be recorded by conventional electro-oculography and three-dimensional infrared video techniques and analyzed for horizontal, vertical and torsional eye movements, depending on the experiments. Balance, posture and gait responses will be recorded

Studies 13

using a forceplate and an active marker motion analysis system and analyzed for torque and force measurements of the feet and for multi-dimensional body movements (head, trunk, legs) using special purpose computer methods. Outcomes of these experiments have resulted and will likely continue to result in a better understanding of normal and abnormal vestibulo-ocular and vestibulo-spinal control mechanisms, and will contribute to the development of new methods of diagnosis, prevention, treatment and rehabilitation of human balance disorders, including falls in the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PERIPHERAL AND CENTRAL POSTURAL DISORDERS IN THE ELDERLY Principal Investigator & Institution: Horak, Fay B.; Senior Scientist and Professor; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 30-SEP-1989; Project End 31-MAR-2004 Summary: (adapted from Investigator's abstract) The long-term goal of this research is to understand the neurophysiological basis for central and peripheral neurological disorders of postural control in order to provide a scientific basis for the evaluation and rehabilitation of balance disorders in the elderly. The first specific aim is to investigate the extent to which compensatory stepping is controlled in a similar way to step initiation by (1) testing the hypothesis that disorders of voluntary step initiation in 10 Parkinson's patients, 10 healthy young and 10 healthy elderly controls are similar to other disorders in stepping for balance correction (Experiment 1), and (2) determining the effect that a cognitive task has on voluntary step initiation, compensatory stepping, and feet in-place responses in 10 Parkinson patients ON and OFF levodopa and 10 healthy elderly controls (Experiment 2). The second aim investigates the effects of foot placement in stance on postural stability to perturbations in multiple directions. The hypothesis will be tested that 10 Parkinson, 10 cerebellar and 20 healthy elderly controls will not differ in their responses to such perturbations when standing with narrow, wide and diagonal foot placements (Experiment 3). Finally, the third aim is to determine how a cane is used for stability in stance and during surface perturbations. The hypothesis will be tested that a cane can be used to stabilize sway in stance, to modify and trigger automatic postural responses in patients with 10 peripheral neuropathy patients and up to 30 healthy controls, but not in 10 Parkinson's patients (Experiment 4). A better understanding of adaptive postural behaviors such as protective stepping, alterations in foot placement in stance, and use of a cane will provide the scientific rationale for improving balance retraining programs for both neurological patients and for elderly with subclinical disorders affecting balance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHOSPHORUS MRI OF THE LOWER EXTREMETIES IN DIABETICS Principal Investigator & Institution: Greenman, Robert L.; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2004 Summary: (Provided by applicant): The overall objective of this proposal is to develop a three-dimensional MR imaging protocol to investigate the phosphorus-31 metabolism in the muscle tissue in the lower extremities of diabetic patients. Fifteen million people suffer from diabetes mellitus in the United States and there are 650,000 new cases diagnosed each year. Changes in the structure of the basement membrane of capillaries and neuropathy of the autonomic nerves create an effective ischemia in localized

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capillary beds in the lower leg and foot. Anatomical methods exist for assessing the blood flow and nerve viability in the lower legs and feet of diabetics. However, these techniques do not provide a direct assessment of the metabolic state of the affected muscle tissue. Phosphorus magnetic resonance spectroscopy (MRS) has been used to study the metabolism of muscle tissue and assess the metabolic state of ischemic tissue in a noninvasive way in humans. The current MRS localization technique that can be used to provide a regional assessment of the lower leg and foot with the ability to identify focal areas of ischemia is chemical shift imaging (CSI). However, a scan of the lower extremities having a resolution that is high enough to identify local areas with poor blood flow using the currently available CSI technique would take more than 21 minutes making the MR examination prohibitively long. We have exploited the recent advances in high-speed magnetic resonance imaging techniques to develop a method for directly creating images of a single phosphorus metabolite (e.g. phosphocreatine) in human skeletal muscle. We have successfully acquired pure phosphocreatine images of human skeletal muscle in normal volunteers having a spatial resolution of 0.23 cm3 in 2 minutes on a whole body MR scanner. We propose to establish a protocol using a 3dimensional technique for the study of muscle viability in the lower extremities of diabetic patients who suffer from complications resulting from polyneuropathy and localized ischemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SPINAL SOMESTHETIC PATHWAYS Principal Investigator & Institution: Vierck, Charles J.; Professor; Neuroscience; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 01-JUN-1979; Project End 31-MAY-2004 Summary: (adapted from applicant's abstract): The functional consequences of spinal cord injury are often characterized in terms of motor capacities (e.g. weight support, walking, grasping). However, a variety of reflex abnormalities (generally characterized as spasticity) and somatosensory disorders (either loss or exaggeration) can result from spinal cord injury (SCI). Exaggeration of reflexes and sensations can represent the most disturbing functional consequences of SCI. Important goals of this proposal are to determine which spinal lesions are responsible for production of hyperexcitable reflexes and aversive sensations. In addition, a novel method of permanently attenuating aversive sensations (dysesthesias) after injury to a peripheral nerve or the spinal cord will be evaluated. An important feature of the proposed studies is direct comparison of reflex and sensory consequences of peripheral and spinal lesions in rats using newly developed methods for evaluating learned (operant) responses to aversive stimuli, in addition to innate (reflex) responses that are commonly evaluated. The sensory effects of restricted spinal lesions and therapeutic intervention will be tested also in primates, providing important comparisons between rodent and primate models of dysesthesia, and offering crucial tests of the therapeutic potential of spinal application of a selective neurotoxin for neurons with receptors for substance P. The neurons targeted by the substance P toxin contribute importantly to the rostral conduction of disturbing somatosensations. Selective elimination of these cells in spinal segments affected by a peripheral or spinal lesion potentially has considerable advantages over traditional ablative procedures. Ablative lesions of spinal white matter can produce dysesthesias and therefore are used in part to model this sensory abnormality in the proposed studies. Rats and monkeys will be trained to terminate (escape) thermal stimulation of their feet and then will be tested following partial injury to a peripheral nerve or restricted interruption of spinal pathways that have been implicated in production of

Studies 15

dysesthesias. The animals will then receive an intraspinal application of substance Psaporin, the selective neurotoxin for neurons with receptors (NK-1R) for substance P. Subsequent testing will determine whether this procedure has normalized responses to thermal stimulation. The extent of surgical and neurotoxic spinal lesions will be related to effects on responses to thermal stimuli. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT MARINE/BOTANICAL OILS

OF

RHEUMATOID

ARTHRITIS-

Principal Investigator & Institution: Zurier, Robert B.; Professor; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-MAY-2007 Summary: (provided by applicant): The object of this proposal is to determine whether treatment of rheumatoid arthritis (RA) with a combination of fish oil and borage seed oil is superior to treatment with either oil alone. Fish oil is rich in the antiinflammatory n3 unsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and borage oil contains gammalinolenic acid (GLA), an n6 unsaturated fatty acid with antiinflammatory and immunomodulatory properties. Administration of borage oil and of fish oil both suppress the clinical manifestations of RA. Animal studies indicate that the mechanisms whereby fish oil suppresses inflammation are both similar to and different from the means by which GLA reduces inflammation and that the combination treatment is more effective than each treatment alone. This proposal is for a multicenter, two-year, phase 3, double-masked, placebo-controlled trial of 375 patients, which includes 4 treatment groups: 1) corn oil as a polyunsaturated fatty acid control; 2) fish oil; 3) borage oil; 4) fish oil plus borage oil. Radiographic analysis (Sharp Scores) of hands and feet will be done at baseline, 12, and 24 months. Biochemical and molecular mechanisms whereby the fatty acid treatments influence activation of monocytes (cytokine and oxygen radical generation), and T lymphocytes (proliferation, cytokine production, Th1/Th2 skewing, signaling events) will be investigated. Results of the cell activation (ex vivo) studies will be correlated with clinical outcomes. Results of these studies should raise awareness of the usefulness of naturally occurring oils in inflammatory diseases, lead to more rational use of fatty acids in treatment of inflammatory arthritis, and provide a greater understanding of the mechanisms of action of antiinflammatory fatty acids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VISUALIZING DIABETIC FEET TO OPTIMIZE ORTHOTIC FITTING Principal Investigator & Institution: Mueller, Michael J.; Associate Professor; Physical Therapy; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2003; Project Start 01-DEC-1998; Project End 30-NOV-2006 Summary: (provided by applicant): People with Diabetes Mellitus (DM) and peripheral neuropathy are at high risk for skin breakdown and subsequent lower extremity amputation due to unnoticed, repeated trauma (plantar pressures) to the plantar foot during walking. Current rehabilitation methods use subjective methods to fabricate therapeutic footwear m attempts to reduce plantar pressures and prevent skin breakdown, but ulcer recurrence is high (30-57%). The long term goal of this project is to reduce the incidence of skin breakdown and subsequent amputation by designing and fabricating orthotic devices based on structure, tissue mechanics, and external stresses of the diabetic foot. This proposal will capitalize on an efficient and complementary

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research design that uses the same patients and many of the same measures to conduct experimental testing in Aim 1 and to develop and validate three-dimensional computational modeling methods in Aim 2. The goal of Aim 1 is to determine the effect of a total contact insert (TCI), a metatarsal pad, and metatarsal pad placement on forefoot plantar pressures and soft tissue deformation. Combining in-shoe pressure testing with spiral x-ray computed tomography (SXCT) will indicate not only if the orthotic device is effective in reducing forefoot pressures, but also why the orthotic device is effective. The goal of Aim 2 is to develop and validate three-dimensional computational models for estimating the effects of diabetic foot orthoses on peak plantar pressure and tissue deformation. Structural data from SXCT scans, material properties (plantar soft tissue and orthotic device), and external plantar pressure data from people with DM and peripheral neuropathy will be combined to develop and validate the three-dimensional computational model and methods. The validated model will be used to predict optimal characteristics of the total contact insert and metatarsal pad (i.e. material properties, size, and placement). The predicted orthotic device will be tested against the traditional orthotic device described in Aim 1 in a new set of patients for its ability to distribute forefoot plantar pressures evenly. Experimental testing will help to keep computational models realistic and valid while three dimensional computational modeling will enhance the scientific basis of orthotic design and testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Moving ahead on webbed feet. by Masys DR.; 1995 Sep 1; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=116274

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Oh, Doctor! My feet! by [No authors listed]; 1939 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=233648

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Quantitative aerobic and anaerobic bacteriology of infected diabetic feet. by Sapico FL, Canawati HN, Witte JL, Montgomerie JZ, Wagner FW Jr, Bessman AN.; 1980 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=273599

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

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

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Systematic review of topical treatments for fungal infections of the skin and nails of the feet. by Hart R, Bell-Syer SE, Crawford F, Torgerson DJ, Young P, Russell I.; 1999 Jul 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28154

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with feet, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “feet” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for feet (hyperlinks lead to article summaries): •

“Fog (and infection) creeps in on little cat feet”. Author(s): Block PC. Source: Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2003 January; 58(1): 72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12508200&dopt=Abstract

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A 46-year-old man with numbness and shock-like sensations in hands, feet, and jaw. Author(s): Polston DW, Dyck PJ, Dyck PJ, Litchy WJ, Keegan BM. Source: Lancet. Neurology. 2004 January; 3(1): 63-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14693113&dopt=Abstract

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A dissection and computer tomograph study of tarsal coalitions in 100 cadaver feet. Author(s): Solomon LB, Ruhli FJ, Taylor J, Ferris L, Pope R, Henneberg M. Source: Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society. 2003 March; 21(2): 352-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12568969&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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A radiographic comparative study of two series of skeletally mature clubfeet treated by two different protocols. Author(s): Ippolito E, Fraracci L, Caterini R, Di Mario M, Farsetti P. Source: Skeletal Radiology. 2003 August; 32(8): 446-53. Epub 2003 May 03. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12730732&dopt=Abstract

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A systematic review of oral treatments for fungal infections of the skin of the feet. Author(s): Bell-Syer SE, Hart R, Crawford F, Torgerson DJ, Young P, Tyrrell W, Williams H, Russell I. Source: The Journal of Dermatological Treatment. 2001 June; 12(2): 69-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12243661&dopt=Abstract

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Adult-onset Still's disease with vesiculopustules on the hands and feet. Author(s): Lee JB, Kim JW, Lee SS, Kim SJ, Won YH, Lee SC. Source: Journal of Korean Medical Science. 2002 December; 17(6): 852-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483016&dopt=Abstract

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Arteriographic study of the arterial supply of the foot in one hundred cadaver feet. Author(s): Hamada N, Ikuta Y, Ikeda A. Source: Acta Anatomica. 1994; 151(3): 198-206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14758853&dopt=Abstract

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Ask the doctor. I am an 80-year-old woman who had a triple bypass many years ago. The veins of my legs have closed, and my feet and legs are swollen and painful. My doctor explained that the blood flows down the legs but does not flow back up. She also said that nothing can be done for it. Is this true? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2003 July; 13(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888483&dopt=Abstract

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Biomechanical differences among pes cavus, neutrally aligned, and pes planus feet in subjects with diabetes. Author(s): Ledoux WR, Shofer JB, Ahroni JH, Smith DG, Sangeorzan BJ, Boyko EJ. Source: Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2003 November; 24(11): 845-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14655889&dopt=Abstract

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Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Author(s): McQueen FM, Benton N, Perry D, Crabbe J, Robinson E, Yeoman S, McLean L, Stewart N. Source: Arthritis and Rheumatism. 2003 July; 48(7): 1814-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847674&dopt=Abstract

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Burn scar contractures of the feet: efficacy of bilateral simultaneous surgical correction. Author(s): Dhanraj P, Owiesy F, Phillips LG, McCauley RL. Source: Burns : Journal of the International Society for Burn Injuries. 2002 December; 28(8): 814-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12464485&dopt=Abstract

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By the way, doctor. I have diabetes and two years ago I started to have pain in my feet with numbness and tingling. My doctors say that the problem is damage to my nerves related to the diabetes. Any ideas? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2003 January; 28(3): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543609&dopt=Abstract

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Changes in weight distribution at the feet due to occlusal supporting zone loss during clenching. Author(s): Yoshino G, Higashi K, Nakamura T. Source: Cranio. 2003 October; 21(4): 271-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14620700&dopt=Abstract

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Chondrosarcoma of the bones of the feet. Author(s): Patil S, de Silva MV, Crossan J, Reid R. Source: The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2003 September-October; 42(5): 290-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14566721&dopt=Abstract

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Diagnostic value of radiographs of the hands and feet in early rheumatoid arthritis. Author(s): Devauchelle-Pensec V, Saraux A, Alapetite S, Colin D, Le Goff P. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 October; 69(5): 434-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477226&dopt=Abstract

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Diaphyseal nutrient foramina in the first metatarsals in normal and hallux valgus feet: location and surgical implications. Author(s): Monreal-Redondo D, Fernandez-Camacho FJ. Source: Surgical and Radiologic Anatomy : Sra. 2003 July-August; 25(3-4): 234-40. Epub 2003 May 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750846&dopt=Abstract

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Dynamic force distribution during level walking under the feet of patients with chronic ankle instability. Author(s): Nyska M, Shabat S, Simkin A, Neeb M, Matan Y, Mann G. Source: British Journal of Sports Medicine. 2003 December; 37(6): 495-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14665586&dopt=Abstract

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Effects of hyperoxia on thermoregulatory responses during feet immersion to hot water in humans. Author(s): Yamashita K, Tochihara Y. Source: Journal of Physiological Anthropology and Applied Human Science. 2003 July; 22(4): 181-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939533&dopt=Abstract

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Elevation of the nasal mucosal surface temperature after warming of the feet occurs via a neural reflex. Author(s): Assanasen P, Baroody FM, Haney L, deTineo M, Naureckas E, Solway J, Naclerio RM. Source: Acta Oto-Laryngologica. 2003 June; 123(5): 627-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875586&dopt=Abstract

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Excision arthroplasty: an effective method in the management of plantar ulcers with metatarsophalangeal joint infection in anaesthetic feet. Author(s): Oommen AT, Mannam E, Partheebarajan S, Samuel S. Source: Lepr Rev. 2003 March; 74(1): 63-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12669934&dopt=Abstract

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Fetal activity following stimulation of the mother's abdomen, feet, and hands. Author(s): Diego MA, Dieter JN, Field T, Lecanuet JP, Hernandez-Reif M, Beutler J, Largie S, Redzepi M, Salman FA. Source: Developmental Psychobiology. 2002 December; 41(4): 396-406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430163&dopt=Abstract

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Fibular shortening in clubfeet. Author(s): Napiontek M. Source: Journal of Pediatric Orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America. 2003 January; 12(1): 56-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488773&dopt=Abstract

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Gangrene of the feet in Churg-Strauss syndrome. Author(s): Naschitz JE, Loberman Z, Wolffson V, Babich JP, Yeshurun D. Source: Vascular Medicine (London, England). 2003 May; 8(2): 129-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14518616&dopt=Abstract

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Giant cell reparative granuloma of the hand: case report and review of giant cell lesions of hands and feet. Author(s): MacDonald DF, Binhammer PA, Rubenstein JD, Fornasier VL. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 2003 December; 46(6): 471-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14680358&dopt=Abstract

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Growth rates in skeletally immature feet after triple arthrodesis. Author(s): Kuhns CA, Zeegen EN, Kono M, Green T, Moseley CF, Otsuka NY. Source: Journal of Pediatric Orthopedics. 2003 July-August; 23(4): 488-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826948&dopt=Abstract

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Heat-mediated changes to the hands and feet mimicking washerwoman's skin. Author(s): Bohnert M, Pollak S. Source: International Journal of Legal Medicine. 2003 April; 117(2): 102-5. Epub 2003 January 18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690507&dopt=Abstract

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Incidence and management of ulcers in diabetic Charcot feet. Author(s): Larsen K, Fabrin J, Holstein PE. Source: J Wound Care. 2001 September; 10(8): 323-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12964335&dopt=Abstract

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Isolated flexor muscles of the little toe in the feet of an individual with atrophied or lacking 4th head of the M. extensor digitorum brevis and lacking the 4th tendon of the M. extensor digitorum longus. Author(s): Claassen H, Wree A. Source: Ann Anat. 2003 January; 185(1): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597131&dopt=Abstract

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Keeping dancers on their feet. Author(s): Palmer K. Source: Minn Med. 2003 February; 86(2): 33. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611107&dopt=Abstract

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Lower extremity function in terms of shock absorption when landing with unsynchronized feet. Author(s): Maeda A, Shima N, Nishizono H, Kurata H, Higuchi S, Motohashi Y. Source: Journal of Physiological Anthropology and Applied Human Science. 2003 November; 22(6): 279-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14646262&dopt=Abstract

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Macrodystrophia lipomatosa of the feet and subcutaneous lipomas. Author(s): Aydos SE, Fitoz S, Bokesoy I. Source: American Journal of Medical Genetics. 2003 May 15; 119A(1): 63-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707961&dopt=Abstract

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Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. Author(s): Boutry N, Larde A, Lapegue F, Solau-Gervais E, Flipo RM, Cotten A. Source: The Journal of Rheumatology. 2003 April; 30(4): 671-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672183&dopt=Abstract

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Marching in the army: common cutaneous disorders of the feet. Author(s): Oumeish OY, Parish LC. Source: Clinics in Dermatology. 2002 July-August; 20(4): 445-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208634&dopt=Abstract

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MR imaging of neuropathic feet in leprosy patients with suspected osteomyelitis. Author(s): Maas M, Slim EJ, Heoksma AF, van der Kleij AJ, Akkerman EM, den Heeten GJ, Faber WR. Source: International Journal of Leprosy and Other Mycobacterial Diseases : Official Organ of the International Leprosy Association. 2002 June; 70(2): 97-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211902&dopt=Abstract

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Neuropathic pain and dysesthesia of the feet after Himalayan expeditions. Author(s): Ricart de Mesones A, Turon Sans J, Misiego M, Onaga Pueyo H, Real Soriano R, Botella de Maglia J. Source: High Altitude Medicine & Biology. 2002 Winter; 3(4): 395-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12631425&dopt=Abstract

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One pair must last a lifetime. Misshaped feet. Author(s): Phillips P, Evans AM. Source: Aust Fam Physician. 2002 July; 31(7): 645-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12143326&dopt=Abstract

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Painful lesions on the arches of the feet. A pustular, pruritic eruption can be difficult to diagnose and problematic to treat. Author(s): Levine N. Source: Geriatrics. 2002 July; 57(7): 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134460&dopt=Abstract

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Pits on the heels of the feet. Foot odor and slimy feel to the skin of the feet provide clues to diagnosis. Author(s): Levine N. Source: Geriatrics. 2002 November; 57(11): 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442565&dopt=Abstract

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Practical management of neuropathic feet. Author(s): Warren G. Source: Trop Doct. 2002 October; 32(4): 201-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405297&dopt=Abstract

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Pressure distribution patterns under the feet of new walkers: the first two months of independent walking. Author(s): Hallemans A, D'Aout K, De Clercq D, Aerts P. Source: Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2003 May; 24(5): 444-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801204&dopt=Abstract

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Psychiatry in pictures. Photograph of anonymous patient's feet taken May 1998 near Mozambique-Zimbabwe border. Author(s): de Monchy R. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 November; 183: A18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14650377&dopt=Abstract

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Reconstruction of through-and-through gunshot wounds to the feet with free gracilis muscle flaps. Author(s): Pu LL, Medalie DA, Lawrence SJ, Vasconez HC. Source: Annals of Plastic Surgery. 2003 March; 50(3): 286-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800906&dopt=Abstract

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Recurrent nodules on the feet of a child. Author(s): Rotunda A, Schappell D, Robinson-Bostom L. Source: Archives of Dermatology. 2002 September; 138(9): 1245-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12224995&dopt=Abstract

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Self-care secrets. Focus on feet. Here's why people with diabetes should be obsessed with their feet. Author(s): James-Enger K. Source: Diabetes Forecast. 2003 February; 56(2): 77-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14765427&dopt=Abstract

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Soles of the Feet: a mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness. Author(s): Singh NN, Wahler RG, Adkins AD, Myers RE; Mindfulness Research Group. Source: Research in Developmental Disabilities. 2003 May-June; 24(3): 158-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742385&dopt=Abstract

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Spinal neurenteric cyst presenting as burning feet syndrome. Author(s): Jain RS. Source: J Assoc Physicians India. 2003 September; 51: 921-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14710986&dopt=Abstract

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Tackling a new opponent. NFL star tells those with diabetes to “check your feet”. Author(s): Bunch AS. Source: Healthplan. 2003 May-June; 44(3): 51-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12808759&dopt=Abstract

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Tenosynovial (extraarticular) chondromatosis: an analysis of 37 cases of an underrecognized clinicopathologic entity with a strong predilection for the hands and feet and a high local recurrence rate. Author(s): Fetsch JF, Vinh TN, Remotti F, Walker EA, Murphey MD, Sweet DE. Source: The American Journal of Surgical Pathology. 2003 September; 27(9): 1260-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960811&dopt=Abstract

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The fitting of amputated and nonamputated diabetic feet. A French experience at the Villiers-Saint-Denis Hospital. Author(s): Dupre JC, Dechamps E, Pillu M, Despeyroux L. Source: Journal of the American Podiatric Medical Association. 2003 May-June; 93(3): 221-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756313&dopt=Abstract

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The influence of shoe design on plantar pressures in neuropathic feet. Author(s): Praet SF, Louwerens JW. Source: Diabetes Care. 2003 February; 26(2): 441-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547877&dopt=Abstract

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The pattern of skeletal anomalies in the cervical spine, hands and feet in patients with Saethre-Chotzen syndrome and Muenke-type mutation. Author(s): Trusen A, Beissert M, Collmann H, Darge K. Source: Pediatric Radiology. 2003 March; 33(3): 168-72. Epub 2002 November 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612814&dopt=Abstract

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Trash feet after coronary angiography. Author(s): Khan AM, Jacobs S. Source: Heart (British Cardiac Society). 2003 May; 89(5): E17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695482&dopt=Abstract

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Treatment of the hands and feet in Apert syndrome: an evolution in management. Author(s): Fearon JA. Source: Plastic and Reconstructive Surgery. 2003 July; 112(1): 1-12; Discussion 13-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832871&dopt=Abstract

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Tungiasis presenting with whitish nodules on the feet. Author(s): Marrero MD, Nagore E, Igual-Adell R, Rodriguez-Calabuig D, Castejon P. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2003 March; 17(2): 247-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705775&dopt=Abstract

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Ultrasonographic evaluation of plantar fascia bands. A retrospective study of 211 symptomatic feet. Author(s): Vohra PK, Kincaid BR, Japour CJ, Sobel E. Source: Journal of the American Podiatric Medical Association. 2002 September; 92(8): 444-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12237265&dopt=Abstract

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Verrucous skin lesions on the feet in neuropathy. Author(s): Ichimiya M, Hamamoto Y, Muto M. Source: The Journal of Dermatology. 2003 March; 30(3): 263-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12692372&dopt=Abstract

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Academic Periodicals covering Feet Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to feet. 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, 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.”

Dissertations on Feet ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to feet. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “feet” (or a synonym) in their titles. The following covers recent dissertations found when using this search procedure: •

The Effectiveness of Selected Educational Media in Disseminating Knowledge of the Care and Prevention of Injuries to Insensitive Feet to Diabetics of Different Educational Levels by Klesius, Stephen Edward, PhD from The Louisiana State University and Agricultural and Mechanical Col., 1968, 125 pages http://wwwlib.umi.com/dissertations/fullcit/6904480

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CHAPTER 2. NUTRITION AND FEET Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and feet.

Finding Nutrition Studies on Feet The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. Once you have entered 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 “feet” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

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

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

These feet were made for walking. Source: Schardt, D. Nutrition-action-health-letter (USA). (December 1993). volume 20(10) page 1, 5-7.

Additional physician-oriented references include: •

Accurate localization of organ representation areas on the feet & hands using the bidigital O-ring test resonance phenomenon: its clinical implication in diagnosis & treatment--Part I. Author(s): Heart Disease Research Foundation, New York. Source: Omura, Y Acupunct-Electrother-Res. 1994 Jun-September; 19(2-3): 153-90 03601293

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Best feet foremost. Source: Adamson, S Health-Visit. 1994 February; 67(2): 61 0017-9140

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Effect of biotin supplementation of a barley-wheat diet on restoration of healthy feet, legs and skin of biotin deficient sows. Source: Misir, R. Blair, R. Res-Vet-Sci. London : British Veterinary Association. March 1986. volume 40 (2) page 212-218. 0034-5288

•

In vivo effects of Aloe arborescens Miller var. natalensis Berger (Kidachi aloe) on experimental tinea pedis in guinea-pig feet. Source: Kawai, K. Beppu, H. Shimpo, K. Chihara, T. Yamamoto, N. Nagatsu, T. Ueda, H. Yamada, Y. PTR,-Phytother-res. Sussex : John Wiley & Sons Ltd. May 1998. volume 12 (3) page 178-182. 0951-418X

•

On call. I am a 49-year-old man with diabetes. I take Glucophage and I'm careful with my diet. I also walk three miles almost every day. My blood sugar is always below 150, usually in the 130s. My problem is tingling in my fingers and pain in my feet, which often keeps me up at night. Is there anything I can do? Source: Simon, H B Harv-Mens-Health-Watch. 2000 January; 4(6): 8 1089-1102

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Scanning electron microscope observations of hoof horn from horses with brittle feet. Source: Kempson, S A Vet-Rec. 1987 June 13; 120(24): 568-70 0042-4900

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Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons. Author(s): US Air Force Academy Cadet Physical Therapy Clinic, US Air Force Academy, CO 80840, USA. [email protected] Source: Rogers, J S Witt, P L Gross, M T Hacke, J D Genova, P A Phys-Ther. 1998 Nov; 78(11): 1175-85 0031-9023

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Thermal burns in diabetic feet. Author(s): Department of Orthopaedic Surgery, Changi General Hospital, Singapore. Source: Thng, P Lim, R M Low, B Y Singapore-Med-J. 1999 May; 40(5): 362-4 0037-5675

Nutrition 29

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

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

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The following is a specific Web list relating to feet; 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: •

Vitamins Niacin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892,00.html Thiamine Source: Integrative Medicine Communications; www.drkoop.com Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html Vitamin B1 (Thiamine) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B12 (Cobalamin) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com

•

Minerals Stinging Nettle Alternative names: Urtica dioica, Urtica urens, Nettle Source: Integrative Medicine Communications; www.drkoop.com

•

Food and Diet Athlete’s Foot Source: Healthnotes, Inc.; www.healthnotes.com Bananas Source: Healthnotes, Inc.; www.healthnotes.com Brazil Nuts Source: Healthnotes, Inc.; www.healthnotes.com Burdock Alternative names: Arctium lappa, Arctium minus, Arctium tomentosum Source: Integrative Medicine Communications; www.drkoop.com

Nutrition 31

Burdock Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,235,00.html Clams Source: Healthnotes, Inc.; www.healthnotes.com Coffee Source: Healthnotes, Inc.; www.healthnotes.com Crabs Source: Healthnotes, Inc.; www.healthnotes.com Cucumbers Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,18,00.html Garlic Alternative names: Allium sativum Source: Integrative Medicine Communications; www.drkoop.com Limes Source: Healthnotes, Inc.; www.healthnotes.com Mango Source: Healthnotes, Inc.; www.healthnotes.com Papaya Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,60,00.html Squid Source: Healthnotes, Inc.; www.healthnotes.com Turkey Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,92,00.html Variety Meats Source: Healthnotes, Inc.; www.healthnotes.com Zucchini Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND FEET Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to feet. 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 feet 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 “feet” (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 feet: •

“Don't bump my bed, don't touch my feet!” Author(s): Caswell LJ, Eland JM. Source: Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses. 1989 October; 6(4): 111-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2574981&dopt=Abstract

•

A case of feet. Author(s): Wilson A. Source: Aust Coll Midwives Inc J. 1995 March; 8(1): 17-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7619012&dopt=Abstract

•

Accurate localization of organ representation areas on the feet & hands using the bidigital O-ring test resonance phenomenon: its clinical implication in diagnosis & treatment--Part I. Author(s): Omura Y.

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Source: Acupuncture & Electro-Therapeutics Research. 1994 June-September; 19(2-3): 153-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7863839&dopt=Abstract •

Adhesion of dermatophytes to healthy feet and its simple treatment. Author(s): Watanabe K, Taniguchi H, Katoh T. Source: Mycoses. 2000; 43(1-2): 45-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10838846&dopt=Abstract

•

Blistered feet. Author(s): Scgatzki SC. Source: Ajr. American Journal of Roentgenology. 1993 January; 160(1): 32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8416640&dopt=Abstract

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Bringing the feet in from the cold: thermal biofeedback training of foot-warming in Raynaud's syndrome. Author(s): Crockett D, Bilsker D. Source: Biofeedback Self Regul. 1984 December; 9(4): 431-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6537257&dopt=Abstract

•

Effect of biotin supplementation of a barley-wheat diet on restoration of healthy feet, legs and skin of biotin deficient sows. Author(s): Misir R, Blair R. Source: Research in Veterinary Science. 1986 March; 40(2): 212-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3704339&dopt=Abstract

•

Effects of acupuncture on skin temperature in children with neurological disorders and cold feet. Author(s): Svedberg L, Nordahl G, Lundeberg T. Source: Developmental Medicine and Child Neurology. 2001 May; 43(5): 358-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368492&dopt=Abstract

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Effects of acupuncture on skin temperature in children with neurological disorders and cold feet: an exploratory study. Author(s): Svedberg LE, Nordahl UE, Lundeberg TC. Source: Complementary Therapies in Medicine. 2001 June; 9(2): 89-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11444888&dopt=Abstract

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Fetal activity following stimulation of the mother's abdomen, feet, and hands. Author(s): Diego MA, Dieter JN, Field T, Lecanuet JP, Hernandez-Reif M, Beutler J, Largie S, Redzepi M, Salman FA.

Alternative Medicine 35

Source: Developmental Psychobiology. 2002 December; 41(4): 396-406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430163&dopt=Abstract •

Homeopathy treats people, not the soles of their feet. Author(s): Gerring D. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1992 November 15; 147(10): 1407; Author Reply 1408-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1423066&dopt=Abstract

•

Homeopathy treats people, not the soles of their feet. Author(s): Jacobs J. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1992 November 15; 147(10): 1407-8; Author Reply 1408-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1308761&dopt=Abstract

•

Limited joint mobility in the hands and feet of adolescents with Type 1 diabetes mellitus. Author(s): Duffin AC, Donaghue KC, Potter M, McInnes A, Chan AK, King J, Howard NJ, Silink M. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1999 February; 16(2): 125-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10229305&dopt=Abstract

•

Nursing innovation for dry skin care of the feet in the elderly: a demonstration project. Author(s): Brown MM, Boosinger J, Black J, Gaspar T, Sather L. Source: Journal of Gerontological Nursing. 1982 July; 8(7): 393-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6919564&dopt=Abstract

•

The in vivo interaction between vincristine and radiation in a C3H mammary carcinoma and the feet of CDF1 mice. Author(s): Grau C, Hoyer M, Overgaard J. Source: International Journal of Radiation Oncology, Biology, Physics. 1994 December 1; 30(5): 1141-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7961023&dopt=Abstract

•

The scope and limitations of treatment. An interview with Ann Lett, Principle, British School--Reflex Zone Therapy of the Feet. Author(s): Lett A. Source: Complementary Therapies in Nursing & Midwifery. 2001 August; 7(3): 146-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11855511&dopt=Abstract

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•

Thermal burns in diabetic feet. Author(s): Thng P, Lim RM, Low BY. Source: Singapore Med J. 1999 May; 40(5): 362-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10489498&dopt=Abstract

•

'Thermal reflex therapy' a danger for diabetic feet. Author(s): Yeap JS, Anbanandan S, Yeap JK, Borhan Tan M, Harwant S. Source: Med J Malaysia. 2001 March; 56(1): 102-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11503287&dopt=Abstract

•

Washing Irene's feet. Author(s): Langenbach J, Hall E. Source: J Christ Nurs. 1994 Spring; 11(2): 12-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8145117&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/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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The following is a specific Web list relating to feet; 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 Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Angioedema Source: Integrative Medicine Communications; www.drkoop.com Anorexia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Athlete's Foot Source: Healthnotes, Inc.; www.healthnotes.com Attention Deficit Hyperactivity Disorder Source: Integrative Medicine Communications; www.drkoop.com Bone Marrow Disorders Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Carpal Tunnel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com Chronic Myelogenous Leukemia Source: Integrative Medicine Communications; www.drkoop.com Chronic Venous Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Edema Source: Healthnotes, Inc.; www.healthnotes.com Edema Source: Integrative Medicine Communications; www.drkoop.com

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Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Erythema Source: Integrative Medicine Communications; www.drkoop.com Frostbite Source: Integrative Medicine Communications; www.drkoop.com Gout Source: Integrative Medicine Communications; www.drkoop.com Hives Source: Healthnotes, Inc.; www.healthnotes.com Hyperthyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypoparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypothermia Source: Integrative Medicine Communications; www.drkoop.com Hypothyroidism Source: Integrative Medicine Communications; www.drkoop.com Intermittent Claudication Alternative names: Peripheral Vascular Disease Source: Prima Communications, Inc.www.personalhealthzone.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Migraine Headache Source: Integrative Medicine Communications; www.drkoop.com Myelofibrosis Source: Integrative Medicine Communications; www.drkoop.com Myeloproliferative Disorders Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Integrative Medicine Communications; www.drkoop.com Peripheral Vascular Disease Source: Healthnotes, Inc.; www.healthnotes.com Pertussis Source: Integrative Medicine Communications; www.drkoop.com

Alternative Medicine 39

Polycythemia Vera Source: Integrative Medicine Communications; www.drkoop.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com Reiter's Syndrome Source: Integrative Medicine Communications; www.drkoop.com Rheumatoid Arthritis Source: Healthnotes, Inc.; www.healthnotes.com Rheumatoid Arthritis Source: Integrative Medicine Communications; www.drkoop.com Roseola Source: Integrative Medicine Communications; www.drkoop.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com Serum Sickness Source: Integrative Medicine Communications; www.drkoop.com Shock Source: Integrative Medicine Communications; www.drkoop.com Sickle Cell Anemia Source: Healthnotes, Inc.; www.healthnotes.com Tension Headache Source: Healthnotes, Inc.; www.healthnotes.com Tension Headache Source: Integrative Medicine Communications; www.drkoop.com Thrombocytosis Source: Integrative Medicine Communications; www.drkoop.com Varicose Veins Source: Integrative Medicine Communications; www.drkoop.com Vitamin B12 Deficiency Source: Healthnotes, Inc.; www.healthnotes.com Warts Source: Healthnotes, Inc.; www.healthnotes.com Water Retention Source: Integrative Medicine Communications; www.drkoop.com

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Whooping Cough Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Acupressure Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,662,00.html Aston-Patterning Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10118,00.html Barefoot Shiatsu Massage Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Body Reflexology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Chakra Energy Massage Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Didgeridoo Vibrational Healing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/d.html Foot Analysis Alternative names: Grinberg Method Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/f.html Foot Reflexology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/f.html Homuncular Acupuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html

Alternative Medicine 41

Laura Norman Method Alternative names: Laura Norman Method of Reflexology Laura Norman Reflexology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/l.html Macrobiotics Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,714,00.html Massage Source: Integrative Medicine Communications; www.drkoop.com Massage Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,716,00.html Metamorphic Technique Alternative names: metamorphosis; originally called "prenatal therapy" Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Metamorphosis Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Mind & Body Medicine Source: Integrative Medicine Communications; www.drkoop.com Original Ingham Method Alternative names: Ingham method Ingham method of foot reflexology Ingham technique Original Ingham Method of Reflexology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/o.html Polarity Reflexology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Polarity Therapy Alternative names: Polarity polarity balancing Polarity Energy Balancing Polarity Energy Balancing system polarity energy healing polarity healing polarity system Polarity techniques Polarity Wellness Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D.

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Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Reflex Zone Therapy of the Feet Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html Reflexology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730,00.html Reiki Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,731,00.html Relaxation Techniques Source: Integrative Medicine Communications; www.drkoop.com Serenity Facial Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html Tai Chi Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,737,00.html Therapeutic Touch Source: Integrative Medicine Communications; www.drkoop.com Zone Therapy Alternative names: Reflex Zone Therapy reflex zone massage Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/z.html

Alternative Medicine 43

•

Chinese Medicine Dahuang Zhechong Wan Alternative names: Dahuang Zhechong Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Dongchongxiacao Alternative names: Chinese Caterpillar Fungus; Cordyceps Source: Chinese Materia Medica Huanglian Alternative names: Golden Thread; Rhizoma Coptidis Source: Chinese Materia Medica

•

Herbs and Supplements Acanthopanax Senticosus Source: Integrative Medicine Communications; www.drkoop.com Allium Sativum Source: Integrative Medicine Communications; www.drkoop.com Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Althaea Officinalis Source: Integrative Medicine Communications; www.drkoop.com Apium Graveolens Source: Integrative Medicine Communications; www.drkoop.com Arctium Lappa Source: Integrative Medicine Communications; www.drkoop.com Arctium Minus Source: Integrative Medicine Communications; www.drkoop.com Arnica Alternative names: Arnica montana Source: Integrative Medicine Communications; www.drkoop.com Arnica Montana Source: Integrative Medicine Communications; www.drkoop.com Australian Fevertree Source: Integrative Medicine Communications; www.drkoop.com

44

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Barberry Alternative names: Berberis vulgaris, Berberry Source: Integrative Medicine Communications; www.drkoop.com Berberis Vulgaris Source: Integrative Medicine Communications; www.drkoop.com Berberry Source: Integrative Medicine Communications; www.drkoop.com Beta-carotene Source: Prima Communications, Inc.www.personalhealthzone.com Beta-carotene Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10103,00.html Betaine Alternative names: Trimethylglycine Source: Integrative Medicine Communications; www.drkoop.com Bloodroot Source: Prima Communications, Inc.www.personalhealthzone.com Carotenoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,763,00.html Cat's Claw Alternative names: Uncaria tomentosa Source: Integrative Medicine Communications; www.drkoop.com Cayenne Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Celery Seed Alternative names: Apium graveolens Source: Integrative Medicine Communications; www.drkoop.com Cobalamin Source: Integrative Medicine Communications; www.drkoop.com Crataegus Laevigata Source: Integrative Medicine Communications; www.drkoop.com Crataegus Monogyna Source: Integrative Medicine Communications; www.drkoop.com

Alternative Medicine 45

Didanosine Source: Healthnotes, Inc.; www.healthnotes.com Docetaxel Source: Healthnotes, Inc.; www.healthnotes.com Eleuthero Source: Integrative Medicine Communications; www.drkoop.com Eleutherococcus Senticosus Source: Integrative Medicine Communications; www.drkoop.com Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.drkoop.com Ephedra sinensis Source: Integrative Medicine Communications; www.drkoop.com Eucalyptus Alternative names: Eucalyptus globulus, Eucalyptus fructicetorum, polybractea, smithii, Australian Fevertree Source: Integrative Medicine Communications; www.drkoop.com Eucalyptus globulus Source: Integrative Medicine Communications; www.drkoop.com German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Ginger Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787,00.html Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com Ginkgo Biloba Source: Integrative Medicine Communications; www.drkoop.com Ginkgo Biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788,00.html GLA (Gamma-Linolenic Acid) Source: Prima Communications, Inc.www.personalhealthzone.com Glycyrrhiza glabra Source: Integrative Medicine Communications; www.drkoop.com

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Goldenrod Alternative names: Solidago virgaurea Source: Integrative Medicine Communications; www.drkoop.com Hawthorn Alternative names: Crataegus monogyna, Crataegus laevigata Source: Integrative Medicine Communications; www.drkoop.com Indian Tobacco Source: Integrative Medicine Communications; www.drkoop.com Isoniazid Alternative names: Laniazid, Nydrazid Source: Prima Communications, Inc.www.personalhealthzone.com Kelp Source: Healthnotes, Inc.; www.healthnotes.com Kudzu Source: Prima Communications, Inc.www.personalhealthzone.com Lapacho Source: Integrative Medicine Communications; www.drkoop.com Lemon Balm Alternative names: Melissa officinalis, Melissa Source: Integrative Medicine Communications; www.drkoop.com Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Limetree Source: Integrative Medicine Communications; www.drkoop.com Linden Alternative names: Tilia cordata, Tilia platyphyllos, Limetree Source: Integrative Medicine Communications; www.drkoop.com Lipoic Acid Source: Prima Communications, Inc.www.personalhealthzone.com Lobelia Alternative names: Lobelia inflata, Indian Tobacco Source: Integrative Medicine Communications; www.drkoop.com Lobelia Inflata Source: Integrative Medicine Communications; www.drkoop.com Ma huang Source: Integrative Medicine Communications; www.drkoop.com

Alternative Medicine 47

Mad-Dog Skullcap Source: Integrative Medicine Communications; www.drkoop.com Maidenhair Tree Source: Integrative Medicine Communications; www.drkoop.com Marshmallow Alternative names: Althaea officinalis Source: Integrative Medicine Communications; www.drkoop.com Matricaria Recutita Source: Integrative Medicine Communications; www.drkoop.com Melissa Source: Integrative Medicine Communications; www.drkoop.com Melissa Officinalis Source: Integrative Medicine Communications; www.drkoop.com Mentha X Piperita Source: Integrative Medicine Communications; www.drkoop.com Milk Thistle Alternative names: Silybum marianum, St. Mary's Thistle Source: Integrative Medicine Communications; www.drkoop.com Mullein Source: Prima Communications, Inc.www.personalhealthzone.com Nettle Source: Integrative Medicine Communications; www.drkoop.com Pau d'Arco Alternative names: Tabebuia avellanedae, Lapacho Source: Integrative Medicine Communications; www.drkoop.com Peppermint Alternative names: Mentha x piperita Source: Integrative Medicine Communications; www.drkoop.com Red Elm Source: Integrative Medicine Communications; www.drkoop.com Sabal Serrulata Source: Integrative Medicine Communications; www.drkoop.com Saw Palmetto Alternative names: Serenoa repens, Sabal serrulata Source: Integrative Medicine Communications; www.drkoop.com

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Saw Palmetto Source: Prima Communications, Inc.www.personalhealthzone.com Scutellaria Lateriflora Source: Integrative Medicine Communications; www.drkoop.com Serenoa Repens Source: Integrative Medicine Communications; www.drkoop.com Siberian Ginseng Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus, Eleuthero Source: Integrative Medicine Communications; www.drkoop.com Silybum Marianum Source: Integrative Medicine Communications; www.drkoop.com Skullcap Alternative names: Scutellaria lateriflora, Mad-dog Skullcap Source: Integrative Medicine Communications; www.drkoop.com Slippery Elm Alternative names: Ulmus fulva, Red Elm, Sweet Elm Source: Integrative Medicine Communications; www.drkoop.com Solidago Virgaurea Source: Integrative Medicine Communications; www.drkoop.com Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Spirulina and Kelp Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10058,00.html St. Mary's Thistle Source: Integrative Medicine Communications; www.drkoop.com Sweet Elm Source: Integrative Medicine Communications; www.drkoop.com Tabebuia Avellanedae Source: Integrative Medicine Communications; www.drkoop.com Tanacetum Alternative names: Feverfew; Tanacetum parthenium (L.) Schultz-Bip. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tanacetum V Alternative names: Tansy; Tanacetum vulgare (L.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

Alternative Medicine 49

Tea Tree Source: Prima Communications, Inc.www.personalhealthzone.com Tilia Cordata Source: Integrative Medicine Communications; www.drkoop.com Tilia Platyphyllos Source: Integrative Medicine Communications; www.drkoop.com Trimethylglycine Source: Integrative Medicine Communications; www.drkoop.com Ulmus Fulva Source: Integrative Medicine Communications; www.drkoop.com Uncaria Tomentosa Source: Integrative Medicine Communications; www.drkoop.com Urtica Dioica Source: Integrative Medicine Communications; www.drkoop.com Urtica Urens Source: Integrative Medicine Communications; www.drkoop.com Valerian Alternative names: Valeriana officinalis Source: Healthnotes, Inc.; www.healthnotes.com Walnut Leaf Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10110,00.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.

51

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

Patents on Feet By performing a patent search focusing on feet, 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

8Adapted

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

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tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on feet: •

Exerciser Inventor(s): Chen; Ping (No. 29, Nanmei St., Nantun Li, Nantun Dist., Taichung, TW) Assignee(s): None Reported Patent Number: 6,692,419 Date filed: January 24, 2002 Abstract: An exerciser has a base and a rocking plate. The rocking plate is rotatably attached to the base with a ball joint. Consequently, a user can swing or twist body, rotate ankles and develop feet muscles when the user steps on the rocking plate to keep balance. The exerciser can exercise the lower part of the body of a user. This exerciser is more versatile than the prior art. Excerpt(s): The present invention relates to an exerciser, and more particularly to an exerciser that can swing or twist the user's body, rotate the ankles and develop the feet muscles. Although indoor exercisers have become popular in recent years, the conventional indoor exerciser only has one function. For example, a rotating exerciser that can twist the user's waist substantially comprises a bottom plate, a top plate and a series of rollers. The top plate is mounted above the bottom plate. The rollers are rotatably mounted between the bottom plate and the top plate. A user can step on the top plate and rotate the top plate relative to the bottom plate. Consequently, the waist of the user can be twisted, and the abdominal muscles of the user are trained. However, the conventional rotating exerciser only has one function as in the other indoor exercisers, and thus the conventional exerciser is not versatile. Web site: http://www.delphion.com/details?pn=US06692419__

•

Road luge Inventor(s): Smith, III; Charles T. (P.O. Box 1444, Rogue River, OR 97537) Assignee(s): None Reported Patent Number: 6,685,201 Date filed: March 23, 1998 Abstract: A road luge includes an elongated frame having a front end and a back end, a strut extending rearwardly and upwardly from the back end of the frame, a back axle supported on the strut and fixed in orientation relative to the frame, and a single back wheel rotationally mounted on the back axle along the centerline axis of elongation of the frame. The road luge has a front assembly attached to the frame at a location adjacent to the front end of the frame. The front assembly includes two rotationally mounted and steerable front wheels, with one front on either side of the frame. The road luge has a reclining body rest supported on the frame, so that a rider may recline on the body rest with the rider's torso in a substantially horizontal position, and with the rider's feet extending toward the front end of the frame, and the rider's head angled upwardly so as to permit vision toward the front end of the frame. Excerpt(s): This invention relates to a wheeled, one-person vehicle, and, more particularly, to a road luge. A snow luge is a one-person, unpowered sled having a

Patents 53

light-weight frame and snow runners. The snow luge is designed so that the rider reclines on the frame of the snow luge with the feet extending forwardly. The snow luge is typically used in timed race events run down an icy, trough-type track with banked sides. Snow luges have long been popular in winter sports. To extend the training period and enjoyment of the snow luge to the summer months and to those areas which get little snow, the road luge was developed. In its most basic form, the road luge replaces the snow runners of the snow luge with wheels, so that the road luge may operate by rolling downhill on pavement. In the most commonly used road luge, a pair of wheels is supported on pivoting axles at each of the front and back ends of an elongated frame, upon which the rider reclines. Web site: http://www.delphion.com/details?pn=US06685201__ •

System and method of using a plurality of sensors for determining an individual's level of productivity Inventor(s): Kanevsky; Dimitri (Ossining, NY), Zadrozny; Wlodek W. (Tarrytown, NY) Assignee(s): Ibm Corporation (armonk, Ny) Patent Number: 6,675,130 Date filed: December 21, 2000 Abstract: A system is provided having a plurality of sensors for affixing to a person's torso, hands, feet, head, etc. The function of each sensor is to determine the distance between itself and the other sensors to ascertain the distance between the hands and feet, for instance, in order to measure the relative activity of a person's hands and feet. Other sensors, placed on the individual or in the individual's environment, may obtain biological data relating to the person, such as heart pulse, blood pressure, or data relating to the individual's attention level, i.e., gaze data. The system further includes a processor having a memory for storing data collected from the sensors. The data collected by the sensors and stored in the memory provide at least information about different types of movements associated with a particular set of tasks. The processor is programmed with a set of instructions to relate the movements associated with work with different levels of productivity, and even different levels of performing work, e.g., whether the work is being performed carefully or not, i.e., whether the same movements for a given task vary from slow to quick or whether they have a constant pace. The processor is preferably in a remote location and obtains the sensed data via a network. The system is also capable of analyzing sensed data obtained from different individuals, providing feedback to the individuals regarding their level of productivity, either alone or as a group, and offering advice on improving their level of productivity. Excerpt(s): The invention is related to the field of determining and improving productivity of individuals, and specifically, to a system and method of using a plurality of sensors for determining and improving an individual's level of productivity, as well as productivity of a group of individuals. Level of productivity among individuals tends to vary. Employers often evaluate an employee's productivity, especially an employee performing manual and/or repetitive tasks, by videotaping the employee and/or by hiring independent monitoring groups. Such monitoring actions do not necessarily provide reliable results in quantifying the employee's level of productivity, since these monitoring actions only provide a snapshot of a few minutes to a few hours of the employee's work progress, and typically do not apply to professionals. Professional employees are typically evaluated by their output, e.g., number of patients seen, number of sales in the last quarter, and quality level of a published publication. The evaluation

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of their output is a feedback mechanism on the macro level, i.e., after a task is completed. There are no unobtrusive feedback mechanisms that might help a professional better manage their time and tasks on a micro level, i.e., during the execution of a task. Web site: http://www.delphion.com/details?pn=US06675130__

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

Exercise apparatus for a person with muscular deficiency Inventor(s): Duncan, Michael Robert; (Lane Cove, AU), Parker, Simon Geoffrey; (Randwick, AU) Correspondence: Finnegan, Henderson, Farabow, Garrett & Dunner; Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20040023759 Date filed: July 11, 2003 Abstract: An exercise system (10) for exercising at least one limb, such as the legs, of a subject with spinal cord injury or deficiency. The system (10) comprises an exercise bicycle (20) having a crank (17) and pedals (16) to which the feet of the subject can be mounted, and a functional electrical stimulation (FES) system (30). The FES system (30) stimulates the muscles of the legs and includes a transducer (51) mountable to at least one of the legs of the subject (12) that outputs signals representative of the position and/or movement of the leg when performing the exercise. The FES system (30) further includes a control means that receives and processes the signals output by the transducer (51) and outputs control signals to a stimulator (35) that through electrodes (53) provides electrical stimulation to the legs of the subject (12) so as to cause the legs to drive the crank (17) of the bicycle (20). Excerpt(s): The present invention relates to a functional electrical stimulation (FES) system and method of using such a system. More particularly, the invention relates to a device and method for reducing or preventing muscle wastage in persons with spinal cord injury or deficiency. Functional electrical stimulation (FES) systems are seen to have particular future application in providing persons suffering from spinal cord injury or deficiency, such as paraplegia, with a capacity to make controlled movements of their dysfunctional limbs. Functional electrical stimulation systems use electronics to generate electrical impulses. These impulses are then delivered to the nerves or muscles of a subject via electrodes to stimulate movement of the muscles that are otherwise dysfunctional. In order for useful and controlled movements of limbs to be achieved several muscles must usually be operated in concert. This is normally achieved by an algorithm executed under the control of the FES system to deliver a pattern or sequence of stimulation impulses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

9

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

Patents 55

•

REPRODUCIBLE DOLL Inventor(s): Lee, In Bong; (Wonjushi, KR) Correspondence: Dickinson Wright Pllc; Suite 800; 1901 L. ST., N.W.; Washington; DC; 20036; US Patent Application Number: 20040018799 Date filed: July 24, 2002 Abstract: Disclosed is a reproducible doll which a user can assemble to simulate a wanted type of person or animal by himself or herself. According to the present invention, a wanted type of doll is made in such a manner that a head, hands, feet, etc. shaped like corresponding portions of a real person or animal are connected by means of a plurality of connecting bars that form artificial bone sections, joints are formed on the connecting bars to detachably and bendably connect the connecting bars, and artificial muscle sections and artificial skin sections made of elastic materials having elasticity are sequentially fitted with the outsides of the artificial bone sections. Excerpt(s): The present invention relates to a reproducible doll, and more particularly, to a reproducible doll which enables a variety of elements, such as eyebrows, eyes, nose, mouth, and ears to be attached on or detached from corresponding recesses of a head of the doll according to diverse shapes of the head to make a user feeling the pleasure in ornament, and enables hair, e.g., dyed hair, or short cut hair to be worn on the head of the doll to make the user groom the hair of the doll conforming to his/her favorite style. In general, there are many types of dolls with which children can play. Such dolls are largely divided into two types, i.e., finished dolls which are completely assembled in manufacturing factories and then distributed, and prefabricated dolls which are designed to allow users to assemble them by themselves. The former is manufactured to simulate some specific characters or take particular shapes from the beginning, such that disadvantageously they cannot satisfy children's diverse tastes and preferences. Finally, the children lose their interest in the dolls in a short time and as a result, parents cannot help buying new dolls for them, thereby causing an economic burden. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Treadmill Inventor(s): Wang, Leao; (Taiping, TW), Wu, Peter; (Taiping, TW) Correspondence: Kuo-hsiung Chiu; 13F., NO.23, Jiun-ho Street, Peitun District; Taichung; 406; TW Patent Application Number: 20040033865 Date filed: April 29, 2002 Abstract: The present invention relates to a treadmill having a base frame with a handrail. The base frame is provided with two rollers at both ends thereof. A support plate is interposed between both rollers. And a walking belt is disposed around the rollers and the support plate. The base frame has a plurality of crossbars in the position of the support plate, and the crossbars is provided with at least one buffer piece in the middle thereof which is in contact with the bottom face of the support plate. A support element has a bottom member on the base frame and a top member fixed on the bottom of the support plate, and both members are pivotably connected, thereby positioning the

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support plate indirectly on the base frame. Accordingly, the injury of the feet is avoided and the service life of the support plate is prolonged. Excerpt(s): The present invention relates to a treadmill, and more particularly, to a treadmill which offers buffering effect during the walking exercise while the curved extent of the support plate can be counteracted. When the operator walks on the treadmill, the feet exert pressure on the walking belt 11 for a cyclic movement. While the support plate 14 is pressed down, the buffer pieces 13 are simultaneously pressed downward. Therefore, the loading of the support plate 14 can be divided; meanwhile, a reactive force for cushioning is created in order to avoid the exercise injury of the feet. Most of the loading of the support plate 14 is concentrated in the middle thereof so that the middle part thereof is easily crooked and deformed. However, the buffer pieces 13 at the side of the support plate 14 can't effectively reduce or even remove the concentrating stress, thereby deforming or breaking the support plate 14. On the other side, the buffer pieces 13 can be broken, thereby being separated from the support plate 14. Accordingly, the service life of the treadmill 10 is reduced. 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 feet, 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 “feet” (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 feet. You can also use this procedure to view pending patent applications concerning feet. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON FEET Overview This chapter provides bibliographic book references relating to feet. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on feet 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: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, 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. For the format option, select “Monograph/Book.” Now type “feet” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on feet: •

Feet Can Last a Lifetime Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2003. [instructional packet]. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.ndep.nih.gov/. PRICE: Single copy free; $3.00 for each additional kit; Limit 6 kits. Order number: NDEP-2. Summary: People who have diabetes are vulnerable to nerve and vascular damage that can result in loss of protective sensation in the feet, poor circulation, and poor healing of foot ulcers. All of these conditions contribute to the high amputation rate in people with diabetes. Early identification of foot problems and early intervention to prevent problems from worsening can avert many amputations. This booklet is a kit designed

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for primary care and other health care providers who counsel people with diabetes about preventive health care practices, particularly foot care. The kit includes a quickreference pocket card on preventing diabetes foot problems; a disposable monofilament for sensory testing (attached to pocket card); instructions for a visual foot inspection; instructions and a reproducible form for an annual comprehensive foot exam; prescription forms to facilitate Medicare coverage of therapeutic footwear; additional tools to facilitate visual and comprehensive foot exams; a review of current research; a list of additional resources; and patient education materials. All of the materials in the kit may be reproduced without permission and shared with colleagues and patients. 10 figures. 5 tables. 65 references.

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: When following the link below, you may discover non-medical books that use the generic term “feet” (or a synonym) in their titles. •

Amazon.com: http://www.amazon.com/exec/obidos/externalsearch?tag=icongroupinterna&keyword=feet&mode=books

Chapters on Feet In order to find chapters that specifically relate to feet, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and feet 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 “feet” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on feet: •

Vascular Disease In Diabetes: The Head, The Heart and the Feet Source: in Jagger, P.I. Endocrine Society 43rd Postgraduate Assembly Syllabus, San Diego, California, October 9-13, 1991. Bethesda, MD: The Endocrine Society Press. 1991. p. 460-467. Contact: Available from Endocrine Society Press. 9650 Rockville Pike, Bethesda, MD 20814-3998. (301) 571-1802. PRICE: $41. ISBN: 1879225034. Summary: This article comprises a chapter from the proceedings of the Endocrine Society's conference in October 1991. After presenting three case studies of vascular disease in diabetes, the author discusses the risk factors for vascular disease and the therapy for hypertension and hyperlipidemia and its complications in patients with diabetes. Specific topics include cholesterol levels, diabetic nephropathy, the use of thiazide diuretics and beta blockers, the benefits of diet therapy, and the potential dangers of recurring hypoglycemia in the diabetes population with vascular disease. 3 tables. 21 references.

Books

•

59

As a Diabetic, What Do I Need to Know About Diabetes and My Feet? Source: in Tremaine, M.D. and Awad, E.M. Foot and Ankle Sourcebook. Los Angeles, CA: Lowell House. 1994. p. 127-148. Contact: Available from Lowell House. 2029 Century Park East, Suite 3290, Los Angeles, CA 90067. (310) 552-7555. Fax (310) 552-7573. PRICE: $26. ISBN: 1565651502. Summary: This chapter, from a comprehensive health education handbook about foot and ankle problems, reviews the special considerations and precautions necessary for people with diabetes who are concerned about proper foot care. The author stresses that diligence can help readers avoid some of the serious diabetes foot complications that can result in infection, amputation, or even death. Sections in the chapter cover the natural history of diabetes and related foot problems; diabetic vascular disease and its symptoms; peripheral neuropathy; Charcot arthropathy and related ulcers and infection; self-help suggestions, focusing on patient education and a teamwork approach; medical treatment; and surgical treatment, including expectations and complications. The chapter concludes with commonly asked questions and their answers and a brief glossary of relevant terms.

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CHAPTER 6. MULTIMEDIA ON FEET Overview In this chapter, we show you how to keep current on multimedia sources of information on feet. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on feet is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “feet” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, 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 “Videorecording (videotape, videocassette, etc.).” Type “feet” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on feet: •

Feet First Video Source: Harrisburg, PA: Pennsylvania Diabetes Academy. 2001. (videocassette). Contact: Available from Pennsylvania Diabetes Academy. 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820. (717) 558-7750 ext. 1271. Fax (717) 558-7818. E-mail: [email protected]. PRICE: $14.95. Summary: This videotape program is designed to encourage older people with diabetes to take an active part in their own daily foot care, in the interest of preventing foot complications. The videotape is animated with cartoon drawings, depicting older people. The program covers the physiology of cells and how both diabetes and aging can impact the circulation system, particularly that affecting the feet. The program emphasizes that proper foot care can prevent most foot and leg amputations. The program outlines the different ways that diabetic complications, such as peripheral neuropathy and autonomic neuropathy, can affect the feet, causing changes in foot size and shape, and causing some reflexes to be lost, including those for hot, cold, and pain. Signs of circulation problems in the feet including cramps (particularly pain upon

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resting), cold feet, a pale, shiny, purple or puffy appearance, cuts and bruises that heal slowly, feet looking dry and cracked, toenails thickened or infected, and corns or callouses. The program then describes ways to prevent foot problems related to pressure, cold or hot, smoking, breaks in the skin, or infection. Viewers are encouraged to inspect their feet daily, to wear clean socks, to test water temperatures before bathing feet, to treat corns and callouses, to properly care for toenails, and to wear shoes that fit. The program concludes with a list of what not to do.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, 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 “Sound Recordings.” Type “feet” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on feet: •

Serving Individuals with Diabetes who are Blind or Visually Impaired: A Resource Guide for Vocational Rehabilitation Counselors Source: Mississippi State, MS: Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. 1997. 227 p. Contact: Available from Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. Publications Manager, P.O. Drawer 6189, Mississippi State, MS 39762. (601) 325-2001 or (601) 325-8693. Fax (601) 325-8989. TDD (601) 325-8693. PRICE: $25.00 in any format. Summary: This resource guide is designed to help counselors better serve individuals with diabetes who are blind or visually impaired. The guide refers readers to a large collection of resources on various diabetes publications, medications, and appliances. Five sections cover an introduction to diabetes; self management; current medical issues; employment issues; and emotional aspects of diabetes. Topics include myths about diabetes; diabetic eye disease; new nutrition guidelines for diabetes management; oral diabetes medications; diabetes and medications; insulin and measurement devices and systems; maintaining the proper temperature of insulin; blood glucose control; 'talking' blood glucose monitoring systems; and noninvasive glucose monitors. The authors also discuss diabetes and the feet; kidney failure, dialysis, and transplantation; pancreas transplantation; arthritis and diabetes; diabetes and yeast infections; hypoglycemia; diabetic peripheral neuropathy; diabetes and men's sexual health; cardiovascular health; diabetic ketoacidosis; diabetic dermopathy; diabetes and the Individualized Written Rehabilitation Program (IWRP); the use of Braille; health insurance; and scleral shells. The book's appendix includes lists of diabetes-related organizations, publications, listservs, and World Wide Web sites; sources of low-sugar products and products for the blind; and diabetes equipment and supplies, including insulin syringe magnifiers. The resource guide is available in large print, Braille, audiocassette, and computer diskette.

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CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for feet. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with feet. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following

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drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to feet: Botulinum Toxin Type A •

Parenteral-Local - U.S. Brands: Botox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202608.html

Capsaicin •

Topical - U.S. Brands: Zostrix; Zostrix-HP http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202626.html

Didanosine •

Systemic - U.S. Brands: Videx http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202616.html

Ergotamine, Belladonna Alkaloids, and Phenobarbital •

Systemic - U.S. Brands: Bellergal-S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202217.html

Griseofulvin •

Systemic - U.S. Brands: Fulvicin-U/F; Grisactin; Gris-PEG http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202268.html

Leuprolide •

Systemic - U.S. Brands: Lupron; Viadur http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202322.html

Lindane •

Topical - U.S. Brands: Bio-Well; GBH; G-well; Kildane; Kwell; Kwildane; Scabene; Thionex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202329.html

Methysergide •

Systemic - U.S. Brands: Sansert http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202363.html

Miconazole •

Topical - U.S. Brands: Micatin; Monistat-Derm; Zeasorb-AF http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202371.html

Nystatin •

Topical - U.S. Brands: Mycostatin; Nilstat; Nystex; Nystop; Pedi-Dri http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202418.html

Octreotide •

Systemic - U.S. Brands: Sandostatin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202421.html

Researching Medications 65

Salicylic Acid •

Topical - U.S. Brands: Antinea; Duofilm; Freezone; Gordofilm; Hydrisalic; Keralyt; Lactisol; Mediplast; P&S; Paplex; Salac; Salacid; Saligel; Salonil; Sebucare; Trans-Plantar; Trans-Ver-Sal; Viranol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202516.html

Stavudine •

Systemic - U.S. Brands: Zerit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202728.html

Terbinafine •

Systemic - U.S. Brands: Lamisil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202760.html

Thiamine (Vitamin B 1 ) •

Systemic - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html

Zalcitabine •

Systemic - U.S. Brands: HIVID http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202652.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

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Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

69

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

10

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

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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

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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/

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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

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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

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

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

11

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

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

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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 Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “feet” using the “Detailed Search” option. Go directly to the following hyperlink: 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 the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “feet” (or synonyms) into the “For these words:” box. The following is a sample result: •

Guidelines for the Diagnosis and Outpatient Management of Diabetic Peripheral Neuropathy Source: Diabetes Reviews. 7(4): 237-244. 1999. Contact: Available from American Diabetes Association, Inc. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Summary: This article provides guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. These guidelines were developed from an international consensus meeting attended by diabetologists, neurologists, primary care physicians, podiatrists, and diabetes specialist nurses. Diabetic peripheral neuropathy is defined as the presence of symptoms or signs of peripheral nerve dysfunction in people who have diabetes, after exclusion of other causes. The guidelines outline the components of an annual examination of a person who has diabetes and provide recommendations on methods of assessment and management of diabetic peripheral neuropathy and patient education. Assessment guidelines focus on obtaining a patient history; examining the patient, including inspecting the feet and conducting neurological and vascular examinations; performing other investigations; and identifying the at risk foot. Management guidelines focus on education of patients who do not have clinical neuropathy and those who have stage 2 clinical neuropathy and referral of patients who have stage 3 neuropathy. The guidelines use a question and answer format to provide information about who should provide patient education, what methods should be used, and what elements should be included in an education program. Although the guidelines are intended to be used by physicians involved in the outpatient management of people who have diabetes, they emphasize the concept of a multidisciplinary diabetes footcare team. 2 appendices. 4 tables. (AA-M).

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine 13

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

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(NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “feet” (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 33201 1261 459 75 2066 37062

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

Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or

14

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

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

17

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. 18 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 19

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.

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more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

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

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

•

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

20

After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on feet 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 feet. 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 feet. 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 “feet”:

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•

Other guides Ankle Injuries and Disorders http://www.nlm.nih.gov/medlineplus/ankleinjuriesanddisorders.html Athlete's Foot http://www.nlm.nih.gov/medlineplus/athletesfoot.html Foot Health http://www.nlm.nih.gov/medlineplus/foothealth.html Foot Injuries and Disorders http://www.nlm.nih.gov/medlineplus/footinjuriesanddisorders.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 feet. 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: •

Caring for Your Feet Source: Indianapolis, IN: Eli Lilly and Company. 1994. 2 p. Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN 46285. (800) 545-5979 or (317) 276-2000. PRICE: Single copy free. Summary: It is estimated that 50 to 75 percent of amputations could be avoided through proper foot care and early detection and treatment of foot problems. Important points to remember about the feet and diabetes are: diabetes can damage blood vessels in lower legs and feet, resulting in poor circulation; diabetes can cause nerve damage in the feet, causing the foot to be insensitive to pain from injuries; foot problems can quickly become very serious; and serious foot problems usually start in people over 40, who have had diabetes more than 10 years. To assist people with diabetes in avoiding foot problems, recommendations for foot care are provided. A list of actions the doctor can do at each examination to help prevent serious foot problems also is included.

•

Love Your Feet Source: Princeton, NJ: Novo Nordisk Pharmaceuticals, Inc. 1992. 9 p. Contact: Available from Novo Nordisk Pharmaceuticals, Inc. 211 Carnegie Center, Princeton, NJ 08540. (800) 727-6500; in New Jersey (609) 987-5800. PRICE: Free.

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Summary: This booklet discusses foot-care concerns, noting that individuals with diabetes are at high risk of developing foot problems. Seven steps are given for maintaining healthy feet, including care of toenails, proper fit of shoes and socks, diet, and visits to the doctor. A checklist of symptoms is provided along with corresponding actions to alleviate the problem. The booklet is also available in Spanish. •

How Fit Are Your Feet? Source: Bethesda, MD: American Podiatric Medical Association. 200x. 12 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 366-8227 or (301) 581-9200. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This booklet presents a test that members of the general public can take to determine the fitness of their feet. The test first presents a formula that readers can use to determine the approximate number of miles their feet have logged. This is followed by questions about current profession or occupation and the number of years engaged in this occupation, recreation and lifestyle and the number of years engaged in this type of recreation, classification of weight, height of heels on footwear, and presence of various foot and other conditions. Answers to questions are given a score, and total scores are categorized as low, moderate, or high risk for foot and ankle problems. The booklet explains each risk category.

•

Taking Care of Your Feet Source: Minneapolis, MN: Park Nicollet Health Source. 1997. 15 p. Contact: Available from Park Nicollet Health Source. 3800 Park Nicollet Boulevard, Minneapolis, MN 55416. (800) 372-7776 or (612) 993-3534. Fax (612) 993-1840. PRICE: $1.95 for 1-9 copies; $1.75 for 10-99 copies; $1.60 for 100-499 copies. ISBN: 1885115229. Summary: This booklet provides information for people with diabetes about preventing serious foot problems. Foot problems begin when high blood glucose levels cause damage to nerves in the feet. Most foot problems, though, can be prevented or healed before they become serious. The booklet advises readers to follow five steps that can reduce the chances of developing foot problems: control blood glucose levels, practice good foot care habits, check feet daily, treat problems immediately, and visit a health care provider regularly. Good foot care habits include washing feet daily, trimming toenails straight across with a toenail clipper, and wearing shoes that fit well. The booklet includes several pen and ink illustrations and lists of tips relevant to each of the five steps addressed. The booklet concludes with a list of things not to do. (AA-M).

•

Diabetic Foot Care: Treatment and Self-Care for Healthy Feet Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This booklet, which is available in both English and Spanish, provides people who have diabetes with information on foot problems and their treatment. The structures of the foot include bones, nerves, blood vessels, joints, skin, and fat. Damaged nerves, blocked blood vessels, weakened bones, collapsed joints, and broken down skin may cause foot problems in people who have diabetes. Diagnosis of a foot problem

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requires a medical history, a foot examination, and possible diagnostic and imaging studies. Prevention of foot infections involves examining the feet regularly, learning about the impact of diabetes on the feet, obtaining routine foot care, and having customized footwear made. If a minor infection develops, treatment involves having the infected area cleaned by a doctor and taking antibiotics to combat the infection. Severe infections, however, may require surgical intervention and use of intravenous antibiotics. Regular wound care after surgery helps keep the foot free of infection and speeds healing. People who have diabetes should perform daily foot inspections to look for color changes in the skin; swelling; temperature or sensation changes; hot spots; cracks, sores, and ulcers; ingrown toenails; and drainage and odor. Keeping feet healthy involves ensuring that shoes and socks fit well, exercising the feet, and controlling diabetes. •

Guide to Taking Care of Your Feet Source: Alexandria, VA: American Diabetes Association. 2001. [4 p.]. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. E-mail: [email protected]. Website: www.diabetes.org. PRICE: $4.90 for package of 50; plus shipping and handling. Order number: 5983-14. Summary: This brochure helps readers with diabetes understand the importance of taking caring of their feet, to prevent short-term and long-term complications. Topics include how high blood glucose levels can damage the nerves and blood vessels that go to the feet, the importance of checking one's feet every day, coping with foot problems (including calluses and corns), choosing appropriate footwear, and working in tandem with one's health care providers to prevent and manage any foot problems. One miniarticle reviews step-by-step the parts of a comprehensive self foot examination. One sidebar reports a mock interview between a certified diabetes educator and a patient discussing the role of good footwear, daily foot examinations, and coping with foot complications. The brochure includes space for readers to record their health care provider's contact information. The brochure is copiously illustrated with brightly colored graphics.

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Take Care of Your Feet for a Lifetime: A Guide for People with Diabetes. (Cuide Sus Pies Durante: Toda Su Vida) Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2001. 12 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Single copy free; bulk copies available. Order number: NDEP-4. Summary: This brochure provides foot care guidelines to help people with diabetes avoid serious foot problems. Suggestions include taking care of one's diabetes by making healthy lifestyle choices to help keep blood sugar close to normal and by working with a health care team to make a diabetes plan that fits one's lifestyle; checking feet every day for cuts, sores, red spots, swelling, and infected toenails; washing feet every day; using skin lotion, cream, or petroleum jelly on the tops and bottoms of the feet to keep the skin soft and smooth; and using a pumice stone to smooth corns and calluses. Other guidelines include trimming toenails each week or

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when needed, wearing shoes and socks at all times, protecting the feet from hot and cold, keeping the blood flowing to the feet, engaging in exercises that are easy on the feet, and asking the doctor about various aspects of foot care. The brochure also presents tips for proper footwear, comments on Medicare coverage for special footwear, lists sources of additional information, and provides a foot care tip sheet that can be removed from the brochure. •

Take Good Care of Your Feet: Straight Facts About Foot Care and Foot Problems Source: London, Ontario, Canada: Dermal Therapy. 1990. 2 p. Contact: Available from Dermal Therapy. 3 Sprucedale Court, London, Ontario, CANADA N5X2N9. (800) 668-8000. PRICE: Single copy free. Summary: This brochure reviews the basics of everyday foot care and foot problems. Topics include feet and the role of circulation, the problem of athlete's foot, corns and calluses, diabetes and foot disorders, a skin care product called Urea and healthy feet, toenail troubles, and the role of professional care for your feet. A list of seven footcare suggestions for people with diabetes is included. The brochure is produced by the manufacturer of Urea, a moisturizer.

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Diabetes and Your Body: How to Take Care of Your Eyes and Feet Source: Kansas City, MO: American Academy of Family Physicians. 2000. 2 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $22.00 for 100 copies for members, $33.00 for 100 copies for nonmembers. Summary: This brochure, which is presented in question and answer format, provides information about taking care of eyes and feet. The brochure notes that people with diabetes should have their eyes and feet examined at least once a year. The brochure also suggests the following preventive measures: controlling blood sugar, blood pressure, and cholesterol; exercising; following a healthy diet; quitting smoking; and avoiding alcohol. Topics include the effect of diabetes on the body, eye complications, eye care, foot complications, and foot care. Sidebars discuss preventing foot and eye problems, foot care, and deciding when to call a health care provider. (AA-M).

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Flat Feet in Children Source: American Academy of Family Physicians. November 2001. 2 p. Contact: Available from American Academy of Family Physicians. Website: www.familydoctor.org. Summary: This fact sheet discusses causes and treatment for children with flat feet, a condition in which the foot has no arch as a result of baby fat between the foot bones, loose joint connections, or when foot bones are fused together. Any child complaining of pain in the foot, ankle, heel, or arch needs to be taken to the doctor for examination. The doctor may recommend a heel cup or shoe insert for heel pain or special orthopedic shoes or wedges to keep the shoe on the child's foot. There is no need to limit the child's activities. Surgery is only useful in the rare cases where flat feet are caused by fused bones and shoe inserts and casts were not helpful.

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If Your Child Has Flat Feet Source: American Family Physician. 54(3): 1031. September 1, 1996.

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Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This fact sheet for parents of children with flat feet describes what the condition is and its cause, when the child should visit a doctor, should child wear special shoes, and whether surgery is required. Overall, it is revealed that flat feet usually are not problematic, but if pain develops then the child should be taken to the doctor. Normal activities or shoe styles will not make flat feet worse. Surgery to correct flat feet is not helpful for most patients and not recommended except in rare cases involving fused foot bones where other corrective measures have failed. •

Diabetes Feet and Skin Problems Source: in Griffith, H.W. Instructions for Patients. 5th ed. Philadelphia, PA: W.B. Saunders Company. 1994. p. 118. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This fact sheet on diabetes foot and skin problems is from a compilation of instructions for patients, published in book format. The fact sheet provides information in three sections: basic information, including a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. The fact sheet can be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book in which the fact sheet appears is available in English or Spanish.

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Senior Health: Taking Care of Your Feet Source: San Bruno, CA: StayWell Company. 1997. 2 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders; available in tear-off pads of 100. Summary: This fact sheet provides older people with information on taking care of their feet. Tips on preventing or treating foot problems include buying shoes that fit well; exercising the feet by walking each day and stretching them; and protecting the feet by washing them daily, wearing shoes or slippers, wearing clean socks, using foot powder, and cutting toenails properly. The feet should be checked every day for blisters, cuts, and sores. Indications of a foot problem include pain or numbness; pus, oozing, or discharge; color change; wounds that are slow to heal; swelling or growths; strong odor; itching or a rash; and thick, yellow nails.

•

Your Podiatric Physician Talks About Women's Feet Source: American Podiatric Medical Association. 200x. 4 p. Contact: Available online from American Podiatric Medical Association. Website: www.apma.org. Summary: This fact sheet provides women with information on foot health. Many of the foot problems that women experience are caused by wearing shoes with heels higher

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than 2 inches. These types of shoes are considered biomechanically and structurally unsound by podiatrists. In time, wearing high heels may cause enough problems to impair foot function. Women can reduce the abusive effects of high heels include by limiting the amount of time they are worn, selecting shoes with other heel heights, and making sure that the shoes fit properly. Nylon pantyhose may also cause foot problems because nylon generates and traps heat that causes excessive perspiration. This environment is ideal for the growth of fungal infections. Nylon may also abrade skin. Inexpensive pantyhose may cause forefoot problems by constricting the normal expansion of the foot when walking. Guidelines for observing foot health in pregnant women and women over 65 are addressed. In addition, the pamphlet describes women's foot ailments, such as Achilles tendinitis, bunions, hammertoe, metatarsalgia, neuromas, plantar fasciitis, and Haglund's deformity. •

Taking Care of Your Feet: Staying One Step Ahead Source: Lexington, KY: Lexington-Fayette County Health Department. 199x. 7 p. Contact: Available from Lexington-Fayette County Health Department. Division of Nutrition and Health Education, 650 Newtown Pike, Lexington, KY 40508. (606) 2882333. Fax (606) 288-2359. PRICE: $38.00 per 25 copies plus shipping. Summary: This guide to foot care is one in a series of 22 diabetes education materials that combine practical tips and humorous drawings with current diabetes information. The series is written at a sixth grade reading level and is designed to teach and motivate patients to take care of themselves. The booklet provides specific suggestions for readers to implement in their everyday diabetes management. The authors first describe the causes of foot problems in people with diabetes, including nerve damage (neuropathy), blood flow (circulation), and high blood glucose levels (hyperglycemia). Recommendations are provided for avoiding these problems, including quitting smoking, increasing exercise, wearing good shoes, performing foot inspections every day, not going barefoot, adapting slowly to new shoes, daily hygienic care, and obtaining regular foot care from the physician. The authors also list the components of a regular daily foot check. The authors emphasize the importance of regular foot care in preventing serious foot problems, including amputation.

•

Diabetes and Your Feet: Podiatric Care and Treatment Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $1.35 plus shipping and handling; bulk copies available. Summary: This illustrated booklet provides information on foot care people who have diabetes. Diabetes can affect nerves in the feet and keep people from feeling pain, pressure, heat, or cold, or it can cause reduced blood flow and prevent injuries from healing. In addition, shifting bones can cause the feet to become deformed, and collapsed arch joints may no longer absorb pressure and provide stability. Foot infections such as ulcers and bone infections can also develop. A foot evaluation consists of a review of a person's diabetes history and overall health, a foot examination, and xrays or other diagnostic tests. Warning signs of foot problems include color changes; swelling; temperature changes; sensation changes; hot spots; cracks, sores, and ulcers; ingrown toenails; and drainage and odor. A podiatrist can help a person who has diabetes prevent foot infections by examining the person's feet on a regular basis,

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teaching the person about self care, offering routine foot care, and providing customized footwear or inserts. Self care measures include protecting feet with the right shoes and socks, exercising the feet, giving feet special care, and controlling diabetes. Treatment and follow up of minor foot problems are important to prevent infections. Surgical intervention may be needed to treat severe infections. •

After a Hip Fracture: Getting on Your Feet Again Source: San Bruno, CA: StayWell Company. 1998. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have a hip fracture with information on recovering from this injury. The booklet explains why so many older people break their hips, describes the types of hip fractures, and identifies the members of a recovery team. The booklet then outlines the steps involved in preparing for surgical repair of a broken hip, including diagnosing the injury, developing a treatment plan, undergoing a preoperative evaluation, and understanding the risks and complications of surgery. This is followed by a discussion of the procedures that a surgeon can use to repair a hip fracture. In addition, the booklet explains what happens following surgery and offers guidelines on exercising in bed, getting up and down, and learning to walk safely. Other topics include using occupational therapy to learn how to modify normal activities of daily living, changing the home environment to make it safe and comfortable, and protecting the hip. Numerous figures.

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Crutches, Walkers, and Canes: On Your Feet Again Source: San Bruno, CA: StayWell Company. 1999. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet, which is available in both English and Spanish, provides people who are using crutches, walkers, or canes with information on getting around safely. Crutches, walkers, or canes can help a leg, ankle, foot, or hip heal by bearing the weight a person would normally put on the injured part. These assistive devices work best when they are custom measured to fit the user. The booklet explains how people can get the best fit with their crutches, walkers, or canes. This is followed by a description of the steps involved in using crutches to walk with and without placing weight on the healing leg or foot, using a walker, walking with a cane, climbing up and down steps and curbs with crutches and canes, going up curbs with a walker, sitting down with crutches and walkers, getting into cars, and going through doors. The booklet also offers other tips on making crutches, walkers, and canes a little easier to use. Numerous figures.

•

Gout and Your Feet Source: Park Ridge, IL: American College of Foot and Ankle Surgeons. 1998. 6 p. Contact: Available from American College of Foot and Ankle Surgeons. 515 Busse Highway, Park Ridge, IL 60068. (800) 421-2237 or (847) 292-2237. Fax (800) 382-8270 or (847) 292-2022. E-mail: [email protected]. Website: www.acfas.org. PRICE: Package of 50 for members $18.50 plus shipping; for nonmembers $27.50 plus shipping.

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Summary: This illustrated brochure provides people who have gout with information on the symptoms, diagnosis, treatment, and prevention of this form of arthritis. Gout occurs as a result of the buildup of uric acid in the body and the joint fluid. This accumulation of uric acid usually occurs when the body has difficulty processing proteins known as purines. Symptoms include sudden, intense pain in one or more joints accompanied by redness, swelling, and warmth over the joint. Although symptoms commonly occur in the big toe, any joint may be affected. Diagnosis is based on a personal and family history, a physical examination, and laboratory tests. Treatment involves the use of oral antiinflammatory medications. If medical treatment is ineffective, surgery may be needed. Prevention involves avoiding foods high in purines, evaluating current medications, and drinking six to eight glasses of water per day. 3 figures. •

Running and Your Feet Source: Bethesda, MD: American Podiatric Medical Association. 1999. 8 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 366-8227 or (301) 581-9200. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This illustrated pamphlet providers joggers with information on the impact of running on the feet. A beginning jogger should visit a podiatric physician before starting an exercise program that includes jogging so that potential problems can be identified and corrected. Frequent joggers should visit a podiatrist regularly to check for any potential stress on the lower extremities. Proper stretching for 5 to 10 minutes is essential prior to beginning an exercise regimen so that strain on muscles, tendons, and joints is reduced. Some effective stretching exercises include the wall pushup, the hamstring stretch, and the lower back stretch. Choice of footwear is determined by weight, foot structure, and running regimen. The safest way to begin a running program is with a four day a week conditioning program for 12 to 16 weeks. Even with the best preparation, aches and pains may occur. Common pains associated with jogging include runner's knee and skin splints.

•

Take Care of Your Feet for a Lifetime Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2003. [16 p.]. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.ndep.nih.gov/. PRICE: Single copy free; Full-text available online at no charge. Order number: 01-4285. Summary: This illustrated patient booklet provides step-by-step instructions for proper foot care for people with diabetes. Topics include the importance of foot care, the basics of general diabetes management, the steps to proper foot care, footwear, skin care, the role of exercise, and how to work in close tandem with one's health care providers. The author provides specific, practical strategies for preventing foot problems. The booklet concludes with the contact information for a variety of related resource organizations. The booklet includes a tear-off reminder card and a patient 'To Do' list, suitable for hanging on a bulletin board.

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•

Feet Can Last a Lifetime: A Health Care Provider's Guide to Preventing Diabetes Foot Problems Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. 1997. (information package). Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Single copy free; bulk orders available. Order number: NDEP-2. Summary: This information package includes foot care materials designed for health care professionals who counsel people with diabetes about preventive health care practices. The package emphasizes the four basic steps for preventive foot care: early identification, early diagnosis, early intervention, and patient education. The package includes a 10 gram, nylon sensory testing monofilament and instructions for using it to test a patient's susceptibility to foot ulcers. A booklet lists steps for preventing diabetes foot problems and foot screening instructions. The booklet also includes a screening form for diabetes foot disease, a certification statement and a prescription form for therapeutic footwear, a research review relevant to the prevention and early intervention for diabetes foot problems, a resource list, and an order form. One page of the booklet addresses Medicare coverage of therapeutic footwear for people with diabetes. A smaller illustrated booklet is designed for health care professionals to distribute to their patients. Twelve numbered tips encourage readers to take care of their diabetes, check and wash their feet daily, keep their skin soft, smooth corns and calluses gently, trim toenails each week or as often as necessary, wear shoes and socks at all times, protect feet from temperature extremes, keep blood flowing to the feet, be more active, and consult with a doctor. This booklet concludes with a list of organizations to contact for more information and a to-do list. The information package also includes a laminated quick reference guide with steps for preventing diabetes foot problems on one side and a foot screening exam on the reverse. Copier-ready masters include a screening form for diabetes foot disease, high risk feet stickers to place on medical records as a reminder, and a Medicare certification statement and prescription form for theraupeutic footwear. A fourth copier-ready master is designed for people with diabetes and includes foot care tips on one side and a to-do list on the reverse. All of the materials in the kit, which are included in a folder, may be reproduced without permission and shared as appropriate with colleagues and patients. 31 references. (AAM).

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Caring for Your Feet: Care of the Foot in Diabetes: The Carville Approach Source: Carville, LA: Gillis W. Long Hansen's Disease Center. 1993. (information package). Contact: Available from Gillis W. Long Hansen's Disease Center. Rehabilitation Branch, 5445 Point Clair Road, Carville, LA 70721. (504) 642-4710. PRICE: Single copy free. Summary: This information packet consists of a videotape and supporting materials about the Lower Extremity Amputation Prevention (LEAP) Program, developed by physicians at the Gillis W. Long Hansen's Diseases Center in Carville, LA, a facility of the Public Health Service of the U.S. Department of Health and Human Services. The program is designed to train family practice and internal medicine physicians, in an effort to reduce the number of lower extremity amputations. The videotape and a patient education brochure, designed to reach patients with limited reading skills, stress

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the importance of daily self inspection of the foot, appropriate footwear selection, and the management of simple foot problems. The foot screening booklet is designed to help health care providers learn the screening process, using a monofilament and a recommended Diabetic Foot Screen form (included); an order sheet for the monofilaments and a pad of forms is included. The booklet also describes the basic concepts of the LEAP program: annual foot screening; patient education, appropriate footwear selection, daily self-inspection of the foot, and the management of simple foot problems. •

Your Podiatric Physician Talks About Flying and Your Feet Source: Bethesda, MD: American Podiatric Medical Association. 1997. 6 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 275-2762 or (301) 581-9277. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This pamphlet provides flight attendants with information on work-related foot problems and foot care. The pamphlet describes the anatomy of the foot and explains why foot problems are frequent health complaints. Common foot ailments, including plantar fasciitis, heel spurs, metatarsalgia, bunions and hammertoes, and neuromas can be effectively treated by podiatrists. The pamphlet also discusses the importance of regular visits to a podiatrist and provides guidelines on selecting proper footwear. 2 figures.

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Sports and Your Children's Feet Source: Bethesda, MD: American Podiatric Medical Association. 1994. 6 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 275-2762 or (301) 581-9277. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This pamphlet provides parents with information on the effect of participating in sports on the foot health of their children. The pamphlet recommends that parents encourage their children to participate, but it cautions against training in a single sport at too young an age because of the risk of developing foot and ankle injuries. Other topics are the benefits of participation in sports, guidelines on selecting proper footwear, advice on preventing overuse injury, and the features and treatment of foot injuries commonly seen in very active children, including ankle sprains, fractures, Sever's disease, shin splints, and stress fractures.

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Fitness and Your Feet Source: Bethesda, MD: American Podiatric Medical Association. 1994. 8 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 275-2762 or (301) 581-9277. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This pamphlet provides the general public with information on the effect of fitness exercising on the feet. Among the benefits of a general exercise and fitness program are increased energy; improved health; increased muscle strength, endurance, and tone; improved self-image; and reduced stress. The pamphlet provides guidelines on planning a fitness program, selecting appropriate shoes and clothing, and caring for feet subjected to an exercise regimen. In addition, the pamphlet describes the features

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and treatment of various conditions that may occur because of the impact of exercise on feet, including blisters, corns and calluses, foot odor, and heel pain. Information on the role of the podiatrist in contributing to a person's overall health is also included. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Facts and Answers to FAQs on Feet and Foot Disorders Summary: A general overview of the foot including foot problems and foot care. Source: American Podiatric Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4290

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Foot Swelling when Traveling Summary: Swelling (edema) of the feet is common during long airline flights. The main factor that contributes to the problem is physical inactivity. Source: Mayo Foundation for Medical Education and Research http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7051

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How Fit Are Your Feet? Self Assessment Quiz Summary: Take this Source: American Podiatric Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6219

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Information to Live By: Human Papillomavirus (HPV) Summary: Answers to basic questions about HPV viruses, types of which can cause warts on the hands and feet, genital warts, and have been linked to cervical cancer. Source: American Social Health Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4625

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Prevent Diabetes Problems: Keep Your Feet and Skin Healthy Summary: Describes how diabetes can damage feet and skin and how people with diabetes can take care of themselves to prevent common complications. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6527

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Your Podiatric Physician Brochure Series Summary: Consumer health information pamphlets discuss several foot health conditions and concerns, including athlete's foot, occupational foot health, warts, foot orthoses, children's feet, foot surgery, heel Source: American Podiatric Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4289

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Your Podiatric Physician Talks About Children's Feet Source: American Podiatric Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7635

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Your Podiatric Physician Talks About Running and Your Feet Source: American Podiatric Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7640 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 feet. 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

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

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

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

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

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

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

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News Services and Press Releases One of the simplest ways of tracking press releases on feet 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 “feet” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to feet. 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 “feet” (or synonyms). 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 “feet” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

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Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “feet” (or synonyms). If you know the name of a company that is relevant to feet, 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 “feet” (or synonyms).

Newsletters on Feet Find newsletters on feet using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “feet.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “feet” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Kidney Failure in Sarcoidosis Source: Sarcoidosis Networking. 8(3): 3. 2000. Contact: Available from Sarcoid Network Association. Sarcoidosis Networking, 13925 80th Street East, Puyallup, WA 98372-3614. Email: [email protected]. Summary: Sarcoidosis is a chronic, progressive systemic granulomatous (causing lesions) disease of unknown cause (etiology), involving almost any organ or tissue, including the skin, lungs, lymph nodes, liver, spleen, eyes, and small bones of the hands or feet. This brief article, from a newsletter for patients with sarcoidosis, reviews the complications of kidney failure in sarcoidosis. Granulomatous infiltration of the kidney may be present in as many as 40 percent of patients with sarcoidosis, but it is rarely extensive enough to cause renal (kidney) dysfunction. The lesions are usually responsive to steroid therapy. Kidney failure has also been diagnosed in patients with sarcoidosis without the presence of lesions, possibly due to hypercalcemia (too much calcium in the blood), involvement of the glomerular filter system, and renal arteritis (inflammation of the arteries of the kidney), which may be associated with severe high blood pressure. It is recommended that all people with active sarcoidosis be screened for hypercalciuria (high levels of calcium in the urine). This may precede development of hypercalcemia, which should be treated. Glucocorticoids are the main choice of therapy and do seem to reduce levels of urinary calcium to normal within a few days. People with sarcoidosis may also have severe pain; the frequent use of pain medication can be another cause of kidney failure. People who take pain medication should ask their physicians to evaluate their kidneys on a regular basis. 9 references.

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “feet” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on feet: •

Fungal Nail Disease: The World Is at Your Feet Source: Harvard Health Letter. 21(9):6; July 1996. Contact: Available from Harvard Health Letter, P.O. Box 380, Boston, MA 02117. Summary: This newsletter article for the general public discusses fungal nail disease, primarily of the toenails. Fungal nail disease may be caused by microorganisms known as dermatophyte or, less commonly, by yeasts and molds. Onychomycosis, which is a common fungal nail disease caused by dermatophyte, may be treated with the new drugs itraconazole and terbinafine. The administration schedule and side effects of these drugs are presented. In addition, prescription and home remedies that were used prior to the development of these two new drugs are highlighted.

•

Getting Relief: Your Aching Feet Source: Harvard Health Letter. 24(5): 1-3. March 1999. Contact: Available from Harvard Health Letter. P.O. Box 380, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. E-mail: [email protected]. Summary: This newsletter article provides the general public with guidelines on preventing and treating foot problems. The feet are subjected to a great deal of pressure each day and endure loads equivalent to several hundred tons. Although heredity and normal age-related changes in the structure of the foot contribute to some problems, most are caused by footwear. Wearing roomy, supportive shoes can prevent many foot problems, as can walking 30 to 40 minutes several times a week. People who experience persistent foot problems should seek the help of an orthopedist or podiatrist. Common foot problems include bunions, corns and calluses, hammertoes, heel pain, neuromas, fungal nail disease, and ingrown toenails. The article describes each of these problems and explains how they are treated. 1 figure.

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Feet: Taking Steps Toward Good Health Source: Harvard Women's Health Watch. 7(7): 4-6. March 2000. Contact: Available from Harvard Women's Health Watch. Department SR, P.O. Box 380, Boston, MA 02117. (800) 829-5921. Email: [email protected]. Summary: This newsletter article provides women with information on foot disorders. Women have four times as many foot problems as men. Much of this foot trouble results from wearing inappropriate shoes that impinge on bones, nerves, and connective tissues in the feet and force them into positions that interfere with normal gait. Conditions that seem to affect women more than men include bunions, plantar fasciitis, hammertoes, neuroma, nail fungus, and ingrown toenail. The article describes these conditions and

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presents measures for treating them. In addition, the article offers suggestions for preventing foot problems, including buying the right shoes by shopping for shoes late in the day, having both feet measured, standing on one foot at a time, ensuring that there is enough length in the toe, determining the shape of the sole, and avoiding buying shoes that are uncomfortable. Other tips include keeping feet clean and dry and stretching the feet and legs.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to feet. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with feet. 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 feet. 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 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 “feet” (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 “feet”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at

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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 “feet” (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 “feet” (or a synonym) into the search box, and click “Submit Query.”

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

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

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

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

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

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

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

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

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

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

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

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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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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

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

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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/

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

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

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

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

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

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

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

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

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•

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

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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

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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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

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

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

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

•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

99

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

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

•

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

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

101

FEET DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] 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] Acclimatization: Adaptation to a new environment or to a change in the old. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]

Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the

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environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] 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] Agonists: Drugs that trigger an action from a cell or another drug. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from

Dictionary 103

which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Ankle Injuries: Harm or hurt to the ankle or ankle joint usually inflicted by an external source. [NIH]

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Ankle Joint: The joint that is formed by the inferior articular and malleolar articular surfaces of the tibia, the malleolar articular surface of the fibula, and the medial malleolar, lateral malleolar, and superior surfaces of the talus. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH]

Dictionary 105

Archaea: One of the three domains of life (the others being bacteria and Eucarya), formerly called Archaebacteria under the taxon Bacteria, but now considered separate and distinct. They are characterized by: 1) the presence of characteristic tRNAs and ribosomal RNAs; 2) the absence of peptidoglycan cell walls; 3) the presence of ether-linked lipids built from branched-chain subunits; and 4) their occurrence in unusual habitats. While archaea resemble bacteria in morphology and genomic organization, they resemble eukarya in their method of genomic replication. The domain contains at least three kingdoms: crenarchaeota, euryarchaeota, and korarchaeota. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteritis: Inflammation of an artery. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthropathy: Any joint disease. [EU] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Aspergillosis: Infections with fungi of the genus Aspergillus. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [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] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [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]

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Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] 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] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] 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] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Bilateral: Affecting both the right and left side of 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] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biophysics: The science of physical phenomena and processes in living organisms. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [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] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological

Dictionary 107

system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blastomycosis: A fungal infection that may appear in two forms: 1) a primary lesion characterized by the formation of a small cutaneous nodule and small nodules along the lymphatics that may heal within several months; and 2) chronic granulomatous lesions characterized by thick crusts, warty growths, and unusual vascularity and infection in the middle or upper lobes of the lung. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [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 transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH]

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Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breathing Exercises: Therapeutic exercises aimed to deepen inspiration or expiration or even to alter the rate and rhythm of respiration. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bunion: A swelling of the bursa mucosa of the ball of the great toe, with thickening of the overlying skin and forcing of the toe outward. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [NIH] Cadmium: An element with atomic symbol Cd, atomic number 48, and atomic weight 114. It is a metal and ingestion will lead to cadmium poisoning. [NIH] Cadmium Poisoning: Poisoning occurring after exposure to cadmium compounds or fumes. It may cause gastrointestinal syndromes, anemia, or pneumonitis. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and

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the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Career Choice: Selection of a type of occupation or profession. [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] 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] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH]

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Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of

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infection or insult. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [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] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citalopram: A selective neuronal serotonin reuptake inhibitor and a clinically effective antidepressant with tolerable side effects. The drug is also effective in reducing ethanol uptake in alcoholics and is used in depressed patients who also suffer from tardive dyskinesia (TD) in preference to tricyclic antidepressants, which aggravate this condition. [NIH]

Clinical Medicine: The study and practice of medicine by direct examination of the patient. [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] 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] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local

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anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] 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,

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spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [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] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [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: 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] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH]

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Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Corn Oil: Oil from corn or corn plant. [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 Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Creeps: Minor tingling, itching or formication occurring alone or, rarely, as the precursors of more severe types of decompression sickness. [NIH]

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Criterion: A standard by which something may be judged. [EU] Cross-Sectional Studies: Studies in which the presence or absence of disease or other healthrelated variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline

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is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Dermal: Pertaining to or coming from the skin. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developmental Biology: The field of biology which deals with the process of the growth and differentiation of an organism. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] 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] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH]

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Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopa: The racemic or DL form of DOPA, an amino acid found in various legumes. The dextro form has little physiologic activity but the levo form (levodopa) is a very important physiologic mediator and precursor and pharmacological agent. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] 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] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH]

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Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electron microscope: A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscopes shows tiny details better than any other type of microscope. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [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] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelins: 21-Amino-acid peptides produced by vascular endothelial cells and functioning as potent vasoconstrictors. The endothelin family consists of three members, endothelin-1, endothelin-2, and endothelin-3. All three peptides contain 21 amino acids, but vary in amino acid composition. The three peptides produce vasoconstrictor and pressor responses in various parts of the body. However, the quantitative profiles of the pharmacological activities are considerably different among the three isopeptides. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing

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radiation, pathogenic organisms, or toxic chemicals. [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]

Environmental Monitoring: The monitoring of the level of toxins, chemical pollutants, microbial contaminants, or other harmful substances in the environment or workplace by measuring the amounts of these toxicants in the bodies of people and animals in that environment, among other methods. It also includes the measurement of environmental exposure. Levels in humans and animals are used as indicators of toxic levels of undesirable chemicals. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [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] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external 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] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [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]

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Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excrete: To get rid of waste from the body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Expeditions: Usually refers to planned scientific data-gathering excursions. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [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] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fasciculation: A small local contraction of muscles, visible through the skin, representing a spontaneous discharge of a number of fibres innervated by a single motor nerve filament. [EU]

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Fasciitis: Inflammation of the fascia. There are three major types: 1) Eosinophilic fasciitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orangepeel configuration suggestive of scleroderma and considered by some a variant of scleroderma; 2) Necrotizing fasciitis, a serious fulminating infection (usually by a beta hemolytic Streptococcus) causing extensive necrosis of superficial fascia; 3) Nodular/Pseudosarcomatous/Proliferative fasciitis, characterized by a rapid growth of fibroblasts with mononuclear inflammatory cells and proliferating capillaries in soft tissue, often the forearm; it is not malignant but is sometimes mistaken for fibrosarcoma. [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] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectins: Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. [NIH] Fibrosarcoma: A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Financial Management: The obtaining and management of funds for institutional needs and responsibility for fiscal affairs. [NIH] Flatus: Gas passed through the rectum. [NIH] Flexor: Muscles which flex a joint. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in

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diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Foot Bones: The tarsus, metatarsus, and phalanges. The tarsus consists of seven bones: calcaneum, astragalus, cuboid, navicular, internal, middle, and external cuneiform bones. The five metatarsal bones are numbered one through five, running medial to lateral. There are 14 phalanges in each foot, the great toe has two while the other toes have three each. [NIH]

Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Foot Injuries: General or unspecified injuries involving the foot. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body

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through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [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]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Expression Profiling: The determination of the pattern of genes expressed i.e., transcribed, under specific circumstances or in a specific cell. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [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] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH]

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Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]

Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanine: One of the four DNA bases. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders

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primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Hallux Valgus: Lateral displacement of the great toe, producing deformity of the first metatarsophalangeal joint with callous, bursa, or bunion formation over the bony prominence. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Helix-loop-helix: Regulatory protein of cell cycle. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] 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

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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] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Hip Fractures: Fractures of the femur head, the femur neck, the trochanters, or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region. For the fractures of the femur neck the specific term femoral neck fractures is available. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [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] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypercalciuria: Abnormally large amounts of calcium in the urine. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH]

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Hyperoxia: An abnormal increase in the amount of oxygen in the tissues and organs. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH]

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Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impulsive Behavior: An act performed without delay, reflection, voluntary direction, or obvious control in response to a stimulus. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] 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] Incidental: 1. Small and relatively unimportant, minor; 2. Accompanying, but not a major part of something; 3. (To something) Liable to occur because of something or in connection with something (said of risks, responsibilities, .) [EU] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [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]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH]

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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] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Iteration: Unvarying repetition or unvarying persistence. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH] 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] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH]

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Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Laboratory Animal Science: The science and technology dealing with the procurement, breeding, care, health, and selection of animals used in biomedical research and testing. [NIH]

Laboratory Personnel: Those health care professionals, technicians, and assistants staffing a research or health care facility where specimens are grown, tested, or evaluated and the results of such measures are recorded. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lacrimal: Pertaining to the tears. [EU] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] 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] Larva: Wormlike or grublike stage, following the egg in the life cycle of insects, worms, and other metamorphosing animals. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Lenses: Pieces of glass or other transparent materials used for magnification or increased visual acuity. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the

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peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified

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who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lubricants: Oily or slippery substances. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Macula Lutea: An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the superior pole of the eye and slightly below the level of the optic disk. [NIH] Macular Degeneration: Degenerative changes in the macula lutea of the retina. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Mannans: Polysaccharides consisting of mannose units. [NIH]

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Marital Therapy: A form of psychotherapy involving the husband and wife and directed to improving the marital relationship. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [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 Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (diagnostic errors), errors in the administration of drugs and other medications (medication errors), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from malpractice in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] 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] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated

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during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metamorphosis: The ontogeny of insects, i. e. the series of changes undergone from egg, through larva and pupa, or through nymph, to adult. [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] Metatarsal Bones: The five long bones of the metatarsus articulating with the tarsal bones proximally and the toes (phalanges) distally. [NIH] Metatarsophalangeal Joint: The articulation between a metatarsal bone and a phalanx. [NIH] Metatarsus: The part of the foot between the tarsa and the toes. [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] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [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] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH]

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Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] 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] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphological: Relating to the configuration or the structure of live organs. [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] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle Hypertonia: Abnormal increase in skeletal or smooth muscle tone. Skeletal muscle hypertonicity may be associated with pyramidal tract lesions or basal ganglia diseases. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Mutagen: Any agent, such as X-rays, gamma rays, mustard gas, TCDD, that can cause abnormal mutation in living cells; having the power to cause mutations. [NIH] Mutagenicity: Ability to damage DNA, the genetic material; the power to cause mutations. [NIH]

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]

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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the organ. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [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] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervous System Diseases: Diseases of the central and peripheral nervous system. This includes disorders of the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscle. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Diseases: A general term encompassing lower motor neuron disease;

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peripheral nervous system diseases; and certain muscular diseases. Manifestations include muscle weakness; fasciculation; muscle atrophy; spasm; myokymia; muscle hypertonia, myalgias, and musclehypotonia. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nociceptors: Peripheral receptors for pain. Nociceptors include receptors which are sensitive to painful mechanical stimuli, extreme heat or cold, and chemical stimuli. All nociceptors are free nerve endings. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH]

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Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Medicine: A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nymph: The immature stage in the life cycle of those orders of insects characterized by gradual metamorphosis, in which the young resemble the imago in general form of body, including compound eyes and external wings; also the 8-legged stage of mites and ticks that follows the first moult. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Occupational Therapy: The field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves. [NIH]

Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculi: Globe or ball of the eye. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic disc: The circular area (disc) where the optic nerve connects to the retina. [NIH]

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Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Optometry: The professional practice of primary eye and vision care that includes the measurement of visual refractive power and the correction of visual defects with lenses or glasses. [NIH] Orbicularis: A thin layer of fibers that originates at the posterior lacrimal crest and passes outward and forward, dividing into two slips which surround the canaliculi. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthotic Devices: Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteodystrophy: Defective bone formation. [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Otolith: A complex calcareous concretion in the inner ear which controls man's sense of balance and reactions to acceleration. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overexpress: An excess of a particular protein on the surface of a cell. [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]

Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine

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consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] 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] Pancreas Transplant: A surgical procedure that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. The healthy pancreas comes from a donor who has just died or from a living relative. A person can donate half a pancreas and still live normally. [NIH] Pancreas Transplantation: The transference of a pancreas from one human or animal to another. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Parturition: The act or process of given birth to a child. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences

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among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peripheral vision: Side vision; ability to see objects and movement outside of the direct line of vision. [NIH] Perspiration: Sweating; the functional secretion of sweat. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmacogenetics: A branch of genetics which deals with the genetic components of variability in individual responses to and metabolism (biotransformation) of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and

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teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [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] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [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] Placental Insufficiency: Failure of the placenta to deliver an adequate supply of nutrients and oxygen to the fetus. [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] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Podiatrist: A doctor who treats and takes care of people's feet. [NIH]

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Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Postural: Pertaining to posture or position. [EU] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prion: Small proteinaceous infectious particles that resist inactivation by procedures modifying nucleic acids and contain an abnormal isoform of a cellular protein which is a major and necessary component. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Professional Practice: The use of one's knowledge in a particular profession. It includes, in the case of the field of biomedicine, professional activities related to health care and the actual performance of the duties related to the provision of health care. [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] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is

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emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU]

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Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] 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] Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupa: An inactive stage between the larval and adult stages in the life cycle of insects. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH]

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Radionuclide Imaging: Process whereby a radionuclide is injected or measured (through tissue) from an external source, and a display is obtained from any one of several rectilinear scanner or gamma camera systems. The image obtained from a moving detector is called a scan, while the image obtained from a stationary camera device is called a scintiphotograph. [NIH]

Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] 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] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractive Power: The ability of an object, such as the eye, to bend light as light passes through it. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of

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treatment. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH]

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Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheology: The study of the deformation and flow of matter, usually liquids or fluids, and of the plastic flow of solids. The concept covers consistency, dilatancy, liquefaction, resistance to flow, shearing, thixotrophy, and viscosity. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rickettsiae: One of a group of obligate intracellular parasitic microorganisms, once regarded as intermediate in their properties between bacteria and viruses but now classified as bacteria in the order Rickettsiales, which includes 17 genera and 3 families: Rickettsiace. [NIH]

Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [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] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to

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create pictures of areas inside the body. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Sequencer: Device that reads off the order of nucleotides in a cloned gene. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino 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] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH]

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Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Medicine: A branch of medicine concerned with the role of socio-environmental factors in the occurrence, prevention and treatment of disease. [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] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] 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]

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Somatosensory Disorders: Disorders of sensory information received from superficial and deep regions of the body. The somatosensory system conveys neural impulses which pertain to proprioception, tactile sensation, thermal sensation, pressure sensation, and pain. Peripheral nervous system diseases; spinal cord diseases; and brain diseases may be associated with impaired or abnormal somatic sensation. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [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 hydrocarbons. [EU]

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Steroid therapy: Treatment with corticosteroid drugs to reduce swelling, pain, and other symptoms of inflammation. [NIH] 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] 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] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Subtrochanteric: Below a trochanter. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron

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releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Tarsus: The region of the articulation between the foot and the leg. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH]

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Tinea Pedis: Dermatological pruritic lesion in the feet, caused by Trichophyton rubrum, T. mentagrophytes, or Epidermophyton floccosum. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tome: A zone produced by a number of irregular spaces contained in the outermost layer of denture of the root of a tooth. [NIH] Tomograph: An X-ray apparatus; an instrument that produces a relatively sharp image of a thin layer of the object, all other layers being blurred by predetermined relative motion of the roentgen tube, film, and subject. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [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] Toxicologic: Pertaining to toxicology. [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] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is

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analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] 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] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ubiquitin: A highly conserved 76 amino acid-protein found in all eukaryotic cells. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in

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the bladder, and leaves the body through the urethra. [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] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visual Cortex: Area of the occipital lobe concerned with vision. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH]

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Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [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] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Walkers: Walking aids generally having two handgrips and four legs. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [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]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX 3 3-dimensional, 14, 101 A Abdomen, 20, 34, 101, 107, 119, 129, 131, 140, 151, 152, 153 Abdominal, 52, 101, 140 Acclimatization, 101 ACE, 101 Acetylcholine, 101, 137 Acidosis, 101, 116 Acoustic, 101 Actin, 101, 135, 136, 155 Activities of Daily Living, 11, 82, 101 Adaptation, 11, 101 Adenine, 101, 145 Adenosine, 101, 108, 142, 153 Adenovirus, 101 Adenylate Cyclase, 101 Adjustment, 101 Adolescence, 102, 140 Adrenal Cortex, 102, 114, 143 Adrenal Medulla, 102, 119, 137 Adrenergic, 102, 117, 119, 152 Adverse Effect, 102, 150 Aerobic, 7, 16, 102 Affinity, 102, 105, 150 Agonists, 10, 102 Airway, 102 Algorithms, 8, 102, 106 Alkaline, 101, 102, 108 Alkaloid, 102, 111, 153 Aloe, 28, 43, 102 Alpha Particles, 102, 145 Alternative medicine, 88, 102 Alveoli, 102, 156 Amino acid, 102, 103, 104, 105, 117, 118, 140, 141, 144, 148, 149, 152, 153, 155 Amino Acid Sequence, 103, 104 Amphetamines, 103, 112 Ampulla, 103, 118 Amputation, 4, 5, 6, 15, 57, 59, 81, 84, 103 Anaerobic, 7, 16, 103 Anaesthesia, 103 Anaesthetic, 20, 103 Anal, 103, 119, 131 Analgesic, 103, 127 Anaphylatoxins, 103, 112 Anaplasia, 103

Anatomical, 14, 103, 111, 128, 134 Anemia, 39, 103, 108, 125 Anemic, 103 Anesthesia, 102, 103 Animal model, 103 Ankle, 4, 9, 18, 19, 20, 23, 59, 76, 77, 79, 82, 85, 103, 104 Ankle Injuries, 76, 85, 103 Ankle Joint, 103, 104 Anomalies, 25, 104 Antibacterial, 104, 151 Antibiotic, 104, 151, 153 Antibiotic Prophylaxis, 104 Antibodies, 104, 127, 135, 142 Antibody, 102, 104, 112, 126, 127, 128, 133, 135, 145, 151 Anticoagulant, 104, 144 Antidepressant, 104, 111 Antifungal, 104, 129 Antigen, 102, 104, 112, 123, 126, 127, 128, 133, 134 Antigen-Antibody Complex, 104, 112 Anti-inflammatory, 104, 105, 114, 124, 127 Anti-Inflammatory Agents, 104, 105, 114 Antiviral, 104, 140 Anuria, 104, 130 Anus, 103, 104 Apolipoproteins, 104, 131 Applicability, 104 Approximate, 77, 104 Aqueous, 104, 106, 115 Archaea, 105, 134 Arginine, 103, 105, 137 Arterial, 7, 18, 105, 111, 127, 144, 153 Arteries, 89, 105, 107, 110, 114, 132, 134, 135, 145 Arterioles, 105, 107, 109 Arteritis, 89, 105 Artery, 105, 114, 140, 145, 148 Arthropathy, 59, 105 Arthroplasty, 20, 105 Articular, 104, 105, 131, 139 Articulation, 105, 134, 153 Aspergillosis, 105, 129 Aspirin, 3, 105 Astrocytes, 105, 134 Atrophy, 105, 137 Atypical, 9, 105

160 Feet

Auditory, 105 Autonomic, 4, 13, 61, 101, 105, 136, 137, 141 Autonomic Neuropathy, 4, 61, 105 B Bacteria, 104, 105, 106, 120, 134, 148, 149, 151, 154, 156 Bacterial Physiology, 101, 106 Bactericidal, 106, 119 Bacteriophage, 106, 154 Base, 52, 55, 101, 106, 115, 116, 129, 130 Basement Membrane, 13, 106, 120, 130 Basophils, 106, 124, 131 Benign, 106, 136, 157 Beta blocker, 58, 106 Bilateral, 19, 106, 140 Bile, 106, 122, 131, 151 Biochemical, 15, 106, 121, 124, 130, 139, 149 Bioengineering, 11, 70, 106 Biomechanics, 106 Biophysics, 106 Biopsy, 106 Biotechnology, 16, 17, 71, 88, 106 Biotin, 28, 34, 106 Biotransformation, 106, 141 Bladder, 105, 107, 113, 122, 155, 156 Blastomycosis, 107, 129 Blood Cell Count, 107, 125 Blood Coagulation, 107, 108, 121, 153 Blood Glucose, 4, 62, 77, 78, 81, 107, 125, 129 Blood Platelets, 107, 149 Blood pressure, 53, 79, 89, 107, 109, 127, 135, 141, 145, 150 Blood transfusion, 107 Blood-Brain Barrier, 107, 131 Body Fluids, 107, 108, 117, 150 Bone Marrow, 37, 107, 123, 132, 135 Bone scan, 107, 148 Bowel, 103, 107, 116, 129 Bradykinin, 107, 137 Brain Diseases, 108, 140, 151 Brain Stem, 108, 110 Branch, 84, 97, 108, 115, 132, 137, 140, 141, 145, 150, 151, 153 Breakdown, 15, 108, 116, 122, 138 Breathing Exercises, 108 Breeding, 108, 130 Buffers, 108 Bunion, 108, 125 Burns, 19, 28, 36, 37, 108

Burns, Electric, 108 Bypass, 18, 108 C Cadaver, 17, 18, 108 Cadmium, 108 Cadmium Poisoning, 108 Caffeine, 108, 145 Calcium, 89, 108, 112, 126, 150, 155 Calcium Channels, 108 Calculi, 109, 124 Calibration, 109 Capillary, 14, 107, 109, 156 Carbohydrate, 109, 114, 124, 149 Carcinogenic, 109, 128, 144, 151 Carcinogens, 109, 138 Carcinoma, 35, 109 Cardiac, 17, 25, 108, 109, 119, 120, 136, 151, 152 Cardiovascular, 17, 62, 105, 108, 109, 149 Cardiovascular disease, 109 Cardiovascular System, 105, 109 Career Choice, 109 Carotene, 44, 109, 147 Case report, 21, 109, 111 Case series, 109, 111 Causal, 109, 119 Cause of Death, 109 Cell Adhesion, 110 Cell Differentiation, 110, 150 Cell Division, 105, 110, 115, 133, 142, 144 Cell membrane, 108, 110, 116, 122, 141 Cell proliferation, 10, 110, 150 Cell Size, 110, 121 Cellulose, 110, 122, 142 Central Nervous System, 101, 103, 108, 110, 112, 122, 131, 134, 139, 149, 153 Centrifugation, 110, 125 Cerebellar, 13, 110 Cerebellum, 12, 108, 110 Cerebral, 9, 107, 108, 110, 115, 119, 138, 144 Cerebral Arteries, 110 Cerebral Cortex, 108, 110 Cerebral Palsy, 9, 110 Cerebrovascular, 109, 110 Cerebrum, 110 Cervical, 25, 86, 110 Cervix, 110 Chemotactic Factors, 110, 112 Chin, 111, 133 Chlorophyll, 111, 122

Index 161

Cholesterol, 58, 79, 106, 111, 114, 131, 132, 151 Cholesterol Esters, 111, 131 Choroid, 111, 147 Chromatin, 111, 119, 132, 137 Chromosomal, 111, 148 Chromosome, 111, 131, 148 Chronic, 7, 20, 37, 89, 107, 111, 113, 128, 130, 149, 152, 157 Chylomicrons, 111, 131 CIS, 111, 147 Citalopram, 111 Clinical Medicine, 111, 143 Clinical study, 111, 114 Clinical trial, 8, 71, 111, 114, 117, 144, 146 Cloning, 106, 111 Coca, 111 Cocaine, 111 Cofactor, 112, 144, 153 Cognition, 112 Cohort Studies, 112, 119 Collagen, 103, 106, 112, 120, 121, 142 Collapse, 108, 112 Complement, 103, 112, 113, 123 Complementary and alternative medicine, 33, 49, 112 Complementary medicine, 33, 113 Compliance, 113 Computational Biology, 71, 113 Computed tomography, 16, 113, 148 Computerized tomography, 113 Conception, 113, 121 Concretion, 109, 113, 139 Conduction, 14, 113 Cones, 113, 147 Confidence Intervals, 113 Connective Tissue, 90, 107, 112, 113, 121, 122, 132, 148, 153 Connective Tissue Cells, 113 Consciousness, 103, 113, 115, 116 Constriction, 113, 129, 148 Consultation, 113 Consumption, 113, 116, 147 Contamination, 113 Contraindications, ii, 113 Contrast medium, 114 Controlled clinical trial, 114 Cooperative group, 114 Coordination, 9, 110, 114 Corn Oil, 15, 114 Coronary, 25, 109, 114, 134, 135 Coronary Angiography, 25, 114

Coronary heart disease, 109, 114 Coronary Thrombosis, 114, 134, 135 Cortex, 12, 114, 139 Cortical, 12, 114, 149 Corticosteroid, 114, 152 Cortisol, 114 Cost Savings, 114 Cranial, 110, 114, 136, 139, 141 Creeps, 17, 114 Criterion, 115 Cross-Sectional Studies, 115, 119 Cues, 115 Curative, 115, 153 Cutaneous, 22, 107, 115 Cyclic, 56, 101, 108, 115, 124, 137, 141, 153 Cyst, 24, 115 Cytogenetics, 115, 148 Cytokine, 15, 115, 140 Cytoplasm, 106, 110, 115, 118, 119, 124, 132, 135, 137, 148 Cytotoxic, 115, 150 D Data Collection, 8, 115 Decompression, 114, 115 Degenerative, 115, 126, 132, 135, 139 Deletion, 115 Delirium, 115 Dementia, 115 Dendrites, 116, 137 Density, 110, 116, 121, 131, 138, 151 Depolarization, 116, 150 Dermal, 79, 116 Detoxification, 116 Developed Countries, 116 Developmental Biology, 116 Diabetes Mellitus, 10, 13, 15, 35, 37, 116, 124, 125 Diabetic Foot, 15, 77, 85, 116 Diabetic Ketoacidosis, 62, 116 Diabetic Retinopathy, 116 Diagnostic Errors, 116, 133 Diagnostic procedure, 51, 88, 116 Diastolic, 116, 127 Digestion, 106, 107, 116, 129, 131, 152 Digestive system, 116, 123 Digestive tract, 105, 116 Direct, iii, 14, 63, 111, 116, 117, 141, 143, 146, 152 Discrete, 116, 153 Disinfectant, 117, 119 Disorientation, 115, 117 Dissection, 17, 117

162 Feet

Distal, 9, 117, 141, 144 Dopa, 117, 131 Dopamine, 112, 117, 131, 137, 141 Dorsal, 10, 117, 143 Double-blind, 117 Double-blinded, 117 Drive, ii, vi, 3, 27, 54, 61, 80, 117 Drug Interactions, 65, 117 Drug Tolerance, 117, 154 Duct, 103, 117, 120 Duodenum, 106, 117, 118, 152 Dyskinesia, 111, 117 E Edema, 19, 37, 86, 116, 117 Effector, 101, 112, 117, 141 Efficacy, 19, 117 Elastic, 55, 118, 151 Elasticity, 55, 118 Elastin, 112, 118, 120 Electrolyte, 114, 115, 118, 130, 150 Electron microscope, 28, 118 Elementary Particles, 118, 132, 137, 144 Embryo, 110, 118 Emodin, 102, 118 Empirical, 118 Endocrine System, 118, 136 Endocrinology, 118, 125 Endoscope, 118 Endoscopic, 118 Endoscopy, 118 Endothelial cell, 107, 118, 153 Endothelins, 10, 118 Endothelium, 118, 137 Endothelium-derived, 118, 137 Endotoxins, 112, 118 Environmental Exposure, 118, 119, 138 Environmental Health, 70, 72, 119 Environmental Monitoring, 119 Enzymatic, 103, 108, 109, 112, 119, 147 Enzyme, 101, 117, 119, 123, 124, 134, 141, 144, 150, 153, 155, 157 Eosinophilia, 119, 121 Eosinophils, 119, 124, 131 Epidemiologic Studies, 119 Epidemiological, 119 Epidermal, 119, 157 Epidermis, 119, 145 Epigastric, 119, 140 Epinephrine, 102, 117, 119, 137, 155 Epithelial, 119, 126, 130 Epithelium, 106, 118, 119 Equipment and Supplies, 62, 119

Erythrocytes, 103, 107, 119 Esophagus, 116, 119, 123, 152 Ethanol, 111, 119 Eukaryotic Cells, 120, 128, 139, 155 Excitability, 9, 120 Excitation, 10, 103, 120, 121, 137 Excrete, 104, 120, 130 Exocrine, 120, 140 Expeditions, 22, 120 Expiration, 108, 120, 147 Extensor, 10, 21, 120 Extracellular, 105, 113, 120, 121, 150 Extracellular Matrix, 113, 120, 121 Extracellular Matrix Proteins, 120 Extracellular Space, 120 Extraction, 120 Extremity, 4, 15, 22, 84, 120 Exudate, 7, 120 Eye Infections, 101, 120 Eye Movements, 12, 120 F Family Planning, 71, 120 Family Practice, 84, 120 Fasciculation, 120, 137 Fasciitis, 81, 85, 90, 121 Fat, 77, 79, 107, 109, 114, 121, 129, 131, 143, 148, 150 Fatigue, 121, 125 Fatty acids, 15, 116, 121 Femoral, 121, 126 Femoral Neck Fractures, 121, 126 Femur, 121, 126 Fetus, 121, 142, 143, 156 Fibroblasts, 113, 121 Fibronectins, 120, 121 Fibrosarcoma, 121 Fibrosis, 121, 148 Financial Management, 121 Flatus, 121, 123 Flexor, 21, 120, 121 Flow Cytometry, 121 Fluorescence, 121, 122 Fluorescent Dyes, 121, 122 Foot Bones, 79, 80, 122 Foot Care, 4, 5, 6, 7, 58, 59, 61, 76, 77, 78, 79, 81, 83, 84, 85, 86, 122 Foot Injuries, 5, 76, 85, 122 Foot Ulcer, 4, 5, 7, 8, 57, 84, 116, 122 Forearm, 107, 121, 122 Fossa, 110, 122 Fundus, 122, 139 Fungi, 7, 104, 105, 120, 122, 134, 157

Index 163

Fungus, 43, 90, 122 G Gait, 12, 90, 122 Gallbladder, 101, 116, 122, 123 Ganglia, 10, 101, 108, 122, 135, 136, 141 Gap Junctions, 122, 153 Gas, 121, 122, 123, 126, 135, 137, 156 Gas exchange, 123, 156 Gastroenterology, 123 Gastrointestinal, 107, 108, 119, 123, 149, 152 Gastrointestinal tract, 119, 123, 149 Gene, 101, 106, 123, 131, 138, 149 Gene Expression, 123 Gene Expression Profiling, 123 Gene Therapy, 101, 123 Genetic Counseling, 123 Genetic Engineering, 106, 111, 123 Genetics, 22, 115, 123, 141 Genital, 86, 105, 123, 125 Genomics, 123 Genotype, 123, 141 Giant Cells, 123, 148 Gland, 102, 114, 123, 132, 140, 149, 152, 153 Glomerular, 89, 123, 130, 147 Glomerulus, 123 Glucocorticoid, 124 Glucose, 62, 77, 107, 110, 116, 124, 125, 127, 129, 148 Glucose Intolerance, 116, 124 Glutamate, 124 Glycoproteins, 108, 121, 124, 129, 144 Glycosaminoglycans, 120, 124 Glycosylation, 124 Gonadal, 124, 151 Gout, 38, 82, 83, 124 Governing Board, 124, 143 Gp120, 124, 140 Grade, 81, 124 Graft, 124, 126 Granulocytes, 124, 150, 157 Granuloma, 21, 124 Guanine, 124, 145 Guanylate Cyclase, 124, 137 Gynecology, 124 H Hair follicles, 125, 157 Hallux Valgus, 20, 125 Health Education, 59, 81, 125 Health Policy, 125 Health Services, 125

Hearing aid, 125 Heart attack, 109, 125 Heart failure, 125 Heartbeat, 125, 152 Helix-loop-helix, 125 Hematocrit, 107, 125 Hemiparesis, 9, 125 Hemodialysis, 125, 130 Hemoglobin, 103, 107, 119, 125 Hemoglobinopathies, 123, 125 Hemolytic, 121, 125 Hemorrhage, 125, 152, 157 Hemostasis, 125, 149 Hepatic, 115, 126 Hepatitis, 126 Hepatocytes, 126 Hereditary, 124, 126, 135, 142 Heredity, 90, 123, 126 Heterotrophic, 122, 126 Hip Fractures, 82, 121, 126 Histology, 126 Homeostasis, 126 Homologous, 123, 126, 152 Hormone, 114, 119, 126, 129, 133, 143, 148, 150, 153 Host, 106, 126 Hybrid, 126 Hybridization, 126 Hydrogen, 101, 106, 108, 109, 120, 126, 135, 137, 138, 139, 144 Hydrophobic, 126, 131 Hygienic, 81, 126 Hyperalgesia, 10, 126 Hypercalcemia, 89, 126 Hypercalciuria, 89, 126 Hyperglycemia, 7, 81, 126 Hyperlipidemia, 58, 126 Hyperoxia, 20, 127 Hypersensitivity, 127, 148 Hypertension, 58, 109, 127 Hyperuricemia, 124, 127 Hypoglycaemia, 115, 127 Hypoglycemia, 58, 62, 127 Hypothalamic, 127 Hypothalamus, 108, 127 Hypoxemia, 127 Hypoxia, 103, 115, 127 I Ibuprofen, 3, 127 Id, 29, 36, 87, 96, 98, 127 Idiopathic, 127, 148 Imidazole, 106, 127

164 Feet

Immersion, 20, 127 Immune response, 104, 114, 127, 152, 156 Immune system, 127, 128, 156, 157 Immunity, 127 Immunodeficiency, 127 Immunodeficiency syndrome, 127 Immunofluorescence, 127 Immunoglobulin, 104, 127, 135 Immunohistochemistry, 127 Immunologic, 110, 127, 140 Immunology, 102, 122, 127 Immunosuppressive, 124, 128 Impairment, 115, 117, 120, 128, 133, 134 Impulsive Behavior, 128 In situ, 128 In Situ Hybridization, 128 In vitro, 123, 128, 154 In vivo, 28, 35, 123, 128 Incidental, 7, 128 Incision, 128, 129 Indicative, 128, 140, 156 Infarction, 128 Infiltration, 89, 128 Infusion, 128, 155 Ingestion, 108, 128, 143 Initiation, 10, 12, 13, 128, 154 Inlay, 128, 147 Inner ear, 128, 139 Innervation, 128 Insight, 128 Insulin, 62, 116, 129, 140 Insulin-dependent diabetes mellitus, 129 Internal Medicine, 84, 118, 123, 129 Intestinal, 109, 129 Intestine, 107, 117, 126, 129, 130 Intoxication, 115, 129, 157 Intracellular, 108, 128, 129, 133, 137, 146, 148, 150 Intravenous, 78, 128, 129 Intrinsic, 102, 106, 129 Invasive, 11, 127, 129, 132 Involuntary, 129, 136, 146, 150, 151 Ion Channels, 105, 129, 153 Ions, 106, 108, 118, 126, 129 Ischemia, 7, 13, 105, 129 Iteration, 8, 129 Itraconazole, 90, 129 J Joint, 9, 19, 35, 52, 79, 83, 104, 105, 121, 129, 139 K Kb, 70, 129

Ketone Bodies, 116, 129 Ketosis, 116, 129 Kidney Failure, 62, 89, 130 Kidney Failure, Acute, 130 Kidney Failure, Chronic, 130 Kidney stone, 130, 155 Kinetics, 108, 130 L Labile, 112, 130 Laboratory Animal Science, 130 Laboratory Personnel, 130 Labyrinth, 128, 130, 144, 149, 156 Lacrimal, 130, 139 Laminin, 106, 120, 130 Large Intestine, 116, 129, 130, 146 Larva, 130, 134 Latency, 130 Lectin, 130, 133 Lenses, 130, 139, 146 Leprosy, 22, 122, 130 Leukemia, 37, 123, 131 Leukocytes, 106, 107, 110, 119, 124, 131, 135, 137 Levodopa, 13, 117, 131 Library Services, 96, 131 Life cycle, 122, 130, 131, 138, 145 Ligaments, 114, 131 Linkage, 10, 131 Lip, 22, 131 Lipid, 104, 129, 131 Lipoprotein, 131, 132 Liposomes, 131 Liver, 89, 101, 106, 116, 122, 123, 126, 131, 148 Liver scan, 131, 148 Liver Transplantation, 131 Localization, 10, 14, 28, 33, 127, 131 Localized, 13, 128, 130, 131, 139, 142, 149, 155 Locomotion, 9, 12, 131, 142 Locomotor, 10, 131 Longitudinal study, 9, 131 Loop, 132 Low-density lipoprotein, 131, 132 Lubricants, 132, 141 Lymph, 89, 110, 118, 132, 148 Lymph node, 89, 110, 132, 148 Lymphatic, 118, 128, 132, 151 Lymphatic system, 132, 151 Lymphocytes, 15, 104, 131, 132, 151, 157 Lymphoid, 104, 132

Index 165

M Macula, 132 Macula Lutea, 132 Macular Degeneration, 132 Magnetic Resonance Imaging, 14, 19, 132, 148 Magnetic Resonance Spectroscopy, 14, 132 Malignant, 121, 132, 136 Mammary, 35, 132 Mannans, 122, 132 Marital Therapy, 133 Medial, 6, 104, 122, 133 Mediator, 117, 133, 149 Medical Errors, 133 Medical Records, 84, 133, 147 Medical Staff, 117, 133 Medication Errors, 133 MEDLINE, 71, 133 Meiosis, 133, 152 Melanin, 133, 141, 155 Membrane Proteins, 131, 133 Memory, 53, 115, 133 Meningitis, 129, 133 Mental, iv, 8, 23, 24, 70, 73, 110, 111, 112, 115, 117, 121, 133, 144, 145, 155 Mental Disorders, 133, 144 Mental Health, iv, 8, 70, 73, 133, 145 Mental Processes, 133, 144 Mental Retardation, 24, 133 Mentors, 134 Mercury, 121, 134 Metabolic disorder, 124, 134 Metabolite, 14, 107, 134 Metamorphosis, 41, 134, 138 Metastasis, 134 Metatarsal Bones, 122, 134 Metatarsophalangeal Joint, 20, 125, 134 Metatarsus, 122, 134 MI, 99, 134 Microbiology, 101, 105, 134 Microglia, 105, 134 Microorganism, 112, 134, 140, 157 Microscopy, 106, 134 Migration, 134 Mobility, 4, 11, 35, 134 Modeling, 16, 134 Modification, 103, 123, 135, 145 Molecule, 104, 106, 112, 117, 118, 120, 124, 125, 130, 135, 138, 139, 146, 150, 156 Monitor, 135, 138 Monoclonal, 135, 145

Monoclonal antibodies, 135 Monocytes, 15, 131, 135 Mononuclear, 121, 124, 135 Morphological, 118, 122, 135 Morphology, 105, 135 Motility, 135, 149 Movement Disorders, 135 Muscle Contraction, 10, 135 Muscle Fibers, 135, 136, 155 Muscle Hypertonia, 135, 137 Muscular Diseases, 135, 137, 140 Musculoskeletal System, 10, 135, 139 Mutagen, 135 Mutagenicity, 135 Myocardial infarction, 114, 134, 135 Myocardium, 134, 135, 136 Myometrium, 136 Myosin, 135, 136, 155 N Nasal Cavity, 136 Nasal Mucosa, 20, 136 NCI, 1, 69, 111, 136 Neonatal, 136 Neoplasia, 136 Neoplasm, 136 Neoplastic, 103, 136 Nephropathy, 58, 136 Nerve, 5, 7, 14, 57, 72, 76, 81, 102, 103, 111, 116, 120, 122, 128, 133, 136, 137, 139, 140, 141, 143, 148, 152, 155 Nerve Endings, 136, 137 Nervous System, 110, 133, 136, 137, 141, 151, 152, 153 Nervous System Diseases, 136, 151 Neural, 12, 20, 134, 136, 151 Neuroendocrine, 136 Neurologic, 10, 136 Neurology, 17, 34, 136 Neuroma, 90, 136 Neuromuscular, 101, 136, 140 Neuromuscular Diseases, 136, 140 Neuronal, 109, 111, 137 Neurons, 10, 12, 14, 112, 116, 122, 131, 136, 137, 152 Neuropathy, 4, 5, 7, 10, 13, 16, 25, 72, 81, 105, 137, 141 Neuropharmacology, 137 Neurophysiology, 116, 137 Neurotoxic, 15, 137 Neurotoxin, 14, 137 Neurotransmitter, 101, 103, 107, 117, 124, 129, 137, 150, 152, 153

166 Feet

Neutrons, 102, 137, 145 Neutrophils, 124, 131, 137 Nitric Oxide, 137 Nitrogen, 102, 120, 130, 137, 155 Nociceptors, 10, 137 Norepinephrine, 102, 117, 137 Nuclear, 120, 138 Nuclear Medicine, 138 Nuclei, 102, 123, 132, 137, 138, 139, 144 Nucleic acid, 126, 128, 137, 138, 143, 145 Nucleic Acid Hybridization, 126, 138 Nucleus, 106, 111, 115, 118, 119, 120, 132, 133, 135, 137, 138, 144 Nymph, 134, 138 O Obstetrics, 138 Occipital Lobe, 138, 156 Occupational Therapy, 82, 138 Ocular, 12, 138 Oculi, 138 Odds Ratio, 138, 147 Oliguria, 130, 138 Oncogene, 138 Opacity, 116, 138 Ophthalmic, 138 Ophthalmology, 138 Opsin, 138, 147, 148 Optic disc, 138 Optic Disk, 116, 132, 139 Optic Nerve, 138, 139, 147 Optometry, 139 Orbicularis, 139 Organ Culture, 139, 154 Organelles, 110, 115, 135, 139 Orthopaedic, 7, 17, 18, 21, 23, 28, 139 Orthotic Devices, 3, 15, 139 Osteoarthritis, 7, 38, 139 Osteodystrophy, 139 Osteomyelitis, 22, 139 Otolith, 12, 139 Outpatient, 72, 139 Overexpress, 139 Oxidation, 107, 116, 139 Oxygenation, 127, 139 P Palliative, 139, 153 Palpation, 28, 139 Pancreas, 62, 101, 106, 116, 123, 129, 140 Pancreas Transplant, 62, 140 Pancreas Transplantation, 62, 140 Paralysis, 125, 140 Paraplegia, 54, 140

Parkinsonism, 131, 140 Parotid, 140, 148 Parturition, 138, 140 Pathogen, 140 Pathogenesis, 140 Pathologic, 101, 106, 108, 114, 127, 140, 143, 151 Pathologies, 140 Patient Education, 8, 58, 59, 72, 76, 84, 94, 96, 99, 140 Pediatrics, 140 Pelvis, 101, 130, 140, 156 Pentoxifylline, 7, 140 Peptide, 103, 140, 144 Peptide T, 140 Perception, 140 Perfusion, 7, 127, 141 Peripheral Nervous System, 136, 137, 140, 141, 152 Peripheral Nervous System Diseases, 137, 140, 141 Peripheral Neuropathy, 4, 13, 15, 59, 61, 62, 72, 141 Peripheral Vascular Disease, 4, 38, 141 Peripheral vision, 141, 156 Perspiration, 81, 141 Petroleum, 78, 141 Pharmacogenetics, 141 Pharmacologic, 103, 141, 154 Phenotype, 10, 141 Phenylalanine, 141, 155 Phosphodiesterase, 140, 141 Phospholipases, 141, 150 Phospholipids, 121, 131, 141 Phosphorus, 13, 108, 141, 142 Phosphorylation, 142 Physical Examination, 83, 142 Physical Fitness, 3, 142 Physical Therapy, 9, 15, 28, 142 Physiologic, 117, 142, 146 Physiology, 61, 118, 123, 124, 137, 142 Pigments, 109, 142, 147 Pilot study, 142 Placenta, 142, 143, 145 Placental Insufficiency, 142 Plants, 102, 108, 111, 118, 124, 130, 135, 137, 142, 143, 148, 154 Plasma, 104, 110, 111, 121, 124, 125, 126, 130, 142 Plasma cells, 104, 142 Plasmids, 142 Platelet Activation, 142, 150

Index 167

Platelet Aggregation, 103, 137, 140, 142 Platelets, 137, 142 Pneumonia, 113, 142 Podiatrist, 6, 7, 81, 83, 85, 86, 90, 142 Poisoning, 108, 115, 129, 134, 143 Polyunsaturated fat, 15, 143 Posterior, 103, 110, 111, 117, 138, 139, 140, 143 Postnatal, 9, 143 Postoperative, 143 Postoperative Complications, 143 Postsynaptic, 143, 150, 153 Post-traumatic, 135, 143 Postural, 11, 12, 13, 143 Potentiation, 143, 150 Practice Guidelines, 73, 143 Preclinical, 143 Precursor, 9, 117, 119, 131, 137, 141, 143, 155 Prenatal, 41, 118, 143 Preoperative, 82, 143 Presynaptic, 136, 137, 143, 152 Prion, 143 Problem Solving, 143 Professional Practice, 139, 143 Progesterone, 143, 151 Progression, 103, 143 Progressive, 89, 110, 116, 117, 124, 130, 139, 142, 143, 147 Projection, 137, 139, 143 Promoter, 144 Prophase, 144, 152 Prophylaxis, 144 Proprioception, 144, 151 Prospective study, 131, 144 Protein C, 103, 104, 106, 131, 144, 155 Protein S, 106, 144, 148, 153 Proteoglycans, 106, 120, 144 Proteolytic, 112, 144 Protocol, 13, 144 Protons, 102, 126, 132, 144, 145 Protozoa, 134, 144 Proximal, 117, 136, 143, 144 Pruritic, 23, 144, 154 Pruritus, 144 Psychiatry, 23, 144, 156 Psychic, 133, 144, 149 Psychology, 144 Psychomotor, 115, 144 Psychotherapy, 133, 145 Public Health, 73, 84, 145 Public Policy, 71, 145

Puerperium, 138, 145 Pulmonary, 107, 113, 130, 145, 156 Pulmonary Artery, 107, 145, 156 Pulmonary Edema, 130, 145 Pulmonary hypertension, 145 Pulse, 53, 135, 145 Pupa, 134, 145 Purines, 83, 145 Pustular, 23, 145 Pyogenic, 139, 145 Q Quality of Life, 145 R Race, 53, 117, 134, 145 Radiation, 35, 101, 118, 119, 121, 145, 148, 157 Radiation therapy, 101, 145 Radioactive, 107, 126, 131, 135, 138, 145, 146, 148 Radiology, 18, 25, 138, 145 Radionuclide Imaging, 146 Radiopharmaceutical, 146 Random Allocation, 146 Randomization, 146 Randomized, 117, 146 Randomized clinical trial, 146 Reagent, 146 Receptor, 10, 101, 104, 117, 124, 140, 146, 149, 150 Receptors, Serotonin, 146, 149 Recombinant, 146, 156 Recombination, 123, 146 Rectum, 104, 116, 121, 123, 130, 146 Recurrence, 15, 24, 146 Refer, 1, 112, 122, 131, 132, 137, 138, 146, 154, 156 Reflex, 14, 20, 35, 36, 40, 41, 42, 120, 146 Refraction, 146, 151 Refractive Power, 139, 146 Regimen, 83, 85, 117, 146 Relative risk, 147 Reliability, 28, 147 Remission, 146, 147 Renal failure, 115, 125, 147 Research Design, 16, 147 Research Support, 147 Respiration, 108, 135, 147 Respiratory Physiology, 147, 156 Restoration, 28, 34, 142, 147, 157 Retina, 111, 113, 116, 132, 138, 139, 147, 157 Retinal, 12, 116, 139, 147, 148

168 Feet

Retinol, 147, 148 Retrospective, 25, 147 Retrospective study, 25, 147 Retroviral vector, 123, 148 Rheology, 140, 148 Rheumatism, 19, 127, 148 Rheumatoid, 15, 19, 22, 39, 148 Rheumatoid arthritis, 15, 19, 22, 148 Rhodopsin, 138, 147, 148 Ribosome, 148, 155 Rickettsiae, 148 Risk factor, 58, 80, 119, 144, 147, 148 Risk patient, 8, 148 S Sanitation, 148 Saponins, 148, 151 Sarcoidosis, 89, 148 Satellite, 10, 148 Scans, 16, 19, 148 Scleroderma, 39, 121, 149 Screening, 84, 85, 111, 149 Sebaceous, 149, 157 Secretion, 114, 129, 134, 141, 149 Secretory, 149, 152 Sedentary, 149 Sediment, 149 Seizures, 115, 149 Self Care, 82, 101, 149 Semicircular canal, 12, 128, 149 Sensibility, 103, 126, 149 Sensor, 53, 149 Sepsis, 149 Septic, 149 Sequence Analysis, 149 Sequence Homology, 140, 149 Sequencer, 149 Sequencing, 149 Serotonin, 111, 137, 146, 149, 155 Serum, 39, 103, 112, 130, 132, 149 Shedding, 149 Shock, 4, 17, 22, 39, 150, 155 Side effect, 63, 90, 102, 111, 127, 150, 154 Signal Transduction, 150 Signs and Symptoms, 80, 147, 150 Skeletal, 14, 18, 25, 135, 150, 151, 155 Skeleton, 101, 121, 129, 150 Smooth muscle, 103, 108, 113, 135, 136, 150, 151, 152 Sneezing, 149, 150 Social Environment, 145, 150 Social Medicine, 150 Sodium, 124, 150, 152

Soft tissue, 16, 107, 121, 150 Solvent, 119, 150 Soma, 150 Somatic, 102, 133, 141, 150, 151 Somatosensory Disorders, 14, 151 Sound wave, 113, 151 Soybean Oil, 143, 151 Spasm, 137, 151 Spasticity, 14, 151 Specialist, 72, 91, 151 Species, 119, 126, 133, 134, 135, 142, 145, 149, 151, 155, 157 Specificity, 102, 108, 151 Spectrum, 134, 151 Spinal cord, 14, 54, 105, 108, 110, 111, 136, 137, 140, 141, 146, 151 Spinal Cord Diseases, 140, 151 Spleen, 89, 132, 148, 151 Stabilizer, 4, 151 Staging, 148, 151 Sterile, 151 Sterilization, 151 Steroid, 89, 114, 148, 151, 152 Steroid therapy, 89, 152 Stimulus, 117, 120, 128, 129, 130, 146, 152, 153 Stomach, 101, 116, 119, 122, 123, 126, 129, 151, 152 Stress, 7, 56, 83, 84, 85, 114, 148, 152 Stroke, 9, 11, 70, 109, 152 Subacute, 128, 152 Subclinical, 13, 128, 149, 152 Subcutaneous, 7, 22, 117, 152 Substance P, 134, 149, 152 Subtrochanteric, 126, 152 Sudden death, 152 Sulfur, 120, 152 Supplementation, 28, 34, 152 Sweat, 127, 141, 152 Sympathomimetic, 117, 119, 137, 152 Symptomatic, 25, 152 Synapse, 102, 143, 152, 155 Synapsis, 152 Synaptic, 137, 150, 152 Synaptic Transmission, 152 Synergistic, 153 Systemic, 64, 65, 89, 107, 115, 119, 128, 145, 148, 149, 153 Systolic, 127, 153 T Tardive, 111, 153 Tarsus, 122, 153

Index 169

Tendinitis, 81, 153 Tendon, 21, 151, 153 Tetracycline, 153 Theophylline, 145, 153 Therapeutics, 34, 66, 153 Thermal, 14, 28, 34, 36, 137, 151, 153 Thigh, 121, 153 Thorax, 101, 153 Threonine, 140, 153 Threshold, 8, 10, 120, 127, 153 Thrombin, 142, 144, 153 Thromboembolism, 153 Thrombomodulin, 144, 153 Thrombosis, 144, 152, 153 Thyroid, 153, 155 Tin, 19, 28, 114, 141, 153 Tinea Pedis, 28, 154 Tissue Culture, 154 Tolerance, 124, 154 Tome, 44, 49, 154 Tomograph, 17, 154 Tomography, 113, 132, 148, 154 Tone, 85, 135, 151, 154 Tonus, 154 Tooth Preparation, 101, 154 Topical, 17, 64, 65, 119, 154 Toxic, iv, 119, 127, 137, 154 Toxicity, 117, 118, 134, 154 Toxicologic, 154 Toxicology, 72, 154 Toxin, 14, 64, 154 Trace element, 153, 154 Transcription Factors, 154 Transduction, 150, 154 Transfection, 106, 123, 154 Transferases, 124, 155 Transfusion, 155 Translating, 155 Translation, 103, 155 Translational, 155 Transmitter, 101, 105, 117, 129, 133, 137, 155 Transplantation, 62, 130, 155 Trauma, 4, 7, 15, 115, 155 Tricyclic, 111, 155 Tropomyosin, 155 Troponin, 155 Tryptophan, 112, 149, 155 Tyrosine, 117, 155 U Ubiquitin, 155 Ulcer, 4, 7, 15, 155

Ulceration, 7, 8, 155 Unconscious, 127, 155 Uremia, 130, 147, 155 Urethra, 155, 156 Uric, 83, 124, 127, 145, 155 Urinary, 89, 109, 138, 155 Urine, 89, 104, 107, 126, 129, 130, 138, 155 Uterus, 110, 122, 136, 143, 156 V Vaccine, 144, 156 Vasoactive, 10, 156 Vasodilator, 107, 117, 156 Vector, 154, 156 Vein, 129, 138, 140, 148, 156 Venous, 37, 107, 144, 156 Ventilation, 156 Ventricle, 127, 145, 153, 156 Venules, 107, 109, 156 Vertebrae, 151, 156 Vesicular, 156 Vestibular, 12, 156 Vestibule, 128, 149, 156 Veterinary Medicine, 71, 156 Vinca Alkaloids, 156 Vincristine, 35, 156 Viral, 121, 123, 154, 156, 157 Virus, 106, 123, 124, 148, 154, 156 Visceral, 105, 156 Visual Cortex, 12, 156 Visual field, 156 Vitreous, 116, 147, 157 Vitreous Body, 147, 157 Vitreous Hemorrhage, 116, 157 Vitro, 157 Vivo, 15, 157 Vulgaris, 44, 157 W Wakefulness, 115, 157 Walkers, 23, 82, 157 Warts, 39, 86, 87, 157 White blood cell, 104, 131, 132, 142, 157 Withdrawal, 115, 157 Wound Healing, 157 X Xenograft, 103, 157 X-ray, 16, 81, 113, 114, 121, 135, 138, 145, 148, 151, 154, 157 Y Yeasts, 90, 122, 141, 157 Z Zymogen, 144, 157

170

Index 171

172 Feet

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

Flat Feet: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References