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

EARLY

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

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

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Early Pregnancy: 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: 0-597-83901-8 1. Early Pregnancy-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 early pregnancy. 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 EARLY PREGNANCY .................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Early Pregnancy ........................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 26 The National Library of Medicine: PubMed ................................................................................ 27 CHAPTER 2. NUTRITION AND EARLY PREGNANCY ........................................................................ 73 Overview...................................................................................................................................... 73 Finding Nutrition Studies on Early Pregnancy .......................................................................... 73 Federal Resources on Nutrition ................................................................................................... 76 Additional Web Resources ........................................................................................................... 77 CHAPTER 3. ALTERNATIVE MEDICINE AND EARLY PREGNANCY.................................................. 79 Overview...................................................................................................................................... 79 The Combined Health Information Database............................................................................... 79 National Center for Complementary and Alternative Medicine.................................................. 80 Additional Web Resources ........................................................................................................... 80 General References ....................................................................................................................... 81 CHAPTER 4. DISSERTATIONS ON EARLY PREGNANCY.................................................................... 83 Overview...................................................................................................................................... 83 Dissertations on Early Pregnancy ............................................................................................... 83 Keeping Current .......................................................................................................................... 84 CHAPTER 5. PATENTS ON EARLY PREGNANCY .............................................................................. 85 Overview...................................................................................................................................... 85 Patents on Early Pregnancy ........................................................................................................ 85 Patent Applications on Early Pregnancy..................................................................................... 94 Keeping Current .......................................................................................................................... 98 CHAPTER 6. BOOKS ON EARLY PREGNANCY .................................................................................. 99 Overview...................................................................................................................................... 99 Book Summaries: Federal Agencies.............................................................................................. 99 Book Summaries: Online Booksellers......................................................................................... 100 The National Library of Medicine Book Index ........................................................................... 101 Chapters on Early Pregnancy .................................................................................................... 103 Directories.................................................................................................................................. 104 CHAPTER 7. MULTIMEDIA ON EARLY PREGNANCY ..................................................................... 105 Overview.................................................................................................................................... 105 Bibliography: Multimedia on Early Pregnancy ......................................................................... 105 CHAPTER 8. PERIODICALS AND NEWS ON EARLY PREGNANCY .................................................. 107 Overview.................................................................................................................................... 107 News Services and Press Releases.............................................................................................. 107 Academic Periodicals covering Early Pregnancy....................................................................... 111 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 113 Overview.................................................................................................................................... 113 U.S. Pharmacopeia..................................................................................................................... 113 Commercial Databases ............................................................................................................... 114 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 117 Overview.................................................................................................................................... 117 NIH Guidelines.......................................................................................................................... 117 NIH Databases........................................................................................................................... 119 Other Commercial Databases..................................................................................................... 121 APPENDIX B. PATIENT RESOURCES ............................................................................................... 123

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Overview.................................................................................................................................... 123 Patient Guideline Sources.......................................................................................................... 123 Finding Associations.................................................................................................................. 127 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 129 Overview.................................................................................................................................... 129 Preparation................................................................................................................................. 129 Finding a Local Medical Library................................................................................................ 129 Medical Libraries in the U.S. and Canada ................................................................................. 129 ONLINE GLOSSARIES................................................................................................................ 135 Online Dictionary Directories ................................................................................................... 135 EARLY PREGNANCY DICTIONARY....................................................................................... 137 INDEX .............................................................................................................................................. 189

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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 early pregnancy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about early pregnancy, 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 early pregnancy, 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 early pregnancy. 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 early pregnancy, 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 early pregnancy. 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 EARLY PREGNANCY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on early pregnancy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and early pregnancy, 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 “early pregnancy” (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: •

Maternal Postprandial Glucose Levels and Infant Birth Weight: The Diabetes in Early Pregnancy Study Source: American Journal of Obstetrics and Gynecology. 164(1, Part 1): 103-111. January 1991. Summary: This article reports on the Diabetes in Early Pregnancy Study, supported by the National Institute of Child Health and Human Development, which recruited women with insulin-dependent diabetes and control women before conception, in order to address the relationship between maternal glycemia and percentile birth weight. Data were analyzed from 323 women with diabetes and 361 controls. Fasting and nonfasting venous plasma glucose were measured on alternate weeks in the first trimester and monthly thereafter. Glycosylated hemoglobin was measured weekly in the first trimester and monthly thereafter. Results show that more infants of the women with

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diabetes were at or above the 90th percentile for birth weight than were infants of control women. The authors stress that monitoring of nonfasting glucose levels, rather than the fasting levels, which are more commonly monitored in clinical practice, is necessary to prevent macrosomia. 2 figures. 7 tables. 29 references. (AA-M).

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

Project Title: AKT 1 AND MAMMARY CELL SURVIVAL DURING THE ESTRUS CYCLE Principal Investigator & Institution: Strange, Robert; Scientist; Amc Cancer Research Center 1600 Pierce St Denver, Co 80214 Timing: Fiscal Year 2001; Project Start 01-JAN-2001; Project End 31-DEC-2004 Summary: Breast cancer can result from excessive proliferation and/or insufficient apoptosis of mammary epithelium. During a woman's life, the breast undergoes dramatic developmental changes with associated changes in proliferation and apoptosis. Reproductive factors associated with increased ovarian hormone exposure, e.g. early menarche and late menopause, increase breast cancer risk. Conversely, factors such as late menarche, early pregnancy and oophorectomy decrease that risk. Not all women become pregnant nor is it likely that early pregnancy or oophorectomy will become generally recommended to decrease breast cancer. In contrast, virtually all women menstruate and, during each menstrual cycle, their mammary epithelium undergoes proliferation, differentiation and apoptosis. If proliferation and apoptosis are not well balanced during the menstrual cycle, these cyclic changes may result in mammary hyperplasia and an increased risk for breast cancer. This is the context in which we propose to study the role of AICt 1 in mammary gland development. Akt I activation is common to hormone, growth factor and anchorage mediated epithelial cell survival and Ha-rasinduced tumorigenesis. Akt I has been shown to inhibit apoptosis induced by hormone or growth factor withdrawal and loss of anchorage. Thus, expression and activation of Akt 1 is shared by a number of pathways important for cell survival, and may link very different paths to breast cancer. We found decreased Akt 1 activation in

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

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the mammary gland during involution and the estrus cycle during periods of apoptosis. Akt 1 expression and activation peaks in lactation, then decreases during the period of epithelial cell apoptosis m involution. A similar pattern is found in the mammary gland during the estrus cycle, Akt- 1 activation is strong during proestrus and estrus, and is strongly decreased during metestrus and recovers in diestrus. This pattern is consistent with a role in modulating cell survival and it led us to examine Akt 1 expression in mammary hyperplasias and tumors. AIct 1 expression and activation was increased in three different lines of hyperplasia and was strongly increased in tumors with very different etiologies. These data support the hypothesis that increased expression or activation of Aki 1 is able to alter the survival of mammary epithelial cells by inhibiting apoptosis and thus, contributes to mammary tumorigenesis. Furthermore, these data suggest that inhibition of Akt activation in mammary hyperplasia may impede mammary carcinogenesis. We propose to examine these hypotheses by: 1) irnmunoblot and immunobistochemical analyses of Akt 1 activation and signaling pathways effected in the mammary gland during involution and the estrus cycle; studying the role of hormone milieu in regulation of expression and activation of Akt 1 in mammary cell cultures and inhibiting Aict activation in breast cancer cells; 2) examining the role of activated AIct 1 in mammary epithelial cell survival during the estrus cycle and it's potential contribution to mammary hyperplasia usmg myr-Akt 1 transgenic mice; and 3) studying the potential for inhibiting tumorigenesis in high risk mammary hyperplasia cells by expressing a dominant negative Akt i in mammary fat pad implants of TM-4 hyperplasia cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALCOHOL AND BRAIN DEVELOPMENT Principal Investigator & Institution: West, James R.; Professor; Human Anatomy and Medical Neurobiology; Texas A&M University Health Science Ctr College Station, Tx 778433578 Timing: Fiscal Year 2001; Project Start 29-SEP-1994; Project End 30-JUN-2004 Summary: (Adapted from the Investigator's Abstract) Although it has been 25 years since fetal alcohol syndrome (FAS) was first defined, it is still not clear whether or not the embryo suffers long-term brain deficits after alcohol exposure early in gestation. Since many women are binge drinkers, including those who can stop or significantly reduce their alcohol consumption once they are aware they are pregnant, and since many of them will not know they are pregnant for at least several weeks after conception, binge drinking during this early period may represent a very dangerous practice. Alarmingly, recent studies have provided evidence that contradicts the commonly held view that early pregnancy is not a vulnerable period for inducing birth defects. Therefore, until we understand the consequences of such exposure, misconceptions about the vulnerability of the conceptus during early development increases the likelihood of alcohol related birth defects, and delays the chances that the cause of those birth defects will be identified. This competitive renewal application represents the first comprehensive attempt to evaluate the effects of binge-like alcohol exposure during different discrete developmental events early in pregnancy on longterm structure and function of the brain. First, it utilizes the C57BL/6J mouse, which is known to be susceptible to alcohol-induced craniofacial and brain dysmorphology associated with FAS. Second, the timing of the alcohol exposure will focus on discrete embryonic events. Third by using a standard series of peak blood alcohol concentrations, it will be possible to compare the "relative vulnerability" of different early prenatal periods. The studies will determine whether embryos exposed to alcohol

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during early development, even at blood alcohol concentrations (BACs) below that resulting in facial dysmorphology, nevertheless display lasting central nervous system dysfunction. Specific Aim #1 will evaluate the effects of oral alcohol exposure occurring during gastrulation (gestation day [GD] 7:0) on fetal (GD14:0) somatic growth, brain morphology and craniofacial anomalies, to determine the threshold at which brain deficits may be induced in the absence of craniofacial dysmorphology. Specific Aim #2 will evaluate the effects of alcohol exposure during specific developmental events from fertilization to early gestation. Specific Aim #3 will test the hypothesis that binge-like alcohol exposure that is time-locked to specific developmental events early in development will have more deleterious effects than will similar duration of alcohol exposure that specifically misses the critical events identified in Specific Aim #2. The results will be beneficial for counseling women about the risks of drinking during the initial weeks of pregnancy, and may help to explain the variation in brain damage observed in children damaged by in utero alcohol exposure. The studies also will provide the foundation for mechanistic studies to identify how alcohol exposure damages the developing conceptus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANTIGEN-SPECIFIC MEMORY CD8+ T-CELLS IN PREGNANCY Principal Investigator & Institution: Constantin, Carolyn M.; None; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 17-SEP-2001 Summary: This study will employ an experimental design to determine if the in viva generation of antigen-specific memory CDS+ T-cells in response to an acute viral infection is altered in pregnancy. Lymphocyticchoriomeningitis virus (LCMV) infection in mice will serve as the experimental model. Analysis will include comparing the frequencies of antigen-specific CD percent memory T-cells generated in mice infected with LCMV in early pregnancy (day 7 of gestation) with nonpregnant mice infected at the same time. Genetically identical S-10 week old female C57BL/6 mice will be randomly assigned to the experimental (N=50) and control (N=50) group. The experimental group will be impregnated, then both groups infected with LCMV (Armstrong strain) and allowed to clear the virus. Antigen-specific memory CD8+ Tcells will be enumerated by major histocompatibility complex (MHC) class I tetramer staining for the three immunodominant epitopes." Functional capability of the cells will be evaluated using intracellular cytokine (ICC) staining for the presence of interferongamma (IFNy) and tumor necrosis factor-alpha (TNF) in response to stimulation with cognate peptide as well as plaque assays to assess clearance of the virus. This study will produce data to determine if there is a difference in the generation of antigen specific memory CD8+ T-cells to an acute viral infection in pregnant mice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BIRCWH CAREER DEVELOPMENT PROGRAM Principal Investigator & Institution: Coustan, Donald R.; Women and Infants HospitalRhode Island 101 Dudley St Providence, Ri 02905 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-JUL-2007 Summary: (provided by applicant): The goal of the Brown University BIRCWH Career Development Program is to promote the performance of interdisciplinary research and transfer of findings that will benefit the health of women through the development of well-qualified women's health investigators. The program will achieve this goal by

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accomplishing the following objectives: (1) Provide each Interdisciplinary Women's Health Research scholar with a curriculum tailored to his/her scientific research development needs and interests. Courses will be offered in statistical methods, research design, conduct of research, women's health and gender issues, pathobiology, scientific publishing, grant writing, and additional "tools" necessary to become a successful independent investigator in women's health; (2) Provide each scholar with an intensive exposure to interdisciplinary women's health research and a suitable mentor who can provide the guidance and expertise to assure successful academic development; (3) Provide the research infrastructure (laboratory and research assistants, methodologists, data managers, and statistical support) and adequate protected time to create an environment conducive to investigation into women's health. The program will take advantage of the existing strengths of the Departments of Molecular Microbiology and Immunology and Molecular Biology, Cell Biology and Biochemistry, and Community Health at Brown University, Brown Medical School and its affiliated hospitals, Women & Infants Hospital Division of Research and George Anderson Outcomes Measurement Unit, the Woods Hole Marie Biological Laboratory, the National Perinatal Information Center, and the Cancer Prevention Research Center at the University of Rhode Island. Potential research projects focus in the following five major areas with applications in women's health: (1) Prevention and Behavior Change; (2) Gender Issues in Women's Health; (3) Health Services Research, Epidemiology and Biostatistics; (4) HIV and AIDS in Women; and (5) Obstetric and Gynecologic Research, including perinatal diagnosis and management, screening in early pregnancy, translational immunology, and developmental biology and cell dynamics. This interdisciplinary and cross-institutional program will provide a new cadre of academic investigators who will further the scientific database and improved the health status of women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CELLULAR AND MOLECULAR ASPECTS OF IMPLANTATION Principal Investigator & Institution: Paria, Bibhash C.; Pediatrics; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The formation of deciduum following implantation is considered to function as a protective barrier to the embryo from the maternal insults. Thus, defective implantation and uterine decidualization may account for early pregnancy losses. Identification of embryonic cell-type(s) and embryonic factor(s) for implantation and decidualization will be a major achievement to improve fecundity. The tight junction (TJ) that creates a barrier restricting the paracellular permeability is present only in cells of the epithelium, but not in the stroma. We noticed for the first time that the stromal cells of the primary decidual zone (PDZ) surrounding the implanting blastocyst, but not the secondary decidual zone (SDZ), on day 6 of pregnancy express the TJ and its associated proteins, occludin, claudin-1, and zonula occludens-1 (ZO-1) and ZO-2. Our preliminary results show that the trophoblast (Tr), but not the inner cell mass (ICM), of the blastocyst induces implantation and decidualization reactions with correct expression of ZO-1 in the PDZ. We also provide evidence here that heparin binding-epidermal growth factor-like growth factor (HBEGF) produced by the blastocyst is important for implantation, decidualization, and ZO1 expression in the PDZ. These observations together with the restriction of passage of macromolecular dye to the PDZ induced by normal blastocysts after intravenous administration, but not by artificially induced decidualization, suggest that the embryonic HB-EGF influences implantation, the PDZ formation, and genesis of the TJ in

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the PDZ which creates an avascular permeability barrier to protect the embryo. Therefore, our specific aims are to determine in a murine model: 1) Influence of the Tr in implantation and the PDZ formation, 2) Influence of embryonic HB-EGF in implantation and the PDZ formation, 3) Influence of HB-EGF in the transformation of stromal cells to decidual cells with epithelial characteristics, and 4) The importance of the PDZ as a barrier at the maternal-fetal interface. We will use multiple experimental approaches including RT-PCR, Northern and in situ hybridizations, immunohistochemistry/ immunofluorescence, Western blotting, phosphorylation, electron microscopy, embryo culture and transfer, cell culture, in vivo/in vitro adenoviral vector-driven gene delivery, and others to accomplish our goals. These results will further our understanding regarding uterine protective mechanism(s) to the safeguard of the implanting embryo during early pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CENTER FOR REPRODUCTIVE SCIENCES Principal Investigator & Institution: Terranova, Paul F.; Director & Professor; Physiology; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2001; Project Start 23-APR-1996; Project End 31-MAR-2006 Summary: The University of Kansas Medical Center proposes to establish a U54 Specialized Cooperative Center in Reproductive Research that addresses cutting edge molecular and cellular issues of infertility related to male, female, and establishment of early pregnancy. Three cores and four research projects are proposed by outstanding and well-known reproductive biologists who have dedicated their careers to this field. Project I, Regulation of SF-1 Expression in the Gonads, will use a rodent model system to identify transacting factors regulating SF-1 expression in the testis, characterize the transcription factors, USF1 and 2, regulating SF-1 expression, and identify the minimal region of the Ftz-Z1 gene required for correct spatial and temporal expression of SF-1. The pivotal nature of SF-1 in gonadal development and steroidogenesis underscores the importance of identifying events leading to SF-1 induction and those responsive to SF1's activity. Project II, Src Tyrosine Kinase Regulates Ovarian Function, will examine in mice and humans and its role in ovarian follicular development mechanisms by which Src tyrosine kinase regulates responses of ovarian cells to gonadotropins. Project III, Aspects of Uterine Vascular Changes and Angiogenesis during Implantation will test in mice the hypothesis that vascular endothelial cell growth factor, its receptors and neuropilin-1 are important mediators of vascular permeability and angiogenesis required for implantation and decidualization. In addition, it is hypothesized that failure of implantation in cyclooxygenase-2 null mice is the result of aberrant uterine expression of these genes during the critical peri-implantation period. Project IV, TRAIL and the Human Implantation Site, will investigate the role of trophoblastic TRAIL and its receptors in modulating immunological interactions at the implantation site as well as directing development and function in early human placentas. The Cell Culture and the Tissue Analysis Core and Imaging Core are well established, cost effective cores that will operate as open access since there are numerous NICHD grants approved for core access that complement the U54 projects. The Administrative Core will promote scientific exchange and assist in management of U54 cores and projects. Overall, the Kansas U54 Center, which has been a major focus in this institution for more than three decades, will serve as an efficient, cost-effective vehicle for promoting contemporary research on fertility and infertility. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHICAGO WOMENS INTERAGENCY HIV STUDY CONSORTIUM Principal Investigator & Institution: Cohen, Mardge H.; Hektoen Institute for Medical Research 2100 W Harrison Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 01-JAN-1994; Project End 30-NOV-2002 Summary: The Chicago WIHS cohort consists of 223 HIV infected and 47 HIV uninfected women in 4 sites; the population of the cohort reflects the epidemic in women in Chicago and the nation. The collaborating institutions and investigators have developed an effective and efficient research infrastructure, with strong and consistent impact on the local and national levels. As a part of the national multi-center prospective study, the Chicago consortium continues to investigate a large number of the manifestations and ffects of HIV: including clinical effects, disease progression, as well as immunological, virological, psychosocial and behavioral impact. For WIHS II, the specific aims of the Chicago Consortium are to: 1) Determine how the immunologic, virologic, genetic, coinfections, sexual and drug behaviors, class, and social support system affects the progression of HIV disease in women; 2) Determine the rate of emergence of Protease Inhibitor Resistance; 3) Define the gender-specific characteristics of HIV disease in women, with particular attention to cervical dysplasia, HPV, the virology immunology of the genital tract, gynecologic infections, and hormonal influences; 4) Define the effect of early pregnancy on HIV disease and coincident infections; 5) Describe the role of malignancies to HIV infection; 6) Describe the correlation between oral health and HIV infection; 7) Identify the impact on HIV on the psychological and social status of women including quality of life, depression, neuropsychologic functioning and family interactions; 8) Characterize factors that may interact to influence experiences of HIV infected women in terms of their access to care, compliance with treatment and psychological and social outcomes; 9) Identify activities, attitudes and immune responses which lead at-risk women in the WIHS seronegative control group to seroconvert while others do not; and 10) Develop methods to increase the enrollment and retention of women, ethnic minorities, and socially disenfranchised individuals in clinical research. These aims are possible to accomplish because of the cooperation of the women of WIHS and the interconnected synergy which occurs among the large and dedicated group of clinical scientists who are our investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ENDOCANNABINOID SIGNALING DURING EARLY PREGNANCY Principal Investigator & Institution: Dey, Sudhansu K.; Professor; Pediatrics; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 01-JUL-1990; Project End 30-NOV-2007 Summary: (provided by applicant): Synchronized embryonic development to the blastocyst stage, preparation of the receptive uterus and reciprocal embryo-uterine interactions are critical to implantation. Mechanisms that coordinate these events are not clearly understood. N-arachidonoylethanolamine (anandamide) and 2arachidonoyglycerol (2-AG) function as endogenous ligands (endocannabinoids) for cannabinoid receptors (CB1 and CB2). CB1 and CB2 are G protein-coupled receptors. Their activation inhibits adenylyl cyclase and of N- or P/Q-type Ca++ channels, but induces activation of mitogen-activated protein kinase (MAPK). Our recent observation of expression of functional CB1 in mouse embryos, uterine anandamide synthesis, and dose-dependent anandamide effects on embryo development and implantation suggests that endocannabinoid signaling is important for these processes. Moreover, levels of uterine anandamide and blastocyst CB1 are coordinately down-regulated prior to

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implantation, but remain high during delayed implantation. These results suggest that lower, but not higher levels, of anandamide and CB1 are beneficial for implantation. Indeed, we noted that a low dose of anandamide stimulates blastocyst growth, but a higher dose inhibits this growth. The mechanisms of these biphasic effects still remain elusive. Collectively, the results suggest that endocannabinoid signaling has a biphasic role during pregnancy. We propose that while uterine endocannabinoids and blastocyst CB1 at specific levels play a physiological role in synchronizing embryonic development and uterine receptivity for implantation, their aberrant levels interfere with these processes, and that endocannabinoids mediate these biphasic effects using different signaling pathways. Our specific aims are to study in mice: (1) Are the levels of uterine 2-AG regulated in a similar fashion as anandamide? (2) Do ovarian steroids regulate uterine fatty acid amide hydrolase (FAAH) expression? (3) Do cyclooxygenase-2 (COX2) and FAAH interact in regulating uterine endocannabinoid levels? (4) Does biphasic role of endocannabinoids on embryo development and implantation involve different signaling pathways? (5) Are implantation and pregnancy maintenance altered in the absence of cannabinoid receptors? Our proposed genetic, molecular and physiological approaches using mice as an animal model will provide valuable information for better understanding of risks and benefits of cannabinoid signaling during human pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAMILY & MENTAL HEALTH IN HIV RISK--ADOLESCENT FOLLOWUP Principal Investigator & Institution: Paikoff, Roberta L.; Associate Professor; Psychiatry; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 01-SEP-1993; Project End 31-JAN-2003 Summary: (Applicant's Abstract): This competing continuation application requests funds to extend a longitudinal project examining the role of family and mental health factors in HIV risk exposure during the transition to adolescence to mid-late adolescence -- the time when most youth are likely to be involved in sexual and other risk behaviors (e.g., IV drug use) that can lead to exposure to HIV, other sexually transmitted diseases, early pregnancy or fatherhood, and other negative health consequences. A sample of 315 urban African-American families living in high rise housing neighborhoods in Chicago were first contacted when their children were pre-adolescent (10-12 years of age) and followed through early adolescence (12-14 years of age). Continued funding is requested to follow the sample to mid-late adolescence (16-18 years of age), in order to better understand the influence of pre and early adolescent experiences upon HIV risk exposure in later adolescence. At the initial two data waves, extensive videotape interaction and interview data were collected on individual (mental health, cognitive level, pubertal development), familial support, supervision/monitoring, control/decision-making, conflict, affect, problem solving, and communication) and friendship (support, values) factors, as well as upon HIV/AIDS knowledge and attitudes, and HIV risk behavior. The proposed follow-up wave would focus on these same factors, adapting as needed to new developmental levels. For example, in addition to videotaping the family, same sex friends would be requested to be involved in data collection, as such relationships may be powerful in communication of risk and behavioral decision making. In addition to assessment of friendship relationships, qualities of romantic relationships (with the possibility of both same and other sex relationships) will be assessed. An extensive strategy for recruitment and tracking and for adapting of assessments is proposed; included in this strategy is development of a youth collaborative board to advise on these issues. Results will be used to further

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develop existing programs aimed at primary and secondary prevention of HIV risk exposure for urban African-American youth and families, as well as to explore new possibilities for the incorporation of friendship and romantic partner relationships into these programs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FSH DIRECTED SIGNALING IN GRANULOSA CELLS--ROLE OF AKAP Principal Investigator & Institution: Hunzicker-Dunn, Mary E.; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001 Summary: Differentiation of granulosa cells from an immature to a mature phenotype is regulated by FSH-stimulated activation of cAMP-dependent protein kinase (PKA). While some early and many late response genes have been identified downstream of PKA in immature granulosa cells, the signaling pathways beyond PKA which lead to activation of these genes are poorly understood. We have determined in immature cells that FSH-activated PKA directly phosphorylates the nuclear protein histone H3 and that PKA promotes the unique activation of both the p38 and p42/44 mitogen activated protein kinase (MAPK) pathways; these pathways are inhibited by cAMP in most other cells. Activation of PKA in mature granulosa cells (by LH) similarly promotes activation of the p42/44 MAPK pathway and phosphorylation of histone 3, but as shown by others, leads to down-regulation of some of the late response genes activated in immature granulosa cells and up- regulation of other proteins. Recent studies suggest that the cellular location of PKA (a) is a critical determinant for phosphorylation of appropriate target proteins and (b) is regulated by association with A- kinase anchoring proteins (AKAPs). We hypothesize that the unique responses of granulosa cells to PKA, like MAPK activation, and distinct responses between immature versus mature cells are mediated in part by specific expression of one or more AKAPs. In support of this hypothesis, we have demonstrated that FSH promotes the induction of an 80 kDA AKAP which preferentially binds RIIalpha, and that expression of AKAP 80 promotes the redistribution of PKAIIalpha in mature granulosa cells. Aims of this proposal will test the hypotheses that actions of FSH in immature granulosa cells require anchoring of PKA to AKAPs; that the FSH-inducible 80 kDA AKAP is a unique protein which colocalizes with PKAIIalpha in preovulatory granulosa cells; and that AKAP 80 is required for PKA to activate responses characteristic of mature granulosa cells; This basic knowledge of how cAMP/PKA signals in granulosa cells is expected to provide insights towards understanding pathways which regulate ovulation and luteinization and which can translate into safer and more effective treatments of infertility and early pregnancy loss. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENOMIC BASIS OF REPRODUCTIVE HISTORY ON BREAST CANCER Principal Investigator & Institution: Russo, Jose; Senior Member; Fox Chase Cancer Center Philadelphia, Pa 19111 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Although the agents and the mechanisms that cause breast cancer are still uncertain, there is substantial evidence that breast cancer risk is strongly dependent on endocrinological and reproductive conditions, such as early

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menarche, late menopause, and nulliparity. An early first full term pregnancy, on he other hand, confers a lifetime protection. Experimentally we have demonstrated that the protection conferred by pregnancy is mediated by induction of breast differentiation, which is manifested through obular development, reduced cell proliferation and steroid hormone receptor content, and a "genomic signature" that is associated with refractoriness to chemically induced carcinogenesis. This application proposes to test the hypothesis that early pregnancy imprints in the breast permanent genomic changes that reduce the lifetime risk of the developing breast cancer. This hypothesis will be demonstrated through the following specific aims: 1: To characterize the specific gene expression profile of women at "low" and 'high" risk of developing breast cancer because of reproductive history. Gene expression in normal breast tissue obtained from postmenopausal women with a history of one or more early full term pregnancies will he compared to gene expression in normal breast tissue from postmenopausal women who are nulliparous. For this purpose we will perform a large-scale analysis of gene expression using available human cDNA libraries for determining the expression pattern of known and unknown (ESTs) genes. 2: To determine if gene clusters differentially expressed in women at risk of developing breast cancer because of reproductive history (identified in Specific aim 1) are differentially expressed in the breast issue of postmenopausal women with breast cancer compared to postmenopausal women who do not have breast cancer. For this purpose we will perform a case-control study to compare gene expression profiles in the normal, breast tissue of postmenopausal women with invasive breast cancer vs. postmenopausal women with benign breast disease. Knowledge gained through these studies will allow us to identify the "genomic signature" induced by an early pregnancy, and that if proven to be functionally relevant would serve as molecular markers for assessing breast cancer risk in large populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IGF-1 DEVELOPMENT

RECEPTOR

SIGNALING

IN

MAMMARY

GLAND

Principal Investigator & Institution: Hadsell, Darryl L.; Assistant Professor; Pediatrics; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2003; Project Start 24-JAN-1997; Project End 28-FEB-2007 Summary: (provided by applicant): The cells of the terminal end bud (TEB) are the most proliferative and invasive cells found during postnatal development in mammals. These cells, through their enormous proliferative capacity, drive the development of the entire mammary ductal system, serve as a source of mammary progenitor cells, and are the single most important target for carcinogens within the mammary gland. The ability of endocrine-, paracrine- and extracellular matrix-derived signals to harness this enormous regenerative potential and direct it into a highly ordered developmental pattern makes the TEB both an important and very fascinating system with which to study the endocrine regulation of intracellular signaling. Our analysis of grafted mammary tissue from a knockout mouse model has demonstrated that a targeted inactivating mutation of the gene for the IGF-I receptor (lgf1r) dramatically reduces mammary ductal development and decreases TEB cell proliferation(1). This proliferative defect, however, is partial restored by early pregnancy. In breast cancer cell models the IGF-I receptor as well as a handful of other hormone receptors signal through insulin receptor substrate (IRS) proteins, and two serine threonine kinases, ERK and Akt. The overall hypothesis addressed in this proposal is that IGF-I receptor stimulates TEB cell proliferation through insulin responsive substrate (IRS)-dependent activation of ERK and Akt during

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virgin ductal development and that pregnancy or the ovarian steroid hormones estradiol (E2) and progesterone (P) increase the sensitivity of IRS-dependent signaling pathways to insulin receptor-dependent activation in Igf1r-/- TEB. Through the use confocal microscopy with recently developed antibodies to detect cell signaling in-situ, we will learn how signaling pathways are regulated in TEBs and what the significance of these pathways is to processes important to both normal mammary gland function and breast cancer. The specific aims are; 1) determine if estrus cycle, ovarectomy, early pregnancy, or exogenous E2+P alters IGF-I-, or insulin-induced phosphorylation of IRS1, -2, ERK and Akt in mammary glands of normal mice, 2) determine if IGF-IR or IR dependent activation of ERK, and Akt is attenuated in the TEB of lgf1r -/- grafts and if early pregnancy or exogenous E2+P can restore this activation, and 3) determine if overexpression of IRS-1 or IRS-2 within the mammary epithelium restores development of Igf1r-/- mammary epithelium and enhances insulin-dependent posphorylation of ERK and Akt. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON SUPPLEMENTS AND ZINC IN PREGNANCY AND LACTATION Principal Investigator & Institution: King, Janet C.; Professor of Nutrition; Nutrition; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 24-SEP-1999; Project End 31-MAR-2004 Summary: It is a common practice to give supplemental iron to all pregnant women world-wide. The dose can vary from 60 mg/d to as much as 240 mg/d. When therapeutic doses of iron are prescribed, it is rare to also prescribe supplemental zinc. Studies in experimental animals and humans show that supplemental iron interferes with zinc absorption. In a recent longitudinal study of zinc absorption during pregnancy done by us, four of the 14 women studied were prescribed supplemental iron by their physicians. Although zinc absorption increased during pregnancy reaching a significant change during lactation, this adjustment was not observed in the four women taking supplemental iron. The need for absorbed zinc increases by 0.7 mg/d during pregnancy and 1.4 mg/d during early lactation. Our study showed that this need is met by upregulating zinc absorption if supplemental iron is not given. Administration of supplemental iron may impair this change in zinc use during pregnancy and lactation. The purpose of this proposed study, therefore, is to define the effect of supplemental iron on the metabolic adjustments in zinc utilization in healthy women during pregnancy and lactation. We hypothesize that a daily supplement of 100 mg iron inhibits zinc absorption and reduces the net uptake of zinc from the gastro-intestinal tract during late pregnancy and early lactation when the additional need for zinc is the greatest. Two groups of 15 women each will be recruited in early pregnancy and will be studied at 12-14, 32-34 weeks of gestation, and at 4-6 weeks postpartum. One group will receive 100 mg supplemental iron daily; the other group will be unsupplemented. All women will be given a prenatal vitamin supplement plus 8 mg iron and 5 mg zinc to assure a stable basal intake of the micronutrients throughout the study. Using stable isotopes, iron and zinc absorption and zinc kinetics will be measured. Biochemical measures of iron and zinc status will also be determined. All women will reside in a metabolic unit for 6 days during each test. Results from this comprehensive, longitudinal study will provide new data on the effects of iron supplementation on zinc utilization during pregnancy and lactation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ISOLATION OF ANTI-KAPOSI'S SARCOMA FACTORS Principal Investigator & Institution: Birken, Steven; University of Md Biotechnology Institute Baltimore, Md 212023101 Timing: Fiscal Year 2001 Summary: Recent reports from other collaborators in this program as well as other investigators have shown that crude clinical pharmaceutical preparations of hCG approved for human injection inhibit the growth of Kaposi's Sarcoma (KS) cells in tissue culture as well as Kaposi tumors in both animal models and human patients. Factors contained within these hCG preparations are potential therapeutic reagents for patient treatment. Virtually any protein in the circulation can appear in the urine even at trace concentrations. The pharmaceutic forms of hCG for human use are produced from the urine of pregnant women but are only 35% hCG by weight. We have shown that anti-KS factors similar in size on gel filtration to those present in such clinical grades on crude hCG appear in higher concentrations in raw urine form women in the first trimester of pregnancy. During pregnancy, a wide variety of growth factors are secreted both by mother and fetus. None of the known factors tested exhibit the anti-KS activities found in commercial preparations of hCG, hCG subunits and the hCG beta core. The hypothesis of this project is that the factors responsible for these anti-KS effects (name hCG associated factors or HAF) are proteins or peptides in blood which are excreted into the urine during early pregnancy or other states. These proteins are distinct from hCG, hCGbeta, or hCGbeta core. In order to test this hypothesis, the following aims are proposed: 1. Isolate the anti-KS (HAF) proteins from the urine of women in early pregnancy in collaboration with project 1. 2. To chemically characterize the isolated HAF molecules by primary structural analysis and develop immunoassays to them. 3. To determine the precise chronological pattern of HAF excretion in early pregnancy and to investigate whether other physiological states lead to excretion of HAF to help understand the natural functions of these molecules. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MARKER ASSISTED SELECTION OF BOVINE BLASTOCYSTS Principal Investigator & Institution: Kubisch, Hans M.; None; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 30-JUN-2003 Summary: (adapted from the applicant's Abstract): The goal of this study is to investigate the possibility of using marker-assisted selection of superior embryos to increase pregnancy rates following transfer of in vitro-derived blastocysts. Such a strategy could have a significant impact on the treatment of fertility problems in humans, where pregnancy rates after in vitro fertilization and transfer of early stage embryos have remained well below 25%. An investigation of the feasibility of markerassisted embryo selection requires a large number of embryos and recipients under controlled conditions, criteria that are unlikely to be met for human embryos. It is, therefore, proposed to use the secretion of interferon-tau (IFN-t) by bovine blastocysts as a model system to examine the hypothesis that the level of a protein produced by an individual embryo can be a useful predictor of its developmental competence. The IFN-t are Type 1 interferons that are expressed and secreted by the embryos of cattle and sheep during early pregnancy and while their precise physiological role remains unclear, there is mounting evidence implicating these interferons in the mechanism of pregnancy recognition. IFN-t can be easily detected in the culture medium of in vitroderived bovine blastocyst, but there exists virtually no information on the significance of

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the observation that individual blastocysts can produce vastly different amounts of IFNt. The aims of this proposal, therefore, are to gain further understanding of IFN-t production in embryos as well as its significance for subsequent development. Specific questions to be addressed are: 1) can culture conditions affect IFN-t production; 2) are there genotypic effects on its production; 3) does the amount of IFN-t produced by in vitro-derived blastocysts differ from that of blastocysts generated in vivo, and what is the nature of the increase in interferon-t that is found in blastocysts that are older at blastulation; 4) is IFN-t imprinted or does the amount of IFN-t that is produced by parthenogenetic and androgenetic blastocysts differ from that of control embryos, and lastly, 5) can the amount of IFN-t that is secreted in culture be a useful aid to predict the likelihood of pregnancy following transfer into recipients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MATERNAL & FETAL CONSEQUENCES OF TOBACCO SMOKE EXPOSURE Principal Investigator & Institution: Deloia, Julie A.; Assistant Professor; MageeWomens Health Corp Pittsburgh, Pa Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Human pregnancy is a balance between supporting the conceptus and maintaining the health of the mother. Profound cardiovascular and immune system adaptations must occur throughout pregnancy for a successful outcome. The mechanisms and functions of many of these adaptations still allude our understanding; however, we do know that perturbations in both the cardiovascular and immune changes can have deleterious and sometimes devastating consequences to the pregnancy. This proposal will focus on the consequences to pregnancy of one external stress; cigarette smoking. Smoking during pregnancy has many negative outcomes, including an increased risk of early pregnancy loss, premature birth and intrauterine growth restriction. Infants born of mothers who smoked during pregnancy have an increased risk of developing Type 2 diabetes and obesity and suffer from an elevated frequency of chromosomal translocations. The cause and effect relationship between smoking and poor pregnancy outcome most likely occurs at multiple levels. We hypothesize that smoking enhances the inflammatory response that occurs naturally during pregnancy and pushes it out of balance, leading to vascular compromise and fetal and maternal morbidity. We will test our hypothesis by determining to what extent smoking influences the inflammatory response of both mother and fetus, investigate the influence of genetic background on smoking-related consequences and establish a mouse model to examine in utero effects of smoking. Despite concerted public health efforts to reduce cigarette smoking in this country, it remains a leading cause of morbidity and mortality. The prevalence of pregnant women who smoke ranges from 10 - 25%, with consequent long range health effects to both mother and infant. Successful completion of this proposal should significantly increase our understanding of smoking related morbidity and potentially guide public health professionals to segments of the population that would benefit from more aggressive public hearth intervention strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS OF ACTION OF HAF--KAPOSI'S SARCOMA Principal Investigator & Institution: Gallo, Robert C.; Professor and Director; University of Md Biotechnology Institute Baltimore, Md 212023101

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Early Pregnancy

Timing: Fiscal Year 2001 Summary: In the course of studies on the pathogenesis of Kaposi's Sarcoma (KS), we observed an unusual phenomena: regression of malignant [sarcoma] tumors derived from xeno-transplanted neoplastic human KS cells [KS Y-1 and KS SLK] and immunodeficient mice during early pregnancy. This led us to experiments designed to determine the identity and mechanism(s) of action of the active factor(s) subsequent found in both urine and sera of mice and women in early pregnancy. These factor(s) have the following effects: (1) kill KS tumor cells in vitro and in mice with the transplanted tumors by inducing programmed cell death; (2) inhibit angiogenesis in three different test systems; (3) promote growth of bone marrow hematopoietic precursors; (4) are anti-wasting; (5) inhibit HIV-1 expression in vitro, in HIV-1 transgenic mice, and inhibit SIV infection of monkeys; and (6) are not toxic within the concentration range used in these experiments. This factor(s), tentatively called hCGassociated factor [HAF], is present in some clinical grade crude commercial preparations of hCG and some commercial preparations of hCG and some commercial preparations of the beta chain of hCG [betahCG], is protein in nature, can be separated from hCG and betahCG [and to date the partially purified material retains all biological activities], can be mimicked by certain synthetic peptides of betahCG we call Satellins, and utilizing the crude active hCG preparations have been demonstrably active in clinical trials. Our suspicion is that HAF may be an internal fragment of betahCG resulting from a specific proteolysis and that this fragment is a variable containment of some commercial preparations of hCG and betahCG. Work in this proposal will: (1) confirm these observations, many of which are preliminary; (2) define some of the general mechanisms involved for some of these diverse biological effects, utilizing partially purified [hCG-free] poly or oligo peptide fractions and the Satellins; (3) explore the possibility that several of these effects [anti-KS, anti-angiogenic, anti-HIV activities, and even the pro-hematopoietic effect] may be due to a common mechanism, HAF-induction of programmed cell death; (4) carry out some of the bioassays for the chemical purification steps [in Project 2]; and, (5) characterize the biological effects of purified HAF. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MIDLIFE ADAPTATION AND HEALTH IN RURAL SOCIETY Principal Investigator & Institution: Lorenz, Fredrick O.; Sociology and Anthropology; Iowa State University of Science & Tech Ames, Ia 500112207 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2003 Summary: (adapted from investigator's abstract): This is a revised application proposing to examine how chronic economic and family adversity, experienced earlier in the life course, affects the health of rural adults at midlife. The study is to be conducted by collecting a new wave of data in the year 2000 from the adults in two established panels, the Iowa Youth and Families Project (IYFP) and the Iowa Single Parent Project (ISPP). Both panels were initiated in the wake of the farm crisis and are being returned to during a time when rural families are struggling despite national prosperity. Aim #1 tests hypotheses linking chronic economic pressure and family stress, documented in 1991, 1992 and 1994 when the adults in the study were in their late 30s and early 40s, to subsequent psychological and physical health as reported in 2000. Part of this aim is to determine whether decade-long trajectories of change in response to chronic adversity are the same for psychological and physical health. Aim #2 examines the extent to which chronic adversity affects the distribution, timing, and sequencing of midlife events and transitions. These events and transitions, in turn, are hypothesized to affect

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psychological and physical health. Is there evidence, for example, that chronic economic pressure sets in motion a sequence of events (e.g. job disruptions, marital discord) which, when unresolved, affects health? Is there evidence that chronic family stress, videotaped repeatedly in the early 1990s, affects the timing of midlife transitions (e.g. early pregnancy of child, etc.) which, when unresolved, affects health? Aim #3 tests hypotheses about the moderating role of personal and social resources, as well as the history of chronic adversity, on the ability of parents to resolve difficult midlife events and transitions, and to cope with those events and transitions that are difficult to resolve. The original IYFP (n=413 couples) and ISPP (n=109 divorced women) panels have been kept intact by annual telephone interviews. The plan is to conduct in-home interviews with the married couples and single women in fall, 2000. The interviews will include a life history calendar to document midlife events and transitions that occurred between 1995 and 1999. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODULATION OF THE RECEPTIVE ENDOMETRIUM BY CG Principal Investigator & Institution: Fazleabas, Asgerally T.; Professor; Obstetrics and Gynecology; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2007 Summary: (provided by applicant): The initiation of pregnancy requires a precisely timed synchrony between endometrial development and the implanting blastocyst. This "receptive window" is initially dependent on estrogen and progesterone. However, signals from the developing embryo further modify the receptive uterus. During the previous funding period we addressed this issue in a non-human primate model. We demonstrated that in addition to the specific changes that are induced by estrogen and progesterone during the window of receptivity, infusion of chorionic gonadotrophin (CG) in a manner that mimics blastocyst transit further modulates the uterine environment. Changes are evident in all three major cell types i.e., the luminal epithelium, glandular epithelium and stromal fibroblasts. The modulation of the cytoskeletal architecture in stromal fibroblasts and the increase in secretory activity in glandular epithelial cells are regulated by CG acting directly on the endometrium, independent of the ovary. Furthermore these responses are suppressed when the progesterone receptor is antagonized. Since our in vivo studies have clearly demonstrated a direct effect of CG on modulating uterine receptivity, we now propose a series of studies to determine the function of two gene products that are induced in stromal fibroblasts in response to CG stimulation. Stromal Cell Protein (SCP) and Notch1 are both expressed in stromal cells and their expression is regulated both in vivo and vitro by CG. The first Specific Aim is focused on determining the mechanisms by which SCP activates Recombination Activating Gene in immune cells, which in turn may be responsible for altering the phenotype of lymphocyte populations within the endometrium. We hypothesize that these regulating mechanisms play a central role in providing immune tolerance to the fetal allograft. In the second Specific Aim we propose to determine the role of Notch-1 to inhibit apoptosis in stromal fibroblasts. In addition, Notch-1 is also able to influence the commitment to phenotypic differentiation within the lymphoid lineage. Thus, these studies will provide insight into the mechanisms by which stromal fibroblasts play an important role during the establishment of pregnancy. Understanding the complex immune and cell differentiation mechanisms within the uterine environment during early pregnancy has direct relevance to our ability to identify causes of infertility, pregnancy failure and other possible causes of infertility in women.

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Early Pregnancy

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

Project Title: NEUROENDOCRINE RESPONSES TO MATING IN THE FEMALE Principal Investigator & Institution: Erskine, Mary S.; Professor; Biology; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 28-FEB-2003 Summary: (adapted from applicant's abstract): In many female mammals, vaginocervical stimulation (VCS) received during mating modifies sexual responsiveness and initiates or induces several neuroendocrine changes which influence reproductive success. VCS is required in rodent for initiation of the endocrine changes of early pregnancy or pseudopregnancy (PSP), in particular twice-daily surges of prolactin (PRL) secretion which maintain corpus luteum function. The particular characteristics of the VCS received by the female during mating are critical determinants of whether PSP will occur, and there is a unique correspondence between the pattern of VCS which the female requires for initiation of pregnancy and the patterning of copulatory stimulation received by the female during mating. Therefore, this model system offers an opportunity to examine at the cellular level how the expression of behavior can influence neural function over a prolonged period. Despite advances in our understanding of the endocrine mechanisms responsible for PSP, our knowledge remains incomplete, particularly in the area of the initiation phase of the PRL surges. Recent work from the PI's laboratory has shown that a productive approach to the question of how mating stimulation initiates PRL surges is to use naturally-occurring patterns of coital stimulation to evaluate changes in neural function which are specific to PSP. Research carried out during the tenure of this grant will explore the proximal neural and endocrine changes which occur in response to VCS in several areas of the brain which the investigator's have identified to be involved in the process by which VCS is transduced into the PRL surge of early pregnancy/PSP. Experiments will: 1) determine which specific PRL responses to mating are responsible for PSP; 2) explore the role of the medial amygdala in transducing the afferent genitosensory input into the neuroendocrine changes of PSP; 3) examine whether ascending noradrenergic fibers are involved in initiating changes within the medial amygdala necessary for PSP; and 4) examine the role of oxytocin neurons in the paraventricular nucleus in the induction of PRL urges by mating. The broad research goal of this Independent Scientist Award application is to use neuroethological approaches to define the cellular mechanisms by which mating behavior initiates neuroendocrine responses of early pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHYSIOLOGY OF HUMAN RELAXIN Principal Investigator & Institution: Weiss, Gerson; Professor and Chair; Ob/Gyn & Women's Health; Univ of Med/Dent Nj Newark Newark, Nj 07103 Timing: Fiscal Year 2001; Project Start 15-JAN-1986; Project End 31-DEC-2003 Summary: Relaxin, a product of the pregnancy corpus luteum, is a peptide hormone which causes alterations of connective tissue. We have demonstrated an association between maternal serum relaxin concentrations and premature delivery. Our working hypothesis is that relaxin has a physiological role in cervical changes during pregnancy. Hyperrelaxinemia, by accentuating these changes increases the likelihood of premature birth. We propose to study two models of the human cervix. The first is the monkey cervix. The cervix of the monkey is similar to that of the human as is the endocrinology of the monkey luteal phase and early pregnancy. We plan to stimulate the

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endocrinology of early pregnancy in the rhesus monkey to determine the effects of relaxin on the uterus. Ovariectomized, steroid-replaced rhesus monkeys will be treated with either relaxin vehicle to determine the specific anatomic, microstructural and enzymatic changes causes by relaxin. Our second model is human lower uterine segment (LUS) cells in vitro. We have already shown that these cells contain relaxin receptors and respond to relaxin by increasing expression of proMMP-1 and proMMP-3 and decreasing levels of TIMP-1, changes which promote collagenolysis. We will expand these studies, utilizing clues derived from the in vivo monkey studies. We will compare these results to results obtained from LUS cells of women without corporalutea, who are laxinemic, to observe potential relaxin effects in late pregnancy. We plan to define the mechanisms of action of relaxin on monkey cervical fibroblasts and human lower uterine segment fibroblasts. We will define the interrelationships of relaxin with estrogen, progesterone and other uterotropic substances in these two models. The major clinical problem in obstetrics today is premature birth. There is at present little understanding of the factors which control uterine and cervical function to initiate normal or premature birth. What is clear is that this is a multi-factorial system of overlapping control mechanisms. Relaxin has clearly been shown to be a factor in the process. That relaxin is the only hormone whose levels are associated with prematurity suggests a major role. It is likely that better understanding of the physiological role of relaxin will allow for the development of agents which can better control cervical connective tissue changes to both decrease premature delivery and facilitate delivery at term. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTING HEALTH-RISKING BEHAVIORS IN DELINQUENT GIRLS Principal Investigator & Institution: Chamberlain, Patricia; Executive Director; Oregon Social Learning Center, Inc. 160 E 4Th Ave Eugene, or 97401 Timing: Fiscal Year 2002; Project Start 15-JUN-2002; Project End 31-MAY-2007 Summary: (provided by investigator): Females under 18 have become the fastestgrowing segment of the juvenile justice population, with their arrests accounting for 27 percent of total arrests during 1999. Regardless of offense type, studies show that from 60 percent to 87 percent of adolescent female offenders need substance abuse treatment (Prescott, 1998). These juvenile justice statistics, as well as a growing body of research evidence suggest high levels of comorbidity between substance use and delinquency in adolescent females. In addition to continued delinquency and substance use problems, additional short- and long-term outcomes include health-risking sexual behavior, mental health disorders, early pregnancy, school dropout, welfare dependence, and mortality. Despite the documented need, effective interventions targeting multiple outcomes for these high-risk females have not been reported in the literature. We propose to conduct a randomized intervention with 100 females, ages 12-16, referred from the juvenile justice system who are in need of out-of-home placement because of serious delinquency. Half will be placed in Treatment Foster Care (TFC), where one girl is placed in a family home with foster parents who have been recruited, trained, and are supervised to provide a set of treatment components hypothesized to be related to our specific short- and long-term outcomes. The other half will be placed in Group Care (GC), where girls typically live with 6-15 peers experiencing similar problems with delinquency. Multi-method, multi-agent measures will be collected to form indicators and constructs of the intervention components and outcomes. We focus on the following overall aims: 1) to develop and implement an individualized multi-component

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intervention model for girls referred by juvenile justice who have multiple arrests and high levels of co-occurring problems with substance use, and participation in healthrisking sexual behaviors; 2) to examine the effects of the intervention on a set of shortterm (proximal) outcomes at two points during the intervention; 3) to examine the mediating effects of the proximal outcomes on more distal outcomes at 12 months postintervention and in semi-annual follow-ups. It is hypothesized that proximal outcomes will predict distal outcomes, regardless of group assignment (i.e., TFC or GC). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROGESTERONE RECEPTOR AND ACTION IN THE PRIMATE OVARY Principal Investigator & Institution: Stouffer, Richard L.; Senior Scientist and Head; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001; Project Start 01-JUL-1985; Project End 28-FEB-2006 Summary: (Adapted from the applicant's abstract) The demonstrated activity of progestin to promote ovulation, coupled with the demonstration of progesterone receptor in the luteinizing, ovulating follicle and in the differentiated corpus luteum is compelling evidence for further investigation of the potential actions of progesterone in the ovulating follicle and corpus luteum. This proposal is directed to an investigation of the molecular and cellular events that are steroid/progesterone regulated during follicle rupture and luteinization of the periovulatory follicle, in the maintenance of luteal structure-function in the developed corpus luteum of the nonfertile cycle, and in the rescue of the corpus luteum during early pregnancy. Three treatment protocols will be used in which luteotropic support is sustained via exogenous luteinizing hormone/chorionic gonadotropin during the periovulatory interval, at midluteal phase of the cycle, and in simulated early pregnancy. These protocols are combined with progesterone ablation (using the 3B-hydroxysteroid dehydrogenase inhibitor, Trilostane) and progestin replacement (using the analog, R5020), followed by removal of periovulatory follicle or corpus luteum for analyses. These analyses include indices of tissue remodeling (protease expression, vascularization, cell proliferation), tissue differentiation (cholesterol utilization, steroid genesis, steroid receptor expression), and tissue regression (apoptosis). From these approaches, novel autocrine actions of progesterone in the luteinizing follicle and corpus luteum may be revealed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROLACTIN REGULATION OF DECIDUAL ACTIVIN AND APOPTOSIS Principal Investigator & Institution: Bowen-Shauver, Jennifer M.; Physiology and Biophysics; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2004 Summary: (provided by applicant): During normal pregnancy, the decidua undergoes a tightly regulated process of apoptotic regression to accommodate the developing fetus. Recent studies from this laboratory indicate that activin A may act as a pro-apoptotic factor during this reorganization. In contrast, prolactin, which is produced by human and rodent decidua, acts as an anti-apoptotic factor in this tissue and is able to down regulate expression of activin A. Female mice lacking a functional prolactin or prolactin receptor gene undergo normal decidualization during early pregnancy, in the presence of exogenous progesterone, but are infertile due to fetal death and resorption from midpregnancy. We hypothesize that the anti-apoptotic effects of prolactin are carried

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out through inhibition of decidual activin A expression and that the absence of prolactin results in pregnancy failure due to premature expression of activin A in the decidua and a resulting disorganization in decidual apoptosis. Our specific aims are 1) to determine the mechanism by which prolactin inhibits activin A expression in the decidua, 2) determine whether the anti-apoptotic effects of prolactin are mediated through inhibition of activin A in the decidua, and 3) determine whether fetal death in the prolactin null mouse is due to premature expression of activin A and apoptosis in the decidua. We will address these aims by manipulating signal transduction molecules within cultured cells, treating cultured cells with prolactin, activin, and inhibitors, and examining decidual regression in prolactin-null animals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF IGFBP-1 BY FKHR AND HOXA10 IN PREGNANCY Principal Investigator & Institution: Kim, Ji-Yong Julie.; Obstetrics and Gynecology; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2003; Project Start 07-JUL-2003; Project End 31-MAY-2007 Summary: (provided by applicant): The long-term objective of this application is to better understand the dynamic interaction that occurs between the conceptus and the mother that allow for the establishment and maintenance of pregnancy. The major focus of our research is on the molecular events that occur in the endometrium in response to early embryonic signals and the invading trophoblast. Aberrant expression of genes in the endometrium during this time is detrimental to the maintenance of pregnancy and could lead to miscarriages, spontaneous abortions and infertility. In response to pregnancy hormones and conceptus factors, the endometrium undergoes a major transformation, termed decidualization. During this process, the stromal cells of the endometrium express important genes. This study focuses on the regulation of a major secretory product of the decidualizing stromal cells, insulin-like growth factor binding protein-1 (IGFBP-1). IGFBP-1 modulates the actions of insulin-like growth factors (IGFs) which are critical during early pregnancy and can act independently of IGFs to regulate trophoblast invasion. Recently, we demonstrated that two transcription factors, FKHR and HOXA10, which have been demonstrated to be important in reproductive processes, interact with one another and up regulate the IGFBP-1 promoter in a cooperative manner in endometrial stromal cells. Based on this novel data, studies have been designed to further delineate the mechanisms involved in the cooperative up regulation of the IGFBP-1 promoter by FKHR and HOXA10. In aim 1 the binding sites of FKHR and HOXA10 on the IGFBP-1 promoter are identified. With the use of a powerful new technique, chromatin immunoprecipitation (CHIP), the binding sites for endogenous FKHR and HOXA10 proteins on the endogenous IGFBP-1 gene within the chromatin in the decidualized stromal cells are determined. This technique allows one to study interaction of transcription factors with the chromatin as they occur in situ. In aim 2, characterization of FKHR and HOXA10 and determination of binding sequences on the IGFBP-1 gene in cells originating from non-pregnant and pregnant baboon endometrium will be performed by taking "snapshots" of the cells and tissue using formaldehyde cross linking. These studies will demonstrate the influence of the conceptus on FKHR and HOXA10 expression and their activation of the IGFBP-1 gene. In aim 3, FKHR and HOXA10 expression and activity in the endometrium of baboons with endometriosis will be studied. The objective of aim 3 is to determine why FKHR and HOXA10 do not significantly activate the IGFBP-1 promoter. The stromal cells from baboons with endometriosis are obviously different from that of a normal animal. These studies will give a better understanding of the molecular events that may be associated

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with increased implantation failure in women with endometriosis. The three aims in this application will provide valuable insights into the molecular dynamics of the endometrium in response to pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF THE CORPUS LUTEUM Principal Investigator & Institution: Zeleznik, Anthony J.; Professor; Cell Biology and Physiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-SEP-1982; Project End 30-JUN-2004 Summary: The overall goal of this proposal is to elucidate the physiological and cellular mechanisms responsible for the regression of the primate corpus luteum as well as to understand the mechanisms by which the lifespan of the corpus luteum is prolonged during early pregnancy. Results of our previous work have identified two dramatic alterations that occur in luteal cells following ovulation: i) a cessation of the expression of the cAMP and PKA- dependent nuclear transcription factor CREB and ii) a dramatic decrease in the responsiveness of the corpus luteum to LH that occurs during the mid through late luteal phase of the menstrual cycle that is ultimately responsible for luteal regression. The goal of the research presented in the current proposal is to directly test the hypothesis that the eruption in intracellular cAMP levels that occurs in response to the mid-cycle gonadotropin surge sets into play a program of intracellular effectors that result in diminishing trophic effects of LH and this is regulated by the down-regulation of the cAMP-dependent nuclear transcription factor CREB. This hypothesis will be tested using state of the art physiological and molecular approaches. Aim 1 will identify the cellular mechanisms responsible for the loss of CREB expression during luteinization. The specific hypothesis is that the large increase in ovulatory cAMP levels directs the expression of the CREB transcription repressor ICER and this is temporally associated with the cessation of CREB and PCNA expression. In Aim 2, a recombinant adenovirus vector that expresses a dominant-negative mutant of CREB will be used to block CREB signaling in granulosa cells. The specific hypothesis is that the loss of CREBof CREB and PCNA expression. In Aim 2, a recombinant adenovirus vector that expresses a dominant-negative mutant of CREB will be used to block CREB signaling in granulosa cells. The specific hypothesis is that the loss of CREB-mediated transcription will directly inhibit PCNA expression and cell proliferation but will not inhibit the acute effects of LH on progesterone production. Aim 3 will use adenoviral vectors in vivo in monkeys to constitutively activate the cAMP/PKA/CREB signaling pathway. The specific hypothesis is that activation of this signaling system will bypass the decline in LH receptors and prolong the functional lifespan of the primate corpus luteum. In addition to providing novel information regarding the physiology of the primate corpus luteum, results of these studies will further our understanding of the causes of luteal phase defects in humans which are thought to be a significant cause of infertility and early pregnancy loss. Further, our novel use of adenoviruses to directly alter ovarian protein expression in vivo will provide new ways to approach the understanding of other ovarian disorders that impact upon women's health such as polycystic ovarian disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REPRODUCTIVE DEVELOPMENT

BIOLOGY:

EARLY

PREGNANCY

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AND

Principal Investigator & Institution: Kinsey, William H.; Professor; Anatomy and Cell Biology; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2001; Project Start 01-MAY-1996; Project End 30-APR-2006 Summary: (provided by applicant): The objective of this program is to prepare postdoctoral trainees to establish independent research careers in the areas of early pregnancy and embryonic development. The training program will consist of three elements; independent laboratory research, group seminars and other functions held jointly with the Center for Reproductive Sciences, and formal course work in research ethics as well as subjects that will enhance the trainee's research expertise. The independent research will occur in a laboratory selected by the trainee from a group of ten scientists who are leaders in various aspects of reproductive and developmental biology. The members of this training group have well-established, NIH-funded programs and have trained more than 70 post- doctoral fellows. Areas of study include fertilization, peri-implantation development, trophoblast-uterine interactions, pituitary regulation of early pregnancy, the immunobiology of implantation and early pregnancy as well as regulation of gene expression during development. The strength of this group is enhanced by collaboration among the members as evidenced by the record of joint publications, grants, and students. This program will take advantage of an existing Center for Reproductive Sciences comprising 19 Principal Investigators and 58 additional staff and trainees to provide an enhanced training environment. The Center for Reproductive Sciences sponsors an active seminar program and hosts a regional conference in reproductive biology, which provide additional opportunities for trainees to present their work. The recruitment, selection and guidance of trainees will be coordinated through an Internal Advisory Committee, with input from all participating faculty and in consultation with an External Advisor, who will meet with the group once each year. Applicants who have been awarded a Ph.D. degree in one of the biological sciences, or a D.V.M. degree or M.D. degree and who demonstrate a commitment to research in reproductive biology will be considered for entry into the program. An emphasis will be placed on recruiting under represented minorities into the program. The records of the seven trainees selected during the first funding period are impressive. Six competed successfully for external funds (NRSA, Lalor and American Heart Association fellowships) and all three of the trainees who have completed their training have assumed academic faculty positions. The overall success of the program will ultimately be measured by the contributions of these trainees after they have established independent research programs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RHESUS MHC CLASS I MOLEC EXPRESSION IN PREIMPLANT EMBRYOS & EARLY IMPLANT SITE Principal Investigator & Institution: Golos, Thaddeus G.; Associate Professor; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001 Summary: OBJECTIVE To determine the ontogeny of Mamu-AG expression in the rhesus monkey preimplantation embryo and implantation site. RESULTS Previous studies demonstrated that the rhesus monkey placenta expresses a unique MHC class I molecule. Surprisingly, and in contrast to the human placenta (but similar to the baboon placenta), MHC class I immunostaining and mRNA expression in the definitive rhesus

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placenta is primarily localized to syncytiotrophoblasts in contact with maternal blood, whereas the human placenta HLA-G is localized to the extravillous cytotrophoblasts, invading maternal uterine endometrium during early gestation. We thus need to define the expression of MHC class I molecules in the earliest stages of gestation. We used PCR to evaluate the expression of Mamu-AG mRNA in preimplantation rhesus monkey embryos through the blastocyst stage. The expression of the mRNA was not detectable in these embryos, although we were able to readily amplify the mRNA for G3PDH from single embryos. The limit of sensitivity of the Mamu-AG assay is less than 10 trophoblast equivalents. However, we were able to detect Ma mu-AG mRNA and MHC class I immunostaining in trophoblasts growing out from cultured rhesus embryos, suggesting that trophoblast differentiation and outgrowth is associated with the initiation of MHC class I expression. In rhesus implantation sites at days 14, 15, 19 and 21 of gestation the trophoblastic shell (extravillous trophoblasts) were strongly positive for MHC class I immunostaining, and also demonstrated Mamu-AG expression by in situ hybridization. In these early pregnancy samples syncytiotrophoblast immunostaining was reduced in intensity compared to mature chorionic villi in the definitive placenta. These results are similar to the pattern of HLA-G expression in the human placenta during extravillous trophoblast differentiation and invasion of the maternal endometrium. FUTURE DIRECTIONS We will evaluate the expression of MHC class I molecules during embryo attachment in vivo and in vitro on defined substrates to understand the signals which give rise to developmentally regulated Mamu-AG expression. KEY WORDS trophoblast, blastocyst, endometrium, placenta, MHC. FUNDING HD34216 Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF ESTROGEN-REGULATED GENES DURING EARLY PREGNANCY Principal Investigator & Institution: Bagchi, Indrani C.; Professor; Veterinary Sciences; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2005 Summary: The long-term goal of this proposal is to explore how the steroid hormone estrogen (E) regulates growth and differentiation processes in the endometrium during early pregnancy (preimplantation period), which lead to acquisition of the receptive state that allows blastocyst implantation. E exerts its cellular effects by regulating the expression of specific target genes. The identity, profile of expression, and function of the E-regulated genes at various stages of the reproductive cycle and pregnancy, however, remain largely unknown. The specific aims of this proposal are to: 1. Isolate and identify genes that are regulated in response to nidatory E in rat uterus during delayed implantation. The messenger RNA differential display method will be used to isolate and identify the cDNAs representing mRNAs whose expression is induced or repressed in rat uterus in response to an implantation-inducing dose of E. To determine whether the newly identified E-regulated genes are potential modulators of implantation, their spatio-temporal expression in rat uterus during early pregnancy will be analyzed by Northern blotting, in situ hybridization, and immunohistochemistry. 2. Assess the functional roles of the newly identified cDNAs in implantation. A recently developed antisense technology will be used to regulate specific gene expression in intact rat uterus. This will involve administration of antisense oligodeoxynucleotides targeted against mRNA transcript of each candidate gene into the preimplantation uterus to suppress the steady state level of that mRNA. If this intervention also leads to

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an impairment in implantation, it will allow the establishment of a functional link between this gene and the implantation process. 3. Analyze the function of a novel Eregulated gene, ERG1, in early pregnancy. A novel gene (ERG1) that is tightly regulated by E in two key reproductive tissues, the uterus and oviduct, has recently been isolated. ERG1 is expressed in the surface epithelium of the uterus in a highly stage-specific manner during the ovarian cycle and early pregnancy. To determine the functional role of ERG1 during early pregnancy, mice harboring a targeted germ line mutation of ERG1 will be developed and analyzed for potential reproductive phenotypes, such as impairment in embryo transport through the oviduct, defects in epithelial cell morphology and function, and lack of uterine receptivity for implantation. The proposed research will help us to identify molecules that mediate E regulation of critical events during early pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TISSUE INTERACTIONS AND HORMONAL RESPONSES IN THE UTERUS Principal Investigator & Institution: Bigsby, Robert M.; Associate Professor; Obstetrics and Gynecology; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 15-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from the applicant's abstract) Knowing how tissue interactions affect physiology is important for understanding pathologies of hormonally regulated organs. In the uterus, tissue interactions mediate steroid hormone effects, playing key roles in events of early pregnancy. Although estrogen regulates cell signaling in a stroma-to-epithelium direction in the uterus, a paracrine factor mediating this effect has not been identified. Also, hormonal regulation of a pathway in the reciprocal direction has not been studied. In both human and rodent, estrogen stimulation of a progesterone dominated uterus causes proliferation of the endometrial stroma. Proposed studies will test the hypothesis: 1) Progesterone priming for and estrogen induction of cellular proliferation in the uterine stroma occurs indirectly through activation of progesterone receptor (PR) and estrogen receptor-alpha (ER alpha) in the overlying epithelium. 2) IGF-I is a paracrine mediator of steroid action in the uterus. The hypothesis will be tested using tissue recombinations grown in xenograft. Uterine epithelium (epi) and mesenchyme (mes) will be derived from neonatal wild-type mice, ER alpha knockout (ER alpha KO) mice, PR knockout (PRKO) mice, or IGF-I knockout mice. These knockout models were chosen because: ER alpha KO mouse uterus shows no growth response to estradiol stimulation, indicating that it is devoid of any growth-promoting ER; PRKO mouse uterus exhibits no stromal response to progesterone/estrogen treatment or to a decidualizing stimulus; in the IGF-I knockout mouse uterus estrogen stimulated cells are arrested in G2. The specific aims are: 1. Determine the tissue specificity of the steroid receptor-mediated events regulating cell proliferation. 2. Determine the role of tissue specific expression of IGF-I in mediation of steroid induced proliferation in the uterus. For each type of knockout animal, tissue will be separated and recombined in all 4 possible combinations: epi+/mes+, epi-/mes-, epi+/mes-, epi/mes+ (+, target gene status). Tissue recombinants will be grown in athymic mice. Effects of hormone treatments will be tested using tritiated thymidine incorporation or mitotic index as the endpoint. If hypothesis 1 proves correct, this will be a novel demonstration of hormonal regulation via an epithelium-to-stroma interaction, thereby leading to a new concept of hormone action in steroid-responsive organs. If IGF-I proves

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critical for tissue interactions it will be the first paracrine factor to be definitively identified as a mediator of steroid action in the uterus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TROPHOBLAST DIFFERENTIATION Principal Investigator & Institution: Soares, Michael J.; Professor; Molecular & Integrative Phys; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2002; Project Start 01-JUL-1986; Project End 30-APR-2007 Summary: (provided by applicant): The placenta provides the physiological interface between mother and fetus and is critically involved in controlling the environment in which the embryo/fetus develops. Trophoblast cells, the parenchymal cells of the placenta, differentiate along a multilineage pathway, and form the backbone of the gestational conduit that is essential for viviparity. These important cells produce hormones and cytokines that redirect the activities of the maternal environment and they possess transport machinery that facilitates the delivery of nutrients to the fetus. Disruptions in trophoblast development can lead to early pregnancy loss, intrauterine growth retardation, and tumorigenesis. These represent serious health problems whose etiologies are not sufficiently understood. The objectives of this project are to understand control mechanisms involved in regulating trophoblast cell differentiation. We focus on the role of the phosphatidylinositol 3-kinase (PI3-K)/akt pathway in the regulation of trophoblast cell differentiation. We propose that an essential feature of the differentiation of trophoblast giant cells is their acquisition of a constitutively activated PI3-K/akt pathway. The proposed research addresses three specific aims. Experiments outlined in Specific Aim No. 1 investigate the control of PI3-K/akt pathway activation during trophoblast cell development. Specific Aim No. 2 examines the impact of the PI3K/akt pathway on the trophoblast cell phenotype, including endoreduplication, invasiveness, and endocrine function. Specific Aim No. 3 focuses on the identification of downstream targets of the PI3-K/akt pathway in differentiating trophoblast cells. The proposed studies utilize in vitro investigations with rodent trophoblast cell culture systems and in vivo analysis of rodent trophoblast cells developing in situ. Identification of regulatory mechanisms controlling trophoblast cell differentiation will provide a better understanding of placental development and insights into the etiology of early pregnancy loss, intrauterine growth retardation, and various disorders and neoplasms of the placenta. 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, 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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and type “early pregnancy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for early pregnancy in the PubMed Central database: •

Association between outcome of pregnancy and glycaemic control in early pregnancy in type 1 diabetes: population based study. by Temple R, Aldridge V, Greenwood R, Heyburn P, Sampson M, Stanley K.; 2002 Nov 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=136924

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Cross-Reactivity between Chlamydia trachomatis Heat Shock Protein 10 and Early Pregnancy Factor. by Betsou F, Borrego MJ, Guillaume N, Catry MA, Romao S, Machado-Caetano JA, Sueur JM, Mention J, Faille N, Orfila J.; 2003 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154954

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 early pregnancy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “early pregnancy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for early pregnancy (hyperlinks lead to article summaries): •

A characteristic cluster of fetal sonographic markers that are predictive of fetal Turner syndrome in early pregnancy. Author(s): Bronshtein M, Zimmer EZ, Blazer S. Source: American Journal of Obstetrics and Gynecology. 2003 April; 188(4): 1016-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712103&dopt=Abstract

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A class of diabetes in mother, glycemic control in early pregnancy and occurrence of congenital malformations in newborn infants. Author(s): Mironiuk M, Kietlinska Z, Jezierska-Kasprzyk K, Piekosz-Orzechowska B. Source: Clin Exp Obstet Gynecol. 1997; 24(4): 193-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9478316&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 longitudinal study of maternal serum vascular endothelial growth factor in early pregnancy. Author(s): Evans PW, Wheeler T, Anthony FW, Osmond C. Source: Human Reproduction (Oxford, England). 1998 April; 13(4): 1057-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9619570&dopt=Abstract

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A new mathematical formula for predicting long bone length in early pregnancy. Author(s): Rosati P, Guariglia L, Capelli G. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 February; 19(2): 184-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11876813&dopt=Abstract

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A prospective randomized study on the measured blood loss in medical termination of early pregnancy by three different misoprostol regimens after pretreatment with mifepristone. Author(s): Tang OS, Lee SW, Ho PC. Source: Human Reproduction (Oxford, England). 2002 November; 17(11): 2865-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407040&dopt=Abstract

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A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Author(s): Jain JK, Dutton C, Harwood B, Meckstroth KR, Mishell DR Jr. Source: Human Reproduction (Oxford, England). 2002 June; 17(6): 1477-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12042265&dopt=Abstract

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A prospective study of spontaneous abortion: relation to amount and source of drinking water consumed in early pregnancy. Author(s): Swan SH, Waller K, Hopkins B, Windham G, Fenster L, Schaefer C, Neutra RR. Source: Epidemiology (Cambridge, Mass.). 1998 March; 9(2): 126-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9504279&dopt=Abstract

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A Th2 chemokine, TARC, produced by trophoblasts and endometrial gland cells, regulates the infiltration of CCR4+ T lymphocytes into human decidua at early pregnancy. Author(s): Tsuda H, Michimata T, Hayakawa S, Tanebe K, Sakai M, Fujimura M, Matsushima K, Saito S. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2002 July; 48(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12322891&dopt=Abstract

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Accumulation of 67Ga citrate in early pregnancy. Author(s): Kurosaki H, Saito Y, Kawashima M, Ebara T, Yamakawa M, Mitsuhashi N. Source: Ann Nucl Med. 2001 June; 15(3): 289-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11545204&dopt=Abstract

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Accuracy of single measurements of pregnancy-associated plasma protein-A, human chorionic gonadotropin and progesterone in the diagnosis of early pregnancy failure. Author(s): Dumps P, Meisser A, Pons D, Morales MA, Anguenot JL, Campana A, Bischof P. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 January 10; 100(2): 174-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11750960&dopt=Abstract

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Accuracy of transvaginal sonography for diagnosis of complete atrioventricular septal defect in early pregnancy. Author(s): Bronshtein M, Zimmer EZ, Blazer S. Source: The American Journal of Cardiology. 2003 April 1; 91(7): 903-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12667587&dopt=Abstract

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Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial. Author(s): Smith C, Crowther C, Beilby J. Source: Birth (Berkeley, Calif.). 2002 March; 29(1): 1-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11843784&dopt=Abstract

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Adverse environment and prevention of early pregnancy disorders. Author(s): Diav-Citrin O, Ornoy A. Source: Early Pregnancy. 2000 January; 4(1): 5-18. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11719818&dopt=Abstract

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An update on the identity of early pregnancy factor and its role in early pregnancy. Author(s): Bose R. Source: Journal of Assisted Reproduction and Genetics. 1997 October; 14(9): 497-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9401865&dopt=Abstract

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An update on the identity of early pregnancy factor and its role in early pregnancy. Author(s): Cavanagh AC. Source: Journal of Assisted Reproduction and Genetics. 1997 October; 14(9): 492-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9401863&dopt=Abstract

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Angiogenesis in the human corpus luteum: simulated early pregnancy by HCG treatment is associated with both angiogenesis and vessel stabilization. Author(s): Wulff C, Dickson SE, Duncan WC, Fraser HM. Source: Human Reproduction (Oxford, England). 2001 December; 16(12): 2515-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11726568&dopt=Abstract

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Angiotensin-converting-enzyme inhibitors in early pregnancy. Author(s): Lip GY, Churchill D, Beevers M, Auckett A, Beevers DG. Source: Lancet. 1997 November 15; 350(9089): 1446-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9371172&dopt=Abstract

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Anti-annexin V antibodies in patients with early pregnancy loss or implantation failures. Author(s): Matsubayashi H, Arai T, Izumi S, Sugi T, McIntyre JA, Makino T. Source: Fertility and Sterility. 2001 October; 76(4): 694-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11591400&dopt=Abstract

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Association between abnormal microbiological flora of the lower genital tract in early pregnancy and socio-economic, demographic and environmental risk factors. Author(s): Wasiela M, Hanke W, Kalinka J. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2001 November-December; 7(6): 1250-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11687738&dopt=Abstract

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Association between outcome of pregnancy and glycaemic control in early pregnancy in type 1 diabetes: population based study. Author(s): Temple R, Aldridge V, Greenwood R, Heyburn P, Sampson M, Stanley K. Source: Bmj (Clinical Research Ed.). 2002 November 30; 325(7375): 1275-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458245&dopt=Abstract

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Bacterial vaginosis in early pregnancy and adverse pregnancy outcome. Author(s): Purwar M, Ughade S, Bhagat B, Agarwal V, Kulkarni H. Source: The Journal of Obstetrics and Gynaecology Research. 2001 August; 27(4): 175-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11721727&dopt=Abstract

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Bacterial vaginosis in early pregnancy and pregnancy outcome. Author(s): Kurki T, Sivonen A, Renkonen OV, Savia E, Ylikorkala O. Source: Obstetrics and Gynecology. 1992 August; 80(2): 173-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1635726&dopt=Abstract

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Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis. Author(s): Jacobsson B, Pernevi P, Chidekel L, Jorgen Platz-Christensen J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 November; 81(11): 1006-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421167&dopt=Abstract

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Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Author(s): Clapp JF 3rd, Kim H, Burciu B, Lopez B. Source: American Journal of Obstetrics and Gynecology. 2000 December; 183(6): 1484-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11120515&dopt=Abstract

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Biochemical analyses of mesenchymal fluid in early pregnancy. Author(s): Jauniaux E, Gulbis B, Hyett J, Nicolaides KH. Source: American Journal of Obstetrics and Gynecology. 1998 April; 178(4): 765-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9579441&dopt=Abstract

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Biochemical assessment of placental function: early pregnancy. Author(s): Grudzinskas JG, Westergaard JG, Teisner B. Source: Clin Obstet Gynaecol. 1986 September; 13(3): 553-69. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3533358&dopt=Abstract

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Biochemical consideration of human early pregnancy factor (EPF). Author(s): Sueoka K, Kusama T, Baba J, Wallach EE, Iizuka R. Source: Prog Clin Biol Res. 1989; 294: 317-29. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2726971&dopt=Abstract

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Biochemical investigation of fetal renal maturation in early pregnancy. Author(s): Gulbis B, Jauniaux E, Jurkovic D, Gervy C, Ooms HA. Source: Pediatric Research. 1996 April; 39(4 Pt 1): 731-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8848352&dopt=Abstract

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Biological and immunological activity of human chorionic gonadotrophin in maternal serum during early pregnancy. Author(s): Ranta T, Ylinen K, Stenman UH, Nikula H, Huhtaniemi I. Source: Clinical Endocrinology. 1988 November; 29(5): 495-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3253031&dopt=Abstract

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Biological markers during early pregnancy: trophoblastic signals of the periimplantation period. Author(s): Glasser SR, Julian J, Munir MI, Soares MJ. Source: Environmental Health Perspectives. 1987 October; 74: 129-47. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3319548&dopt=Abstract

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Bleeding in early pregnancy. Author(s): Tippett S, Jewell D, Masson G, Elphinstone K. Source: The Practitioner. 1989 November 8; 233(1478): 1425-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2616516&dopt=Abstract

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Blood loss in termination of early pregnancy by vacuum aspiration and by combination of mifepristone and gemeprost. Author(s): Chan YF, Ho PC, Ma HK. Source: Contraception. 1993 January; 47(1): 85-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8436004&dopt=Abstract

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Blood loss in termination of early pregnancy with mifepristone and gemeprost. Author(s): Prasad RN, Choolani M, Roy A, Ratnam SS. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1995 August; 35(3): 329-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8546658&dopt=Abstract

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Blunted erythropoietin production and decreased erythropoiesis in early pregnancy. Author(s): Beguin Y, Lipscei G, Thoumsin H, Fillet G. Source: Blood. 1991 July 1; 78(1): 89-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2070061&dopt=Abstract

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Budd-Chiari syndrome in early pregnancy. Author(s): Perez J, Talavera A, Castro F, Torres EA. Source: P R Health Sci J. 1998 September; 17(3): 285-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9883475&dopt=Abstract

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Changes in the effects of interleukin-1beta and tumor necrosis factor-alpha on platelet activation in early pregnancy. Author(s): Bar J, Zosmer A, Hod M, Lahav J, Elder MG, Sullivan MH. Source: Platelets. 2001 December; 12(8): 453-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11798393&dopt=Abstract

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Characteristic changes of large granular lymphocytes that strongly express CD56 in endometrium during the menstrual cycle and early pregnancy. Author(s): Kodama T, Hara T, Okamoto E, Kusunoki Y, Ohama K. Source: Human Reproduction (Oxford, England). 1998 April; 13(4): 1036-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9619567&dopt=Abstract

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Characterization of endometrial T lymphocyte subpopulations in spontaneous early pregnancy loss. Author(s): Vassiliadou N, Bulmer JN. Source: Human Reproduction (Oxford, England). 1998 January; 13(1): 44-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9512226&dopt=Abstract

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Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Author(s): ACEP Clinical Policies Committee and Clinical Policies Subcommittee on Early Pregnancy. American College of Emergency Physicians. Source: Annals of Emergency Medicine. 2003 January; 41(1): 123-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514693&dopt=Abstract

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Collection of villous tissue under ultrasound guidance to improve the cytogenetic study of early pregnancy failure. Author(s): Greenwold N, Jauniaux E. Source: Human Reproduction (Oxford, England). 2002 February; 17(2): 452-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821294&dopt=Abstract

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Comparison of periovulatory and early pregnancy blood levels of oxytocinase (CAP1) and isooxytocinase (CAP2). Author(s): Dziechciowski M, Klimek R. Source: Early Pregnancy. 2001 April; 5(2): 113-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753524&dopt=Abstract

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Compensatory placental growth after restricted maternal nutrition in early pregnancy. Author(s): Lumey LH. Source: Placenta. 1998 January; 19(1): 105-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9481792&dopt=Abstract

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Conception to ongoing pregnancy: the 'black box' of early pregnancy loss. Author(s): Macklon NS, Geraedts JP, Fauser BC. Source: Human Reproduction Update. 2002 July-August; 8(4): 333-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206468&dopt=Abstract

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Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Author(s): Wang X, Chen C, Wang L, Chen D, Guang W, French J. Source: Fertility and Sterility. 2003 March; 79(3): 577-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12620443&dopt=Abstract

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Correlates of recreational physical activity in early pregnancy. Author(s): Ning Y, Williams MA, Dempsey JC, Sorensen TK, Frederick IO, Luthy DA. Source: J Matern Fetal Neonatal Med. 2003 June;13(6):385-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962263&dopt=Abstract

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Current challenges in the assessment and management of patients with bleeding in early pregnancy. Author(s): Bryan S. Source: Emergency Medicine (Fremantle, W.A.). 2003 June; 15(3): 219-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12786641&dopt=Abstract

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Current clinical progress in early pregnancy investigation. Author(s): Stemmer SM. Source: Early Pregnancy. 2000 January; 4(1): 74-81. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11719824&dopt=Abstract

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Current issues in management of miscarriage and early pregnancy bleeding. Author(s): Moore J, Shillito TJ, Walker JJ. Source: Hosp Med. 2002 March; 63(3): 134-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11933813&dopt=Abstract

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Current progress in early pregnancy investigation and the steps ahead. Author(s): Barnea ER. Source: Early Pregnancy. 2000 January; 4(1): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11719817&dopt=Abstract

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Current progress in early pregnancy investigation. Author(s): Polliotti BM. Source: Early Pregnancy. 1997 June; 3(2): 127-40. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9429854&dopt=Abstract

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Current progress in early pregnancy investigation. Author(s): Stemmer SM. Source: Early Pregnancy. 2001 April; 5(2): 149-52. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753528&dopt=Abstract

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Current progress in early pregnancy investigation. Author(s): Stemmer SM. Source: Early Pregnancy. 2001 January; 5(1): 4-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11743627&dopt=Abstract

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Current progress in early pregnancy investigation. Author(s): Stemmer SM. Source: Early Pregnancy. 2000 July; 4(3): 214-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11727014&dopt=Abstract

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Cytohormonal evaluation of vaginal smears by phase contrast microscopy with special reference to progesterone deficiency pattern during early pregnancy as predictor of abortion. Author(s): Raina W, Batra A, Ranga S, Das SK, Talib VH. Source: Indian J Pathol Microbiol. 1998 January; 41(1): 85-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9581082&dopt=Abstract

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Cytokines during early pregnancy of mammals: a review. Author(s): Schafer-Somi S. Source: Animal Reproduction Science. 2003 January 15; 75(1-2): 73-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12535585&dopt=Abstract

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Decreased type V collagen expression in human decidual tissues of spontaneous abortion during early pregnancy. Author(s): Iwahashi M, Nakano R. Source: Journal of Clinical Pathology. 1998 January; 51(1): 44-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9577371&dopt=Abstract

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Defective endovascular trophoblast invasion in primary antiphospholipid antibody syndrome-associated early pregnancy failure. Author(s): Sebire NJ, Fox H, Backos M, Rai R, Paterson C, Regan L. Source: Human Reproduction (Oxford, England). 2002 April; 17(4): 1067-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925407&dopt=Abstract

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Delivery outcome after the use of antidepressants in early pregnancy. Author(s): Ericson A, Kallen B, Wiholm B. Source: European Journal of Clinical Pharmacology. 1999 September; 55(7): 503-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10501819&dopt=Abstract

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Depression and anxiety in early pregnancy and risk for preeclampsia. Author(s): Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Source: Obstetrics and Gynecology. 2000 April; 95(4): 487-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10725477&dopt=Abstract

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Detection of Chlamydia trachomatis infection in early pregnancy using selfadministered vaginal swabs and first pass urines: a cross-sectional community-based survey. Author(s): Oakeshott P, Hay P, Hay S, Steinke F, Rink E, Thomas B, Oakeley P, Kerry S. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2002 October; 52(483): 830-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392124&dopt=Abstract

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Detection of early pregnancy factor in human sera. Author(s): Qin ZH, Zheng ZQ. Source: Am J Reprod Immunol Microbiol. 1987 January; 13(1): 15-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2436493&dopt=Abstract

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Detection of early pregnancy forms of human chorionic gonadotropin by home pregnancy test devices. Author(s): Butler SA, Khanlian SA, Cole LA. Source: Clinical Chemistry. 2001 December; 47(12): 2131-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11719477&dopt=Abstract

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Detection of immunosuppressive early pregnancy factor in humans. Author(s): Mehta AR, Menezes J, Peter J, Hinduja IN, Shahani SK. Source: The Indian Journal of Medical Research. 1987 January; 85: 37-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3583354&dopt=Abstract

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Developing biotechnological and pharmacotherapeutic advances in early pregnancy. Author(s): Ablin RJ. Source: Early Pregnancy. 1996 December; 2(4): 290-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9363228&dopt=Abstract

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Developing biotechnological and pharmacotherapeutic advances in early pregnancy. Author(s): Ablin RJ. Source: Early Pregnancy. 1996 June; 2(2): 133-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9363211&dopt=Abstract

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Differential transcription of steroidogenic enzymes in the equine primary corpus luteum during diestrus and early pregnancy. Author(s): Albrecht BA, MacLeod JN, Daels PF. Source: Biology of Reproduction. 1997 April; 56(4): 821-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9096861&dopt=Abstract

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Distinguishing normal from abnormal gestational sac growth in early pregnancy. Author(s): Nyberg DA, Mack LA, Laing FC, Patten RM. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 1987 January; 6(1): 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3546719&dopt=Abstract

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Distributional changes of purinergic receptor subtypes (P2X 1-7) in uterine epithelial cells during early pregnancy. Author(s): Slater NM, Barden JA, Murphy CR. Source: The Histochemical Journal. 2000 June; 32(6): 365-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10943851&dopt=Abstract

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Does stress influence early pregnancy loss? Author(s): Nelson DB, Grisso JA, Joffe MM, Brensinger C, Shaw L, Datner E. Source: Annals of Epidemiology. 2003 April; 13(4): 223-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12684187&dopt=Abstract

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Dominant IL-10 and TGF-beta mRNA expression in gammadeltaT cells of human early pregnancy decidua suggests immunoregulatory potential. Author(s): Nagaeva O, Jonsson L, Mincheva-Nilsson L. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2002 July; 48(1): 9-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12322898&dopt=Abstract

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Doppler ultrasound investigation of uterine and ovarian blood flow in infertility and early pregnancy. Author(s): Dickey RP. Source: Human Reproduction Update. 1997 September-October; 3(5): 467-503. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9528912&dopt=Abstract

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Dose and time dependent rise of plasma cortisol following administration of mifepristone in early pregnancy. Author(s): Thong KJ, Brooks AN, Baird DT. Source: British Journal of Obstetrics and Gynaecology. 1993 September; 100(9): 880-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8218022&dopt=Abstract

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Down syndrome fetal loss rate in early pregnancy. Author(s): Morris J, Wald N. Source: Prenatal Diagnosis. 2000 August; 20(8): 685-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10951486&dopt=Abstract

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Down syndrome fetal loss rate in early pregnancy. Author(s): Cuckle H. Source: Prenatal Diagnosis. 1999 December; 19(12): 1177-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10590442&dopt=Abstract

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Drug use during early pregnancy. The impact of maternal illness, outcome of prior pregnancies and socio-demographic factors. Author(s): Nordeng H, Eskild A, Nesheim BI, Aursnes I, Jacobsen G. Source: European Journal of Clinical Pharmacology. 2001 June; 57(3): 259-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11497342&dopt=Abstract

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Early pregnancy care. Part 1. Author(s): Coggins J. Source: Pract Midwife. 2002 October; 5(9): 14-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400408&dopt=Abstract

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Early pregnancy care. Part 2. Author(s): Coggins J. Source: Pract Midwife. 2003 January; 6(1): 24-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611398&dopt=Abstract

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Early pregnancy factor: an unresolved molecule. Author(s): Lash GE, Legge M. Source: Journal of Assisted Reproduction and Genetics. 1997 October; 14(9): 495-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9401864&dopt=Abstract

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Early pregnancy loss following assisted reproductive technology treatment. Author(s): Winter E, Wang J, Davies MJ, Norman R. Source: Human Reproduction (Oxford, England). 2002 December; 17(12): 3220-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456627&dopt=Abstract

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Early pregnancy sessions. A formative evaluation. Author(s): Ward A. Source: Pract Midwife. 2000 December; 3(11): 32-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12026566&dopt=Abstract

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Early pregnancy termination with mifepristone and misoprostol in the United States. Author(s): Spitz IM, Bardin CW, Benton L, Robbins A. Source: The New England Journal of Medicine. 1998 April 30; 338(18): 1241-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9562577&dopt=Abstract

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Early pregnancy termination with vaginal misoprostol before and after 42 days gestation. Author(s): Zikopoulos KA, Papanikolaou EG, Kalantaridou SN, Tsanadis GD, Plachouras NI, Dalkalitsis NA, Paraskevaidis EA. Source: Human Reproduction (Oxford, England). 2002 December; 17(12): 3079-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456606&dopt=Abstract

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Early pregnancy threshold vaginal pH and Gram stain scores predictive of subsequent preterm birth in asymptomatic women. Author(s): Hauth JC, Macpherson C, Carey JC, Klebanoff MA, Hillier SL, Ernest JM, Leveno KJ, Wapner R, Varner M, Trout W, Moawad A, Sibai B. Source: American Journal of Obstetrics and Gynecology. 2003 March; 188(3): 831-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634666&dopt=Abstract

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Echocardiography in early pregnancy: review of literature. Author(s): Haak MC, van Vugt JM. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2003 March; 22(3): 271-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636327&dopt=Abstract

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Effect of early pregnancy on a previous lower segment cesarean section scar. Author(s): Weimin W, Wenqing L. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 June; 77(3): 201-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12065130&dopt=Abstract

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Effects of a urinary factor from women in early pregnancy on HIV-1, SIV and associated disease. Author(s): Lunardi-Iskandar Y, Bryant JL, Blattner WA, Hung CL, Flamand L, Gill P, Hermans P, Birken S, Gallo RC. Source: Nature Medicine. 1998 April; 4(4): 428-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9546788&dopt=Abstract

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Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department. Author(s): Wong TW, Lau CC, Yeung A, Lo L, Tai CM. Source: Journal of Accident & Emergency Medicine. 1998 May; 15(3): 155-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9639175&dopt=Abstract

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Electrical potential difference between exocelomic fluid and maternal blood in early pregnancy. Author(s): Ward S, Jauniaux E, Shannon C, Rodeck C, Boyd R, Sibley C. Source: The American Journal of Physiology. 1998 May; 274(5 Pt 2): R1492-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9612418&dopt=Abstract

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Elevated plasma homocysteine in early pregnancy: a risk factor for the development of nonsevere preeclampsia. Author(s): Cotter AM, Molloy AM, Scott JM, Daly SF. Source: American Journal of Obstetrics and Gynecology. 2003 August; 189(2): 391-4; Discussion 394-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520204&dopt=Abstract

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Embryonic heart rate in early pregnancy. Author(s): Stefos TI, Lolis DE, Sotiriadis AJ, Ziakas GV. Source: Journal of Clinical Ultrasound : Jcu. 1998 January; 26(1): 33-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9475206&dopt=Abstract

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Endometrial cell specific gene activation during implantation and early pregnancy. Author(s): Tseng L, Mazella J. Source: Frontiers in Bioscience : a Journal and Virtual Library. 2002 June 1; 7: D1566-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045017&dopt=Abstract

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Evaluation of maternal plasma creatine kinase activity as a marker of abnormal early pregnancy. Author(s): Zorn JR, Cherruau B, Abi-Rached F, Dehee A, Danoy X, Le Blond J, Ekindjian O. Source: Human Reproduction (Oxford, England). 1997 November; 12(11): 2534-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9436701&dopt=Abstract

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Evaluation of reagent strips in detecting asymptomatic bacteriuria in early pregnancy: prospective case series. Author(s): Tincello DG, Richmond DH. Source: Bmj (Clinical Research Ed.). 1998 February 7; 316(7129): 435-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492667&dopt=Abstract

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Examination of fetal nasal bone and repeatability of measurement in early pregnancy. Author(s): Kanellopoulos V, Katsetos C, Economides DL. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003 August; 22(2): 131-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905504&dopt=Abstract

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Expression of alpha6 and beta4 integrin subunits on human endometrium throughout the menstrual cycle and during early pregnancy. Author(s): Lanteri E, Pistritto M, Bartoloni G, Cordaro S, Stivala F, Montoneri C. Source: Fertility and Sterility. 1998 January; 69(1): 37-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9457929&dopt=Abstract

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Factors related to early pregnancy recognition in the woman. Author(s): Behr B, Stone B, Foote WD. Source: Journal of Assisted Reproduction and Genetics. 1995 April; 12(4): 278-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7580026&dopt=Abstract

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Feasibility of maternity protection in early pregnancy. Author(s): Von Busch TA, Frazier LM, Sigler SJ, Molgaard CA. Source: International Journal of Occupational and Environmental Health : Official Journal of the International Commission on Occupational Health. 2002 OctoberDecember; 8(4): 328-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12412850&dopt=Abstract

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Fetal biometric ratios by transvaginal sonography as a marker for aneuploidies in early pregnancy. Author(s): Guariglia L, Rosati P. Source: Prenatal Diagnosis. 1997 May; 17(5): 415-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9178315&dopt=Abstract

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Fetal gender determination in early pregnancy through qualitative and quantitative analysis of fetal DNA in maternal serum. Author(s): Honda H, Miharu N, Ohashi Y, Samura O, Kinutani M, Hara T, Ohama K. Source: Human Genetics. 2002 January; 110(1): 75-9. Epub 2001 November 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11810300&dopt=Abstract

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Fetal heart rate in early pregnancy and chromosomal disorders. Author(s): Van Lith JM, Visser GH, Mantingh A, Beekhuis JR. Source: British Journal of Obstetrics and Gynaecology. 1992 September; 99(9): 741-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1420014&dopt=Abstract

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Fetal hydrops secondary to human parvovirus infection in early pregnancy. Author(s): Petrikovsky BM, Baker D, Schneider E. Source: Prenatal Diagnosis. 1996 April; 16(4): 342-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8734809&dopt=Abstract

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Fetal mustache in early pregnancy. Author(s): Bronshtein M, Zimmer EZ, Offir H, Blazer S. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1998 October; 12(4): 252-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9819856&dopt=Abstract

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Fetal polydactyly diagnosis during early pregnancy: clinical applications. Author(s): Zimmer EZ, Bronshtein M. Source: American Journal of Obstetrics and Gynecology. 2000 September; 183(3): 755-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10992205&dopt=Abstract

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Fetal pressure gradient estimations across the ductus venosus in early pregnancy using Doppler ultrasonography. Author(s): van Splunder IP, Stijnen T, Wladimiroff JW. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1995 November; 6(5): 334-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8590204&dopt=Abstract

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Fetal sex determination by high resolution ultrasound in early pregnancy. Author(s): Mielke G, Kiesel L, Backsch C, Erz W, Gonser M. Source: European Journal of Ultrasound : Official Journal of the European Federation of Societies for Ultrasound in Medicine and Biology. 1998 April; 7(2): 109-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9614279&dopt=Abstract

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Fetal trisomy 10 mosaicism: ultrasound, cytogenetic and morphologic findings in early pregnancy. Author(s): Knoblauch H, Sommer D, Zimmer C, Tennstedt C, Heling K, Bollmann R, Bommer C, Tinschert S, Korner H. Source: Prenatal Diagnosis. 1999 April; 19(4): 379-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10327147&dopt=Abstract

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Fetal varicella-herpes zoster syndrome in early pregnancy: ultrasonographic and morphological correlation. Author(s): Petignat P, Vial Y, Laurini R, Hohlfeld P. Source: Prenatal Diagnosis. 2001 February; 21(2): 121-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11241539&dopt=Abstract

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Flow cytometric crossmatch and early pregnancy loss in women with a history of recurrent spontaneous abortions who underwent paternal leukocyte immunotherapy. Author(s): Maruyama T, Makino T, Sugi T, Iwasaki K, Ozawa N, Matsubayashi H, Nozawa S. Source: American Journal of Obstetrics and Gynecology. 1993 May; 168(5): 1528-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8498439&dopt=Abstract

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Foetal heart rate in early pregnancy by detection of optimally estimated displacements with pulsed Doppler signals. Author(s): Yamakoshi Y, Hogaki M. Source: Ultrasonics. 1994 September; 32(5): 391-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8079399&dopt=Abstract

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Folic acid supplements during early pregnancy and likelihood of multiple births: a population-based cohort study. Author(s): Li Z, Gindler J, Wang H, Berry RJ, Li S, Correa A, Zheng JC, Erickson JD, Wang Y. Source: Lancet. 2003 February 1; 361(9355): 380-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12573374&dopt=Abstract

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Follistatin and activin A in extra-embryonic coelomic and amniotic fluids and maternal serum in early pregnancy. Author(s): Riley SC, Balfour C, Wathen NC, Chard T, Evans LW, Groome NP, Wallace EM. Source: Human Reproduction (Oxford, England). 1998 September; 13(9): 2624-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806296&dopt=Abstract

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Free testosterone and abortion in early pregnancy. Author(s): Takeuchi T, Nishii O, Okamura T, Yaginuma T, Kawana T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1993 November; 43(2): 151-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7905430&dopt=Abstract

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Functional status of the pituitary-adrenal axis during treatment of RU486 for termination of early pregnancy in combination with PGs in Chinese women. Author(s): Yang XL, Wu XR. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1989 March; 5(1): 31-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2551132&dopt=Abstract

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Functional studies of human decidua in spontaneous early pregnancy loss: effect of soluble factors and purified CD56+ lymphocytes on killing of natural killer- and lymphokine-activated killer-sensitive targets. Author(s): Vassiliadou N, Bulmer JN. Source: Biology of Reproduction. 1998 April; 58(4): 982-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9546729&dopt=Abstract

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Functions of macrophages in human decidual tissue in early pregnancy. Author(s): Mizuno M, Aoki K, Kimbara T. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 1994 May; 31(4): 180-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8060501&dopt=Abstract

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Gamma delta T cells of human early pregnancy decidua: evidence for local proliferation, phenotypic heterogeneity, and extrathymic differentiation. Author(s): Mincheva-Nilsson L, Kling M, Hammarstrom S, Nagaeva O, Sundqvist KG, Hammarstrom ML, Baranov V. Source: Journal of Immunology (Baltimore, Md. : 1950). 1997 October 1; 159(7): 3266-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9317125&dopt=Abstract

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gammadelta T cells of human early pregnancy decidua: evidence for cytotoxic potency. Author(s): Cochrane Database Syst Rev. 2002;(1):CD000145 Source: International Immunology. 2000 May; 12(5): 585-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11869567

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Gastric cancer during early pregnancy. Two case reports. Author(s): Scharl A, Huber P, Lorenzen J, Gohring UJ. Source: Archives of Gynecology and Obstetrics. 1996; 258(3): 151-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8781704&dopt=Abstract

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Genetic risk factor for unexplained recurrent early pregnancy loss. Author(s): Nelen WL, Steegers EA, Eskes TK, Blom HJ. Source: Lancet. 1997 September 20; 350(9081): 861. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9310606&dopt=Abstract

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Genetically-restricted effector molecules released by human lymphocytes in response to early pregnancy factor. Author(s): Rolfe B, Quinn K, Athanasas S, Cavanagh A, Morton H. Source: Immunology and Cell Biology. 1989 June; 67 ( Pt 3): 205-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2793206&dopt=Abstract

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Gestational age-dependent expression of insulin-like growth factor-binding protein-1 (IGFBP-1) phosphoisoforms in human extraembryonic cavities, maternal serum, and decidua suggests decidua as the primary source of IGFBP-1 in these fluids during early pregnancy. Author(s): Martina NA, Kim E, Chitkara U, Wathen NC, Chard T, Giudice LC. Source: The Journal of Clinical Endocrinology and Metabolism. 1997 June; 82(6): 1894-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9177402&dopt=Abstract

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Gestational diabetes mellitus diagnosed during early pregnancy. Author(s): Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Source: American Journal of Obstetrics and Gynecology. 2000 February; 182(2): 346-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10694335&dopt=Abstract

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Gestational sac diameter in very early pregnancy as a predictor of fetal outcome. Author(s): Oh JS, Wright G, Coulam CB. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 September; 20(3): 267-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230450&dopt=Abstract

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Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Author(s): Olson CM, Strawderman MS, Hinton PS, Pearson TA. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2003 January; 27(1): 117-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532163&dopt=Abstract

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Ginger syrup as an antiemetic in early pregnancy. Author(s): Keating A, Chez RA. Source: Alternative Therapies in Health and Medicine. 2002 September-October; 8(5): 8991. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12233808&dopt=Abstract

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Glucose tolerance in early pregnancy. Author(s): Buch I, Hornnes PJ, Kuhl C. Source: Acta Endocrinol (Copenh). 1986 June; 112(2): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3526785&dopt=Abstract

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Glucose transporter proteins (GLUT) in human endometrium: expression, regulation, and function throughout the menstrual cycle and in early pregnancy. Author(s): von Wolff M, Ursel S, Hahn U, Steldinger R, Strowitzki T. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 August; 88(8): 3885-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12915684&dopt=Abstract

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Glycaemic control during early pregnancy and fetal malformations in women with type I diabetes mellitus. Author(s): Suhonen L, Hiilesmaa V, Teramo K. Source: Diabetologia. 2000 January; 43(1): 79-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10663219&dopt=Abstract

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Glycosaminoglycan accumulation in amniotic fluid during early pregnancy. Author(s): Sloan R, Archbold GP, Lloyd F, Elliott RJ. Source: Biochemical Society Transactions. 1996 February; 24(1): 103S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8674582&dopt=Abstract

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Gonadotropin and inhibin concentrations in early pregnancy in women with and without corpora lutea. Author(s): Santoro N, Schneyer AL, Ibrahim J, Schmidt CL. Source: Obstetrics and Gynecology. 1992 April; 79(4): 579-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1553181&dopt=Abstract

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Gonadotropin-induced successful follicular development, oocyte recovery, fertilization, and cleavage of embryos in undiagnosed early pregnancy. Author(s): Sharma V, Riddle A, Collins W, Campbell S, Mason B. Source: J in Vitro Fert Embryo Transf. 1987 February; 4(1): 61-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3108426&dopt=Abstract

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Granulocyte colony-stimulating factor-induced allogeneic peripheral stem cell donation during early pregnancy. Author(s): Leitner G, Loidolt H, Greinix HT, Hocker P, Dettke M. Source: British Journal of Haematology. 2001 October; 115(1): 233-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11722442&dopt=Abstract

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Growth factor activity in the blood of women in whom preeclampsia develops is elevated from early pregnancy. Author(s): Taylor RN, Heilbron DC, Roberts JM. Source: American Journal of Obstetrics and Gynecology. 1990 December; 163(6 Pt 1): 1839-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2256492&dopt=Abstract

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High NK cell activity in early pregnancy correlates with subsequent abortion with normal chromosomes in women with recurrent abortion. Author(s): Yamada H, Kato EH, Kobashi G, Ebina Y, Shimada S, Morikawa M, Sakuragi N, Fujimoto S. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2001 August; 46(2): 132-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11506077&dopt=Abstract

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High vitamin A intake in early pregnancy and major malformations: a multicenter prospective controlled study. Author(s): Mastroiacovo P, Mazzone T, Addis A, Elephant E, Carlier P, Vial T, Garbis H, Robert E, Bonati M, Ornoy A, Finardi A, Schaffer C, Caramelli L, Rodriguez-Pinilla E, Clementi M. Source: Teratology. 1999 January; 59(1): 7-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9988877&dopt=Abstract

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High-density ovine endometrial cells exhibit natural killer activity during early pregnancy. Author(s): Segerson EC, Beetham PK. Source: Theriogenology. 2000 November 1; 54(8): 1207-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11192179&dopt=Abstract

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HLA-G expression in trophoblast cells circulating in maternal peripheral blood during early pregnancy. Author(s): van Wijk IJ, Griffioen S, Tjoa ML, Mulders MA, van Vugt JM, Loke YW, Oudejans CB. Source: American Journal of Obstetrics and Gynecology. 2001 April; 184(5): 991-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11303210&dopt=Abstract

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Homocysteine and folate levels as risk factors for recurrent early pregnancy loss. Author(s): Nelen WL, Blom HJ, Steegers EA, den Heijer M, Thomas CM, Eskes TK. Source: Obstetrics and Gynecology. 2000 April; 95(4): 519-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10725483&dopt=Abstract

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Hormone analytical and carrier protein alternations following administration of mifepristone (RU 486) for termination of early pregnancy. Author(s): Klinger G, Carol W, Borner A, Michels W, Romero KR. Source: Exp Clin Endocrinol. 1991 March; 97(1): 63-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1864315&dopt=Abstract

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Horner's syndrome after epidural block in early pregnancy. Author(s): Zoellner PA, Bode ET. Source: Reg Anesth. 1991 July-August; 16(4): 242-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1911504&dopt=Abstract

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How many pregnant women in Christchurch are using folic acid supplements in early pregnancy? Author(s): Schader I, Corwin P. Source: N Z Med J. 1999 December 10; 112(1101): 463-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10678210&dopt=Abstract

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Human chorionic gonadotrophin concentrations in early pregnancy after in-vitro fertilization. Author(s): Bjercke S, Tanbo T, Dale PO, Morkrid L, Abyholm T. Source: Human Reproduction (Oxford, England). 1999 June; 14(6): 1642-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10357992&dopt=Abstract

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Human chorionic gonadotropin levels in various compartments in disturbed early pregnancy. Author(s): Dericks-Tan JS, Albrecht M, Theobald M, Taubert HD. Source: Fertility and Sterility. 1989 February; 51(2): 351-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2912783&dopt=Abstract

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Human chorionic gonadotropin patterns in early pregnancy after assisted reproduction. Author(s): Fridstrom M, Garoff L, Sjoblom P, Hillensjo T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 August; 74(7): 534-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618452&dopt=Abstract

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Human decidual leukocytes from early pregnancy contain high numbers of gamma delta+ cells and show selective down-regulation of alloreactivity. Author(s): Mincheva-Nilsson L, Hammarstrom S, Hammarstrom ML. Source: Journal of Immunology (Baltimore, Md. : 1950). 1992 September 15; 149(6): 220311. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1381400&dopt=Abstract

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Human embryonic origin early pregnancy factor before and after implantation. Author(s): Nahhas F, Barnea E. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 1990 March-April; 22(3-4): 105-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2375830&dopt=Abstract

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Human large luteal cells in the menstrual cycle and early pregnancy express leukotriene A4 hydrolase. Author(s): Hattori N, Fujiwara H, Maeda M, Yoshioka S, Higuchi T, Mori T, Ohishi N, Minami M, Fujii S, Ueda M. Source: Molecular Human Reproduction. 1998 August; 4(8): 803-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9733439&dopt=Abstract

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Human luteal function during implantation and early pregnancy. Author(s): Hamberger L, Hahlin M, Bennegard B, Sjoblom P. Source: Annals of the New York Academy of Sciences. 1991; 626: 189-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2058953&dopt=Abstract

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Human peripheral blood mononuclear cells (PBMC) in early pregnancy promote embryo invasion in vitro: HCG enhances the effects of PBMC. Author(s): Nakayama T, Fujiwara H, Maeda M, Inoue T, Yoshioka S, Mori T, Fujii S. Source: Human Reproduction (Oxford, England). 2002 January; 17(1): 207-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11756389&dopt=Abstract

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Human trophoblast interferons: production and possible roles in early pregnancy. Author(s): Aboagye-Mathiesen G, Toth FD, Zdravkovic M, Ebbesen P. Source: Early Pregnancy. 1995 March; 1(1): 41-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9363235&dopt=Abstract

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Hyperhomocysteinemia and recurrent early pregnancy loss: a meta-analysis. Author(s): Nelen WL, Blom HJ, Steegers EA, den Heijer M, Eskes TK. Source: Fertility and Sterility. 2000 December; 74(6): 1196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11119750&dopt=Abstract

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Hyperhomocysteinemia: a risk factor in women with unexplained recurrent early pregnancy loss. Author(s): Wouters MG, Boers GH, Blom HJ, Trijbels FJ, Thomas CM, Borm GF, Steegers-Theunissen RP, Eskes TK. Source: Fertility and Sterility. 1993 November; 60(5): 820-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8224267&dopt=Abstract

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Hysteroscopic treatment of early pregnancy conceived despite intrauterine contraception. Author(s): Van der Pas HF. Source: Acta Eur Fertil. 1986 November-December; 17(6): 481-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3630561&dopt=Abstract

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Identification of early pregnancy factor as chaperonin 10: implications for understanding its role. Author(s): Cavanagh AC. Source: Reviews of Reproduction. 1996 January; 1(1): 28-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9414435&dopt=Abstract

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Images in clinical medicine. Mullerian adenosarcoma and early pregnancy. Author(s): Izban KF, Gooneratne S. Source: The New England Journal of Medicine. 2000 October 19; 343(16): 1167. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11036123&dopt=Abstract

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Immunobiology and immunopathology of early pregnancy. Author(s): Rukavina D, Gill TJ 3rd. Source: Early Pregnancy. 1997 June; 3(2): 141-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9429855&dopt=Abstract

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Immunochemical measurement of early pregnancy isoforms of HCG: potential applications to fertility research, prenatal diagnosis, and cancer. Author(s): Birken S, Kovalevskaya G, O'Connor J. Source: Archives of Medical Research. 2001 November-December; 32(6): 635-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11750741&dopt=Abstract

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Immunohistochemical detection of CD45+, CD56+, and CD14+ cells in human decidua during early pregnancy. Author(s): Ozenci CC, Korgun ET, Demir R. Source: Early Pregnancy. 2001 July; 5(3): 164-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753530&dopt=Abstract

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Immunohistochemical localization of activin A in human endometrial tissues during the menstrual cycle and in early pregnancy. Author(s): Otani T, Minami S, Kokawa K, Shikone T, Yamoto M, Nakano R. Source: Obstetrics and Gynecology. 1998 May; 91(5 Pt 1): 685-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9572211&dopt=Abstract

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Implantation and the survival of early pregnancy. Author(s): Norwitz ER, Schust DJ, Fisher SJ. Source: The New England Journal of Medicine. 2001 November 8; 345(19): 1400-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11794174&dopt=Abstract

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Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome. Author(s): Raziel A, Friedler S, Schachter M, Strassburger D, Mordechai E, Ron-El R. Source: Human Reproduction (Oxford, England). 2002 January; 17(1): 107-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11756371&dopt=Abstract

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Inflammatory markers in the vagina in early pregnancy. Author(s): Oakeshott P, Hay P, Hay S, Adefowora A, Shattock R. Source: International Journal of Std & Aids. 2003 April; 14(4): 289-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716505&dopt=Abstract

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Influence of maternal anaemia during early pregnancy on the development of cleft palate. Author(s): Natsume N, Sugimoto S, Yoshida K, Kawai T. Source: The British Journal of Oral & Maxillofacial Surgery. 1999 August; 37(4): 330-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10475661&dopt=Abstract

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Inhibin and activin subunits are differentially expressed in endometrial cells and leukocytes during the menstrual cycle, in early pregnancy and in women using progestin-only contraception. Author(s): Jones RL, Salamonsen LA, Critchley HO, Rogers PA, Affandi B, Findlay JK. Source: Molecular Human Reproduction. 2000 December; 6(12): 1107-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11101694&dopt=Abstract

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Interruption of early pregnancy with mifepristone in combination with gemeprost. Author(s): Sandstrom O, Brooks L, Schantz A, Grinsted J, Grinsted L, Jacobsen JD, Nielsen SP. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1999 October; 78(9): 806-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10535346&dopt=Abstract

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Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy. Author(s): Jolly M, Taylor M, Rose G, Govender L, Fisk NM. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 October; 108(10): 1098-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11702844&dopt=Abstract

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Interventions for nausea and vomiting in early pregnancy. Author(s): Jewell D, Young G. Source: Cochrane Database Syst Rev. 2002; (1): Cd000145. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869567&dopt=Abstract

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Is ginger root effective for decreasing the severity of nausea and vomiting in early pregnancy? Author(s): Jackson EA. Source: The Journal of Family Practice. 2001 August; 50(8): 720. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11509171&dopt=Abstract

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Is there any evidence for immunologically mediated or immunologically modifiable early pregnancy failure? Author(s): Clark DA. Source: Journal of Assisted Reproduction and Genetics. 2003 February; 20(2): 63-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688590&dopt=Abstract

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Isolated hyperechogenic foci in the fetal thalamus in early pregnancy. Author(s): Bronshtein M, Zimmer EZ, Auslander R, Blazer S. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 April; 17(4): 333-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11339191&dopt=Abstract

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Isolation and purification of an early pregnancy factor-like molecule from culture supernatants obtained from lymphocytes of pregnant women. Author(s): Aranha C, Natraj U, Iyer KS, Shahani S. Source: Journal of Assisted Reproduction and Genetics. 1998 March; 15(3): 117-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9547687&dopt=Abstract

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Isolation of antibodies which neutralise the activity of early pregnancy factor. Author(s): Hammond F, Cavanagh A, Morton H, Hillyard N, Papaioannou A, Clark M, Wanigesekera D, Swanton M, Ward R. Source: Journal of Immunological Methods. 2000 October 20; 244(1-2): 175-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11033030&dopt=Abstract

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Isolation, purification and partial characterization of early pregnancy factor (EPF) from sera of pregnant women. Author(s): Haq A, Mothi BA, Al-Hussein K, Al-Tufail M, Hollanders J, Jaroudi K, AlWaili N, Shabani M. Source: European Journal of Medical Research. 2001 May 29; 6(5): 209-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11410402&dopt=Abstract

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Laboratory methods for evaluating early pregnancy loss in an industry-based population. Author(s): Lasley BL, Lohstroh P, Kuo A, Gold EB, Eskenazi B, Samuels SJ, Stewart DR, Overstreet JW. Source: American Journal of Industrial Medicine. 1995 December; 28(6): 771-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8588563&dopt=Abstract

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Laparoscopic management of adnexal torsion in early pregnancy: a case report. Author(s): Wittich AC, Lockrow EG, Fox JT. Source: Military Medicine. 1994 March; 159(3): 254-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8041478&dopt=Abstract

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Laparoscopic relief of adnexal torsion in early pregnancy. Case reports. Author(s): Shalev E, Rahav D, Romano S. Source: British Journal of Obstetrics and Gynaecology. 1990 September; 97(9): 853-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2146973&dopt=Abstract

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Learning curve in ultrasonographic screening for selected fetal structural anomalies in early pregnancy. Author(s): Taipale P, Ammala M, Salonen R, Hiilesmaa V. Source: Obstetrics and Gynecology. 2003 February; 101(2): 273-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576250&dopt=Abstract

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Leptin during assisted reproductive cycles: the effect of ovarian stimulation and of very early pregnancy. Author(s): Unkila-Kallio L, Andersson S, Koistinen HA, Karonen SL, Ylikorkala O, Tiitinen A. Source: Human Reproduction (Oxford, England). 2001 April; 16(4): 657-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11278213&dopt=Abstract

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Leukocyte function-associated antigen-1 expression on decidual natural killer cells in patients with early pregnancy loss. Author(s): Fukui K, Yoshimoto I, Matsubara K, Hori R, Ochi H, Ito M. Source: Molecular Human Reproduction. 1999 November; 5(11): 1083-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10541572&dopt=Abstract

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Levels of mannose binding lectin in early pregnancy complicated by diabetes mellitus type 1--preliminary report. Author(s): Pertynska M, Tchorzewski H, Cedzynski M, Lewkowicz P, Sobczak M, Cypryk K, Wilczynski J. Source: Ginekol Pol. 2001 December; 72(12A): 1267-71. Erratum In: Ginekol Pol 2002 August; 73(8): 708. Ginekol Pol. 2003 March; 74(3): 256. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11883262&dopt=Abstract

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Local relaxin biosynthesis in the ovary and uterus through the oestrous cycle and early pregnancy in the female marmoset monkey (Callithrix jacchus). Author(s): Einspanier A, Zarreh-Hoshyari-Khah MR, Balvers M, Kerr L, Fuhrmann K, Ivell R. Source: Human Reproduction (Oxford, England). 1997 June; 12(6): 1325-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9222026&dopt=Abstract

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Localization of ubiquitin and ubiquitin cross-reactive protein in human and baboon endometrium and decidua during the menstrual cycle and early pregnancy. Author(s): Bebington C, Bell SC, Doherty FJ, Fazleabas AT, Fleming SD. Source: Biology of Reproduction. 1999 April; 60(4): 920-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10084967&dopt=Abstract

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Long term follow-up of children born after inadvertent administration of a GnRHanalogue in early pregnancy. Author(s): Platteau P, Vandervorst M, Devroey P. Source: Human Reproduction (Oxford, England). 2000 June; 15(6): 1421. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10831582&dopt=Abstract

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Longitudinal evaluation of uteroplacental and umbilical blood flow changes in normal early pregnancy. Author(s): Coppens M, Loquet P, Kollen M, De Neubourg F, Buytaert P. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1996 February; 7(2): 114-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8776236&dopt=Abstract

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Long-term follow-up of children born after inadvertent administration of a gonadotrophin-releasing hormone agonist in early pregnancy. Author(s): Lahat E, Raziel A, Friedler S, Schieber-Kazir M, Ron-El R. Source: Human Reproduction (Oxford, England). 1999 October; 14(10): 2656-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10528003&dopt=Abstract

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Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study. Author(s): Olsen SF, Secher NJ. Source: Bmj (Clinical Research Ed.). 2002 February 23; 324(7335): 447. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11859044&dopt=Abstract

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Low dose weekly methotrexate in early pregnancy. A case series and review of the literature. Author(s): Ostensen M, Hartmann H, Salvesen K. Source: The Journal of Rheumatology. 2000 August; 27(8): 1872-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10955326&dopt=Abstract

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Low fetal loss rates after ultrasound-proved viability in early pregnancy. Author(s): Simpson JL, Mills JL, Holmes LB, Ober CL, Aarons J, Jovanovic L, Knopp RH. Source: Jama : the Journal of the American Medical Association. 1987 November 13; 258(18): 2555-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3312659&dopt=Abstract

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Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Author(s): Pop VJ, Kuijpens JL, van Baar AL, Verkerk G, van Son MM, de Vijlder JJ, Vulsma T, Wiersinga WM, Drexhage HA, Vader HL. Source: Clinical Endocrinology. 1999 February; 50(2): 149-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10396355&dopt=Abstract

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Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after a previous cesarean delivery. Author(s): Ito M, Nawa T, Mikamo H, Tamaya T. Source: J Med. 1998; 29(1-2): 85-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9704295&dopt=Abstract

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Luminescence luteinizing hormone/choriogonadotropin (LH/CG) bioassay: measurement of serum bioactive LH/CG during early pregnancy in human and macaque. Author(s): Jia XC, Perlas E, Su JG, Moran F, Lasley BL, Ny T, Hsueh AJ. Source: Biology of Reproduction. 1993 December; 49(6): 1310-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8286613&dopt=Abstract

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Luteinising hormone and early pregnancy loss. Author(s): Pearce JM. Source: Lancet. 1991 January 12; 337(8733): 120. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1670711&dopt=Abstract

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Luteotropic effects of prostaglandin E2 on the human corpus luteum of the menstrual cycle and early pregnancy. Author(s): Hahlin M, Dennefors B, Johanson C, Hamberger L. Source: The Journal of Clinical Endocrinology and Metabolism. 1988 May; 66(5): 909-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2834411&dopt=Abstract

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Macrophage migration inhibitory factor in the human endometrium: expression and localization during the menstrual cycle and early pregnancy. Author(s): Arcuri F, Ricci C, Ietta F, Cintorino M, Tripodi SA, Cetin I, Garzia E, Schatz F, Klemi P, Santopietro R, Paulesu L. Source: Biology of Reproduction. 2001 April; 64(4): 1200-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11259268&dopt=Abstract

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Manual vacuum aspiration, a safe and effective alternative in early pregnancy termination. Author(s): Hemlin J, Moller B. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 June; 80(6): 563-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380295&dopt=Abstract

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Maternal attitudes to amniotomy and labor duration: a survey in early pregnancy. Author(s): Ryan J. Source: Journal of Midwifery & Women's Health. 2000 July-August; 45(4): 360-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10983440&dopt=Abstract

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Maternal attitudes to amniotomy and labor duration: a survey in early pregnancy. Author(s): Impey L. Source: Birth (Berkeley, Calif.). 1999 December; 26(4): 211-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10655824&dopt=Abstract

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Maternal homocysteine and chorionic vascularization in recurrent early pregnancy loss. Author(s): Nelen WL, Bulten J, Steegers EA, Blom HJ, Hanselaar AG, Eskes TK. Source: Human Reproduction (Oxford, England). 2000 April; 15(4): 954-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10739849&dopt=Abstract

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Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study. Author(s): Pop VJ, Brouwers EP, Vader HL, Vulsma T, van Baar AL, de Vijlder JJ. Source: Clinical Endocrinology. 2003 September; 59(3): 282-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12919150&dopt=Abstract

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Maternal serum inhibin A concentrations in early pregnancy after IVF and embryo transfer reflect the corpus luteum contribution and pregnancy outcome. Author(s): Treetampinich C, O'Connor AE, MacLachlan V, Groome NP, de Kretser DM. Source: Human Reproduction (Oxford, England). 2000 September; 15(9): 2028-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10967009&dopt=Abstract

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Matrix metalloproteinase-28 transcript and protein are expressed in rhesus monkey placenta during early pregnancy. Author(s): Li QL, Illman SA, Wang HM, Liu DL, Lohi J, Zhu C. Source: Molecular Human Reproduction. 2003 April; 9(4): 205-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12651902&dopt=Abstract

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Memory performance, but not information processing speed, may be reduced during early pregnancy. Author(s): de Groot RH, Hornstra G, Roozendaal N, Jolles J. Source: J Clin Exp Neuropsychol. 2003 June; 25(4): 482-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911102&dopt=Abstract

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Methylene tetrahydrofolate reductase (MTHFR) 677T-->C mutation and unexplained early pregnancy loss. Author(s): Grandone E, Margaglione M, Colaizzo D, d'Addedda M, D'Andrea G, Pavone G, Di Minno G. Source: Thrombosis and Haemostasis. 1998 May; 79(5): 1056-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9609248&dopt=Abstract

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Midwifery management of first trimester bleeding and early pregnancy loss. Author(s): Thorstensen KA. Source: Journal of Midwifery & Women's Health. 2000 November-December; 45(6): 48197. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11151462&dopt=Abstract

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Misoprostol used alone for the termination of early pregnancy. A review of the evidence. Author(s): Blanchard K, Winikoff B, Ellertson C. Source: Contraception. 1999 April; 59(4): 209-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10457864&dopt=Abstract

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Misoprostol's effect on uterine arterial blood flow and fetal heart rate in early pregnancy. Author(s): Yip SK, Tse AO, Haines CJ, Chung TK. Source: Obstetrics and Gynecology. 2000 February; 95(2): 232-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10674585&dopt=Abstract

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Modulation of T-cell CD3-zeta chain expression in early pregnancy. Author(s): Eblen AC, Gercel-Taylor C, Nakajima ST, Taylor DD. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2002 March; 47(3): 167-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069202&dopt=Abstract

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Myomectomy during early pregnancy. Author(s): Wittich AC, Salminen ER, Yancey MK, Markenson GR. Source: Military Medicine. 2000 February; 165(2): 162-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10709382&dopt=Abstract

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Natural history of fetal simple renal cysts detected in early pregnancy. Author(s): Blazer S, Zimmer EZ, Blumenfeld Z, Zelikovic I, Bronshtein M. Source: The Journal of Urology. 1999 September; 162(3 Pt 1): 812-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10458386&dopt=Abstract

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Nausea and vomiting in early pregnancy. Author(s): Jewell D. Source: American Family Physician. 2003 July 1; 68(1): 143-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887120&dopt=Abstract

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Nausea and vomiting in early pregnancy. Author(s): Jewell D. Source: Clin Evid. 2002 June; (7): 1277-83. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230746&dopt=Abstract

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Nephrotic syndrome in early pregnancy--is renal biopsy always necessary? Author(s): Pandya BK, Gibson SP, Robertson IG. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 April; 17(4): 672-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11917065&dopt=Abstract

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New frontiers in early pregnancy investigation. Author(s): Barnea ER. Source: Early Pregnancy. 1995 March; 1(1): 1-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9363229&dopt=Abstract

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Nonsteroidal anti-inflammatory drugs in early pregnancy. Author(s): Ericson A, Kallen BA. Source: Reproductive Toxicology (Elmsford, N.Y.). 2001 July-August; 15(4): 371-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11489592&dopt=Abstract

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Nonvisualization of the fetal gallbladder in early pregnancy: comparison with clinical outcome. Author(s): Blazer S, Zimmer EZ, Bronshtein M. Source: Radiology. 2002 August; 224(2): 379-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147832&dopt=Abstract

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Normal pregnancy outcome after inadvertent exposure to long-acting gonadotrophinreleasing hormone agonist in early pregnancy. Author(s): Taskin O, Gokdeniz R, Atmaca R, Burak F. Source: Human Reproduction (Oxford, England). 1999 May; 14(5): 1368-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10325295&dopt=Abstract

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Nutrient insult in early pregnancy. Author(s): Coad J, Al-Rasasi B, Morgan J. Source: The Proceedings of the Nutrition Society. 2002 February; 61(1): 51-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12002795&dopt=Abstract

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Nutrient-gene interactions in early pregnancy: a vascular hypothesis. Author(s): Steegers-Theunissen RP, Steegers EA. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 February 10; 106(2): 115-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12551774&dopt=Abstract

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Obesity is a risk factor for early pregnancy loss after IVF or ICSI. Author(s): Fedorcsak P, Storeng R, Dale PO, Tanbo T, Abyholm T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 January; 79(1): 43-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10646815&dopt=Abstract

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Obesity may confound relation of early pregnancy loss to risk of heart disease. Author(s): Davies MJ. Source: Bmj (Clinical Research Ed.). 2003 May 24; 326(7399): 1146. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764003&dopt=Abstract

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Olfactory modulation of nausea during early pregnancy? Author(s): Hummel T, von Mering R, Huch R, Kolble N. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 December; 109(12): 1394-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12504977&dopt=Abstract

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One laparoscopic puncture for treatment of ovarian cysts with adnexal torsion in early pregnancy. A report of two cases. Author(s): Garzarelli S, Mazzuca N. Source: J Reprod Med. 1994 December; 39(12): 985-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7884759&dopt=Abstract

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Onset of maternal arterial blood flow and placental oxidative stress. A possible factor in human early pregnancy failure. Author(s): Jauniaux E, Watson AL, Hempstock J, Bao YP, Skepper JN, Burton GJ. Source: American Journal of Pathology. 2000 December; 157(6): 2111-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11106583&dopt=Abstract

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Outcome of failed pregnancies managed in an early pregnancy unit. Author(s): Acharya G, Morgan H. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 August; 74(2): 211-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11502304&dopt=Abstract

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Ovarian origin of plasma and peritoneal fluid prorenin in early pregnancy and in patients with ovarian hyperstimulation syndrome. Author(s): Itskovitz-Eldor J, Kol S, Lewit N, Sealey JE. Source: The Journal of Clinical Endocrinology and Metabolism. 1997 February; 82(2): 461-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9024237&dopt=Abstract

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Ovulation induction and early pregnancy loss in a woman susceptible to autoimmune diseases: a possible interrelationship. Author(s): Macut D, Micic D, Suvajdzic N, Sumarac M, Kendereski A, Zoric S, Elezovic I, Petrovic R, Cvijovic G, Gligorovic P. Source: Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology. 2000 June; 14(3): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10923274&dopt=Abstract

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Ovum factor and early pregnancy factor. Author(s): Morton H, Rolfe BE, Cavanagh AC. Source: Curr Top Dev Biol. 1987; 23: 73-92. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3330508&dopt=Abstract

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Oxytocin and vasopressin receptors in human and uterine myomas during menstrual cycle and early pregnancy. Author(s): Fuchs AR, Behrens O, Maschek H, Kupsch E, Einspanier A. Source: Human Reproduction Update. 1998 September-October; 4(5): 594-604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10027613&dopt=Abstract

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Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy: a comparative study. Author(s): Hjelmstedt A, Widstrom AM, Wramsby H, Matthiesen AS, Collins A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 February; 82(2): 152-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648178&dopt=Abstract

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Placental nitric oxide production and umbilical artery vascular impedance in early pregnancy. Author(s): Lees C, Jauniaux E, Jurkovic D, Campbell S. Source: Obstetrics and Gynecology. 1998 May; 91(5 Pt 1): 761-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9572226&dopt=Abstract

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Plasminogen activator inhibitor 1 4G/5G polymorphism and coagulation factor XIII Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss. Author(s): Dossenbach-Glaninger A, van Trotsenburg M, Dossenbach M, Oberkanins C, Moritz A, Krugluger W, Huber J, Hopmeier P. Source: Clinical Chemistry. 2003 July; 49(7): 1081-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816904&dopt=Abstract

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Pregnancy outcome with ACE-inhibitor use in early pregnancy. Author(s): Steffensen FH, Nielsen GL, Sorensen HT, Olesen C, Olsen J. Source: Lancet. 1998 February 21; 351(9102): 596. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492804&dopt=Abstract

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Prenatal diagnosis of Dandy-Walker syndrome in early pregnancy presenting with increased nuchal translucency and generalized edema at 13 weeks of gestation. Author(s): Chen SH, Lin MY, Chang FM. Source: Prenatal Diagnosis. 2003 June; 23(6): 514-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813770&dopt=Abstract

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Prenatal diagnosis of limb-body wall complex in early pregnancy using threedimensional ultrasound. Author(s): Liu IF, Yu CH, Chang CH, Chang FM. Source: Prenatal Diagnosis. 2003 June; 23(6): 513-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813769&dopt=Abstract

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Prevalence and predictors of health risk behaviours during early pregnancy: Saskatoon Pregnancy and Health Study. Author(s): Muhajarine N, D'Arcy C, Edouard L. Source: Canadian Journal of Public Health. Revue Canadienne De Sante Publique. 1997 November-December; 88(6): 375-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9458562&dopt=Abstract

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Prevention of early pregnancy loss in autoantibody seropositive women. Author(s): Geva E, Amit A, Lerner-Geva L, Lessing JB. Source: Lancet. 1998 January 3; 351(9095): 34-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9433430&dopt=Abstract

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Psychosocial factors related to nausea, vomiting, and fatigue in early pregnancy. Author(s): Chou FH, Lin LL, Cooney AT, Walker LO, Riggs MW. Source: Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2003; 35(2): 119-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854291&dopt=Abstract

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Psychosocial resources and persistent alcohol consumption in early pregnancy--a population study of women in their first pregnancy in Sweden. Author(s): Dejin-Karlsson E, Hanson BS, Ostergren PO. Source: Scand J Soc Med. 1997 December; 25(4): 280-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9460142&dopt=Abstract

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Quantification of fetal motor activity in early pregnancy. Author(s): Jorgensen NP, Marsal K, Lindstrom K. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1989 January; 30(1): 11-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2647536&dopt=Abstract

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Raised levels of maternal serum secretory acetylcholinesterase may be indicative of fetal neural tube defects in early pregnancy. Author(s): Brennand DM, Jehanli AM, Wood PJ, Smith JL. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 January; 77(1): 8-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492710&dopt=Abstract

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Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination. Author(s): Larsson M, Aneblom G, Odlind V, Tyden T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 January; 81(1): 64-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942890&dopt=Abstract

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Recrudescent herpes labialis during and prior to early pregnancy. Author(s): Scott D, Moore S, Ide M, Coward P, Baylis R, Borkowska E. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 March; 80(3): 263-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12628527&dopt=Abstract

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Recurrent early pregnancy loss and consanguinity. Author(s): Saad FA, Jauniaux E. Source: Reproductive Biomedicine Online. 2002 September-October; 5(2): 167-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12419042&dopt=Abstract

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Reference values of fetal orbital measurements by transvaginal scan in early pregnancy. Author(s): Rosati P, Bartolozzi F, Guariglia L. Source: Prenatal Diagnosis. 2002 October; 22(10): 851-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378563&dopt=Abstract

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Regulation of gap junction connexins in the endometrium during early pregnancy. Author(s): Grummer R, Winterhager E. Source: Cell and Tissue Research. 1998 August; 293(2): 189-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9662642&dopt=Abstract

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Relationship among maternal serum endocrinology, placental karyotype, and intervillous circulation in early pregnancy failure. Author(s): Greenwold N, Jauniaux E, Gulbis B, Hempstock J, Gervy C, Burton GJ. Source: Fertility and Sterility. 2003 June; 79(6): 1373-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798885&dopt=Abstract

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Relationship between blood pressure level in early pregnancy and subsequent changes in blood pressure during pregnancy. Author(s): Iwasaki R, Ohkuchi A, Furuta I, Ojima T, Matsubara S, Sato I, Minakami H. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 October; 81(10): 918-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12366481&dopt=Abstract

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Relationship of vaginal bacteria and inflammation with conception and early pregnancy loss following in-vitro fertilization. Author(s): Eckert LO, Moore DE, Patton DL, Agnew KJ, Eschenbach DA. Source: Infectious Diseases in Obstetrics and Gynecology. 2003; 11(1): 11-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839628&dopt=Abstract

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Reliability of serial urine HCG as a biomarker to detect early pregnancy loss. Author(s): Cho SI, Goldman MB, Ryan LM, Chen C, Damokosh AI, Christiani DC, Lasley BL, O'Connor JF, Wilcox AJ, Xu X. Source: Human Reproduction (Oxford, England). 2002 April; 17(4): 1060-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925406&dopt=Abstract

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Sex hormones, hemostasis and early pregnancy loss. Author(s): Nelson DB, Ness RB, Grisso JA, Cushman M. Source: Archives of Gynecology and Obstetrics. 2002 November; 267(1): 7-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410365&dopt=Abstract

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Socioeconomic and environmental risk factors of bacterial vaginosis in early pregnancy. Author(s): Kalinka J, Hanke W, Wasiela M, Laudanski T. Source: Journal of Perinatal Medicine. 2002; 30(6): 467-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12530102&dopt=Abstract

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Sonographic diagnosis of fetal vascular rings in early pregnancy. Author(s): Bronshtein M, Lorber A, Berant M, Auslander R, Zimmer EZ. Source: The American Journal of Cardiology. 1998 January 1; 81(1): 101-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9462619&dopt=Abstract

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Sonographic evaluation of intervillous flow in early pregnancy: use of echoenhancement agents. Author(s): Simpson NA, Nimrod C, De Vermette R, Leblanc C, Fournier J. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1998 March; 11(3): 204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9589145&dopt=Abstract

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Spontaneous loss of early pregnancy and risk of ischaemic heart disease in later life: retrospective cohort study. Author(s): Smith GC, Pell JP, Walsh D. Source: Bmj (Clinical Research Ed.). 2003 February 22; 326(7386): 423-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12595381&dopt=Abstract

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Stage-specific uptake of apolipoprotein-B in ovarian follicles and corpora lutea of the menstrual cycle and early pregnancy. Author(s): Yamada S, Fujiwara H, Kataoka N, Honda T, Nakayama T, Higuchi T, Mori T, Maeda M. Source: Human Reproduction (Oxford, England). 1998 April; 13(4): 944-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9619552&dopt=Abstract

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Stimulation of Kaposi's sarcoma cell growth by urine from women in early pregnancy, the current source for clinical-grade human chorionic gonadotropin preparations. Author(s): Simonart T, Hermans P, Delogne-Desnoeck J, Van Vooren JP, Meuris S. Source: Experimental Dermatology. 2002 August; 11(4): 365-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190946&dopt=Abstract

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Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intraarterial rt-PA. Author(s): Elford K, Leader A, Wee R, Stys PK. Source: Neurology. 2002 October 22; 59(8): 1270-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12391365&dopt=Abstract

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Structural differentiation of human uterine luminal and glandular epithelium during early pregnancy: an ultrastructural and immunohistochemical study. Author(s): Demir R, Kayisli UA, Celik-Ozenci C, Korgun ET, Demir-Weusten AY, Arici A. Source: Placenta. 2002 September-October; 23(8-9): 672-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361686&dopt=Abstract

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Systemic and renal hemodynamic changes in the luteal phase of the menstrual cycle mimic early pregnancy. Author(s): Chapman AB, Zamudio S, Woodmansee W, Merouani A, Osorio F, Johnson A, Moore LG, Dahms T, Coffin C, Abraham WT, Schrier RW. Source: The American Journal of Physiology. 1997 November; 273(5 Pt 2): F777-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9374841&dopt=Abstract

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The determinants of iron status in early pregnancy. Author(s): Robinson S, Godfrey K, Denne J, Cox V. Source: The British Journal of Nutrition. 1998 March; 79(3): 249-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9577303&dopt=Abstract

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The effect of glycemic control in the pre-conception period and early pregnancy on birth weight in women with IDDM. Author(s): Gold AE, Reilly R, Little J, Walker JD. Source: Diabetes Care. 1998 April; 21(4): 535-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9571338&dopt=Abstract

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The evaluation of cardiac biometry in major cardiac defects detected in early pregnancy. Author(s): Smrcek JM, Gembruch U, Krokowski M, Berg C, Krapp M, Geipel A, Germer U. Source: Archives of Gynecology and Obstetrics. 2003 June; 268(2): 94-101. Epub 2002 October 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768297&dopt=Abstract

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The kinetics of serum hCG and progesterone in response to oral and vaginal administration of misoprostol during medical termination of early pregnancy. Author(s): Honkanen H, Ranta S, Ylikorkala O, Heikinheimo O. Source: Human Reproduction (Oxford, England). 2002 September; 17(9): 2315-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12202418&dopt=Abstract

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The mirror image artifact of early pregnancy. Author(s): Lim BH, Amos M, Fairhead AC. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003 May; 21(5): 518-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768571&dopt=Abstract

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The placebo response and effect of time in a trial of acupuncture to treat nausea and vomiting in early pregnancy. Author(s): Smith C, Crowther C. Source: Complementary Therapies in Medicine. 2002 December; 10(4): 210-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594971&dopt=Abstract

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The sonographic approach to the detection of fetal cardiac anomalies in early pregnancy. Author(s): Bronshtein M, Zimmer EZ. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 April; 19(4): 360-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11952965&dopt=Abstract

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T-helper (1) cytokines increase during early pregnancy in women with a history of recurrent spontaneous abortion. Author(s): Rezaei A, Dabbagh A. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2002 August; 8(8): Cr607-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12165750&dopt=Abstract

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Transvaginal sonographic measurement of fetal lingual width in early pregnancy. Author(s): Bronshtein M, Zimmer EZ, Tzidony D, Hajos J, Jaeger M, Blazer S. Source: Prenatal Diagnosis. 1998 June; 18(6): 577-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9664602&dopt=Abstract

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Twenty-four hour blood pressure monitoring in early pregnancy: is it predictive of pregnancy-induced hypertension and preeclampsia? Author(s): Benedetto C, Marozio L, Giarola M, Chiarolini L, Maula V, Massobrio M. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 January; 77(1): 14-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492711&dopt=Abstract

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Ultrasonically dense amniotic fluid in early pregnancy in asymptomatic women without vaginal bleeding. A report of two cases. Author(s): Vengalil S, Santolaya-Forgas J, Meyer W, Myles T. Source: J Reprod Med. 1998 May; 43(5): 462-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9610473&dopt=Abstract

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Ultrasonography in the detection of fetal anomalies in early pregnancy. Author(s): Economides DL, Whitlow BJ, Braithwaite JM. Source: British Journal of Obstetrics and Gynaecology. 1999 June; 106(6): 516-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10426606&dopt=Abstract

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Unsuspected early pregnancy at hysterosalpingography. Author(s): Jongen VH, Collins JM, Lubbers JA, van Selm M. Source: Fertility and Sterility. 2001 September; 76(3): 610-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11532489&dopt=Abstract

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Updated diagnostic criteria for partial and complete hydatidiform moles in early pregnancy. Author(s): Sebire NJ, Makrydimas G, Agnantis NJ, Zagorianakou N, Rees H, Fisher RA. Source: Anticancer Res. 2003 March-April; 23(2C): 1723-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820448&dopt=Abstract

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Urinary cotinine levels in early pregnancy. Author(s): Foundas M, Hawkrigg NC, Smith SM, Devadason SG, Le Souef PN. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1997 November; 37(4): 383-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9429697&dopt=Abstract

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Use of antihistamine drugs in early pregnancy and delivery outcome. Author(s): Kallen B. Source: J Matern Fetal Neonatal Med. 2002 March;11(3):146-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380668&dopt=Abstract

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Use of multivitamins and folic acid in early pregnancy and multiple births in Sweden. Author(s): Ericson A, Kallen B, Aberg A. Source: Twin Research : the Official Journal of the International Society for Twin Studies. 2001 April; 4(2): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11665336&dopt=Abstract

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Uterine artery hemodynamic adaptations through the menstrual cycle into early pregnancy. Author(s): P Dickey R. Source: Obstetrics and Gynecology. 2002 August; 100(2): 379; Author Reply 379-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151169&dopt=Abstract

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Uterine artery hemodynamic adaptations through the menstrual cycle into early pregnancy. Author(s): Bernstein IM, Ziegler WF, Leavitt T, Badger GJ. Source: Obstetrics and Gynecology. 2002 April; 99(4): 620-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12039123&dopt=Abstract

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Uterine expression of alternatively spliced mRNAs of mouse splicing factor SC35 during early pregnancy. Author(s): Nie GY, Li Y, Batten L, Griffiths B, Wang J, Findlay JK, Salamonsen LA. Source: Molecular Human Reproduction. 2000 December; 6(12): 1131-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11101696&dopt=Abstract

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Vaginal bleeding and early pregnancy outcome in an infertile population. Author(s): Dantas ZN, Singh AP, Karachalios P, Asch RH, Balmaceda JP, Stone SC. Source: Journal of Assisted Reproduction and Genetics. 1996 March; 13(3): 212-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8852881&dopt=Abstract

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Vaginal bleeding in early pregnancy. Author(s): Allan A. Source: The Practitioner. 1994 April; 238(1537): 310-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8183818&dopt=Abstract

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Value of ultrasound during the menstrual cycle and early pregnancy. Author(s): Steer CV. Source: British Medical Bulletin. 1990 July; 46(3): 733-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2207604&dopt=Abstract

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Varicella vaccination during early pregnancy: a cause of in utero miliary fetal tissue calcifications and hydrops? Author(s): Apuzzio J, Ganesh V, Iffy L, Al-Khan A. Source: Infectious Diseases in Obstetrics and Gynecology. 2002; 10(3): 159-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625972&dopt=Abstract

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Vascular endothelial growth factor mRNA and its protein expression in decidua after terminating early pregnancy by mifepristone plus misoprostol. Author(s): Huang L, Shi Y. Source: Chinese Medical Journal. 2001 May; 114(5): 517-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11780417&dopt=Abstract

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Very early pregnancy wastage in in vitro fertilization and embryo transfer (IVF-ET). Author(s): Levy T, Goldman JA, Dicker D, Ashkenazi J, Feldberg D. Source: J in Vitro Fert Embryo Transf. 1991 October; 8(5): 250-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1757737&dopt=Abstract

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Visual diagnosis casebook: congenital anomalies associated with maternal varicella infection during early pregnancy. Author(s): Alkalay AL, Pomerance JJ, Yamamura JM, Sittler S, Baladi KS. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1987 Winter; 7(1): 69-71. Erratum In: J Perinatol 1987 Summer; 7(3): 256. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3507549&dopt=Abstract

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Vitamin supplementation and pregnancy outcome in women with recurrent early pregnancy loss and hyperhomocysteinemia. Author(s): Quere I, Mercier E, Bellet H, Janbon C, Mares P, Gris JC. Source: Fertility and Sterility. 2001 April; 75(4): 823-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287044&dopt=Abstract

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Vitamins in early pregnancy. Author(s): Smithells D. Source: Bmj (Clinical Research Ed.). 1996 July 20; 313(7050): 128-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8688768&dopt=Abstract

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Volume measurements of cystic hygroma detected by transvaginal scan in early pregnancy. Author(s): Rosati P, Guariglia L. Source: Prenatal Diagnosis. 1997 September; 17(9): 889-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9316143&dopt=Abstract

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Warm tub bath and sauna in early pregnancy: risk of malformation uncertain. Author(s): Waldenstrom U. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1994 July; 73(6): 449-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8042454&dopt=Abstract

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What do we tell expectant parents about bleeding and risk of miscarriage in early pregnancy? Author(s): Srivastava A, Evans MF. Source: Can Fam Physician. 1998 October; 44: 2099-100. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9805163&dopt=Abstract

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What invasive procedure to use in early pregnancy? Author(s): Jauniaux E, Pahal GS, Rodeck CH. Source: Bailliere's Best Practice & Research. Clinical Obstetrics & Gynaecology. 2000 August; 14(4): 651-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10985936&dopt=Abstract

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Why is there a peak of human chorionic gonadotrophin (HCG) in early pregnancy? Author(s): Chard T, Iles R, Wathen N. Source: Human Reproduction (Oxford, England). 1995 July; 10(7): 1837-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8582993&dopt=Abstract

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Women who spontaneously quit smoking in early pregnancy. Author(s): Panjari M, Bell RJ, Astbury J, Bishop SM, Dalais F, Rice GE. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1997 August; 37(3): 271-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9325503&dopt=Abstract

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Women's coping with a spontaneous abortion occurring in early pregnancy. Author(s): Flandermeyer AA. Source: Chart. 1987 January; 84(1): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3643064&dopt=Abstract

•

Women's expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content. Author(s): Hildingsson I, Waldenstrom U, Radestad I. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 February; 81(2): 118-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942901&dopt=Abstract

•

Women's experiences of miscarriage in early pregnancy. Author(s): Bansen SS, Stevens HA. Source: Journal of Nurse-Midwifery. 1992 March-April; 37(2): 84-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1573450&dopt=Abstract

•

X-chromosome inactivation in the human trophoblast of early pregnancy. Author(s): Uehara S, Tamura M, Nata M, Ji G, Yaegashi N, Okamura K, Yajima A. Source: Journal of Human Genetics. 2000; 45(3): 119-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10807535&dopt=Abstract

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•

Xenobiotic metabolism in humans during early pregnancy: peroxidase-mediated oxidation and bioactivation of 2-aminofluorene. Author(s): Kulkarni AP, Murthy KR. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1995 August; 25(8): 799-810. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8779222&dopt=Abstract

•

Xenobiotic oxidation during early pregnancy in man: peroxidase catalysed chemical oxidation in conceptual tissues. Author(s): Joseph P, Srinivasan SN, Kulkarni AP. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1994 July; 24(7): 583-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7975723&dopt=Abstract

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CHAPTER 2. NUTRITION AND EARLY PREGNANCY Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and early pregnancy.

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

Accumulation of 67Ga citrate in early pregnancy. Author(s): Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Maebashi, Japan. [email protected] Source: Kurosaki, H Saito, Y Kawashima, M Ebara, T Yamakawa, M Mitsuhashi, N AnnNucl-Med. 2001 June; 15(3): 289-91 0914-7187

•

Chondroitin sulphate and heparan sulfate proteoglycan are sequentially expressed in the uterine extracellular matrix during early pregnancy in the rat. Author(s): Department of Anatomy and Histology F13, The University of Sydney, NSW, Australia. Source: Slater, M Murphy, C R Matrix-Biol. 1999 April; 18(2): 125-31 0945-053X

•

Control of fertility in the red fox (Vulpes vulpes): effect of a single oral dose of cabergoline in early pregnancy. Author(s): Vertebrate Pest Research Department, Victorian Institute of Animal Science, Frankston, Australia. [email protected] Source: Marks, C A Brzozowski, M Zurek, H Clark, M Reprod-Fertil-Devolume 2002; 14(1-2): 29-33 1031-3613

•

Current progress in early pregnancy investigation. Source: Stemmer, S M Early-Pregnancy. 2001 January; 5(1): 4-8 1537-6583

•

Cyclin D3 in the mouse uterus is associated with the decidualization process during early pregnancy. Author(s): Department of Molecular and Integrative Physiology, Ralph L Smith Research Center, University of Kansas Medical Center, Kansas City, Kansas 66160-7338, USA. Source: Das, S K Lim, H Paria, B C Dey, S K J-Mol-Endocrinol. 1999 February; 22(1): 91101 0952-5041

•

Effects of Annona squamosa extract on early pregnancy in rats. Author(s): Experimental Laboratory of Obstetrics, Department of Gynecology and Obstetrics of School of Human Medicine of Botucatu-UNESP, Sao Paulo State, Brazil. [email protected] Source: Damasceno, D C Volpato, G T Sartori, T C Rodrigues, P F Perin, E A Calderon, I M Rudge, M V Phytomedicine. 2002 October; 9(7): 667-72 0944-7113

•

How many pregnant women in Christchurch are using folic acid supplements in early pregnancy? Author(s): Christchurch School of Medicine. Source: Schader, I Corwin, P N-Z-Med-J. 1999 December 10; 112(1101): 463-5 0028-8446

•

Interventions for nausea and vomiting in early pregnancy. Author(s): Division of Primary Health Care, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK. [email protected] Source: Jewell, D Young, G Cochrane-Database-Syst-Revolume 2000; (2): CD000145 1469-493X

•

Maternal diet and nutrition during early pregnancy and after delivery in North London. Source: Leck, I. Iles, C.A. Sharman, I.M. Toe, T. Wadsworth, G.R. Prevention of spina bifida and other neural tube defects / edited by John Dobbing. London : Academic Press, c1983. page 197-218. charts. ISBN: 0122188608

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•

Medical termination of early pregnancy: the Swedish experience. Author(s): Department of Women and Child Health, Karolinska Hospital, Stockholm, Sweden. Source: Bygdeman, M Danielsson, K G Marions, L J-Am-Med-Womens-Assoc. 2000; 55(3 Suppl): 195-6, 204 0098-8421

•

Nausea and vomiting in early pregnancy. Source: Sharman, Ivan. Nutr-Food-Sci. London, Jan/February 1983. (80) page 20-22. charts. 0034-6659

•

Eng.

:

Forbes

Publications.

Short time effect of Chemiron (a combination iron preparation), single iron, and different magnesium salts on plasma. Magnesium concentration during early pregnancy in Nigerian women. A preliminary report. Author(s): Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Idi Araba, Nigeria. Source: Ajayi, G O Fadiran, E O Clin-Exp-Obstet-Gynecol. 1998; 25(1-2): 64-6 0390-6663

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

Accumulation of 67Ga citrate in early pregnancy. Author(s): Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Maebashi, Japan. [email protected] Source: Kurosaki, H Saito, Y Kawashima, M Ebara, T Yamakawa, M Mitsuhashi, N AnnNucl-Med. 2001 June; 15(3): 289-91 0914-7187

•

Chondroitin sulphate and heparan sulfate proteoglycan are sequentially expressed in the uterine extracellular matrix during early pregnancy in the rat. Author(s): Department of Anatomy and Histology F13, The University of Sydney, NSW, Australia. Source: Slater, M Murphy, C R Matrix-Biol. 1999 April; 18(2): 125-31 0945-053X

•

Control of fertility in the red fox (Vulpes vulpes): effect of a single oral dose of cabergoline in early pregnancy. Author(s): Vertebrate Pest Research Department, Victorian Institute of Animal Science, Frankston, Australia. [email protected] Source: Marks, C A Brzozowski, M Zurek, H Clark, M Reprod-Fertil-Devolume 2002; 14(1-2): 29-33 1031-3613

•

Current progress in early pregnancy investigation. Source: Stemmer, S M Early-Pregnancy. 2001 January; 5(1): 4-8 1537-6583

•

Cyclin D3 in the mouse uterus is associated with the decidualization process during early pregnancy. Author(s): Department of Molecular and Integrative Physiology, Ralph L Smith Research Center, University of Kansas Medical Center, Kansas City, Kansas 66160-7338, USA. Source: Das, S K Lim, H Paria, B C Dey, S K J-Mol-Endocrinol. 1999 February; 22(1): 91101 0952-5041

•

Effects of Annona squamosa extract on early pregnancy in rats. Author(s): Experimental Laboratory of Obstetrics, Department of Gynecology and Obstetrics of School of Human Medicine of Botucatu-UNESP, Sao Paulo State, Brazil. [email protected] Source: Damasceno, D C Volpato, G T Sartori, T C Rodrigues, P F Perin, E A Calderon, I M Rudge, M V Phytomedicine. 2002 October; 9(7): 667-72 0944-7113

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•

How many pregnant women in Christchurch are using folic acid supplements in early pregnancy? Author(s): Christchurch School of Medicine. Source: Schader, I Corwin, P N-Z-Med-J. 1999 December 10; 112(1101): 463-5 0028-8446

•

Interventions for nausea and vomiting in early pregnancy. Author(s): Division of Primary Health Care, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK. [email protected] Source: Jewell, D Young, G Cochrane-Database-Syst-Revolume 2000; (2): CD000145 1469-493X

•

Maternal diet and nutrition during early pregnancy and after delivery in North London. Source: Leck, I. Iles, C.A. Sharman, I.M. Toe, T. Wadsworth, G.R. Prevention of spina bifida and other neural tube defects / edited by John Dobbing. London : Academic Press, c1983. page 197-218. charts. ISBN: 0122188608

•

Medical termination of early pregnancy: the Swedish experience. Author(s): Department of Women and Child Health, Karolinska Hospital, Stockholm, Sweden. Source: Bygdeman, M Danielsson, K G Marions, L J-Am-Med-Womens-Assoc. 2000; 55(3 Suppl): 195-6, 204 0098-8421

•

Nausea and vomiting in early pregnancy. Source: Sharman, Ivan. Nutr-Food-Sci. London, Jan/February 1983. (80) page 20-22. charts. 0034-6659

•

Eng.

:

Forbes

Publications.

Short time effect of Chemiron (a combination iron preparation), single iron, and different magnesium salts on plasma. Magnesium concentration during early pregnancy in Nigerian women. A preliminary report. Author(s): Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Idi Araba, Nigeria. Source: Ajayi, G O Fadiran, E O Clin-Exp-Obstet-Gynecol. 1998; 25(1-2): 64-6 0390-6663

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

•

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

•

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

•

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

•

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/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

The following is a specific Web list relating to early pregnancy; 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 Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Vitamin a Source: Healthnotes, Inc.; www.healthnotes.com

•

Minerals Folate Source: Prima Communications, Inc.www.personalhealthzone.com

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CHAPTER 3. PREGNANCY

ALTERNATIVE

MEDICINE

AND

EARLY

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to early pregnancy. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “early pregnancy” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Acceptance of Some Acupuncture Applications Source: JAMA. Journal of the American Medical Association. 278(21): 1725-1727. December 3, 1997. Summary: This journal article summarizes the findings of the National Institutes of Health consensus panel on acupuncture. After evaluating current evidence for the efficacy of acupuncture, the 12-member panel concluded that there is clear evidence of efficacy in the control of postoperative nausea and vomiting, nausea and vomiting associated with chemotherapy and postoperative dental pain, and probably for nausea in early pregnancy. The panelists also found that the use of acupuncture, by itself or as an adjunct therapy, results in satisfactory treatment for a number of other conditions, although firm evidence of efficacy has not yet been established. The panelists concluded that more research is needed linking the use of acupuncture to physiological changes

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known to be associated with pain relief, and that more attention should be given to the issues involved in expanding the use of acupuncture into the health care system. In addition, the panelists noted that acupuncture has fewer side effects than many of the drugs or accepted medical procedures used for the same conditions. Finally, the panelists commended the progress the acupuncture educational community has made in establishing training and credentialing programs.

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 early pregnancy 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 “early pregnancy” (or synonyms) into the search box.

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/

Alternative Medicine 81

The following is a specific Web list relating to early pregnancy; 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 Birth Defects Prevention Source: Healthnotes, Inc.; www.healthnotes.com High Homocysteine Source: Healthnotes, Inc.; www.healthnotes.com Mumps Source: Integrative Medicine Communications; www.drkoop.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com

•

Alternative Therapy Trager Approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html

•

Herbs and Supplements Crataegus Alternative names: Hawthorn; Crataegus oxyacantha L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc.; www.healthnotes.com Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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

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CHAPTER 4. DISSERTATIONS ON EARLY PREGNANCY Overview In this chapter, we will give you a bibliography on recent dissertations relating to early pregnancy. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “early pregnancy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on early pregnancy, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Early Pregnancy 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 early pregnancy. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Action of Prostaglandin F2a during Early Pregnancy in the Mouse by Scott, James Elliott; PhD from The University of Manitoba (canada), 1980 http://wwwlib.umi.com/dissertations/fullcit/NK47242

•

Early Pregnancy Associated Nausea and Vomiting: Maternal Risk Factors, Fetal Outcome, and Reproductive Success (Morning Sickness, Biological Fitness, Estrogen Sensitivity, Emetic Center, Multiple Regression) by Weigel, Mary-Margaret, PhD from University of California, Los Angeles, 1985, 200 pages http://wwwlib.umi.com/dissertations/fullcit/8603999

•

Structural Changes in Porcine Uterine Epithelium during the Estrous Cycle, Early Pregnancy and Pseudopregnancy by Keys, Judy Lynn; PhD from University of Guelph (Canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL37899

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•

The Impact of Family Concept on Selective Determinants of Early Pregnancy among Adolescent Females in an Urban Community by Grice, Rowena Consuella, DSW from Howard University School of Social Work, 1980, 286 pages http://wwwlib.umi.com/dissertations/fullcit/8028451

•

Two Studies in Medical Anthropology. I. the Self-diagnosis of Early Pregnancy: a Study of Lay Competence. II. A Crosscultural Investigation of Four Birthing Systems in Sociobiological Perspective. by Jordan, Brigitte, PhD from University of California, Irvine, 1975, 220 pages http://wwwlib.umi.com/dissertations/fullcit/7613875

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON EARLY PREGNANCY 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 “early pregnancy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on early pregnancy, we have not necessarily excluded nonmedical patents in this bibliography.

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

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

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

Antigen associated with early detection of mammalian pregnancy Inventor(s): Hamilton; William C. (Emmett, ID), Sasser; R. Garth (Moscow, ID) Assignee(s): The Idaho Research Foundation, Inc. (Moscow, ID) Patent Number: 4,554,256 Date filed: July 21, 1983 Abstract: Early pregnancy can be determined by detection of a protein in serum, which protein is associated with the placental membrane. The protein is characterized by having an approximate molecular weight of 47,000 to 53,000 and an isoelectric point of from about 4.0-4.4. Excerpt(s): There is a continuing interest in determining physiological compounds which are used for regulation of cellular functions. As these compounds are discovered and studied, a better understanding of the way organs function and communicate is obtained. Pregnancy requires communication between the fetus and the host. The placenta serves as a barrier for transmission of various products produced by the fetus and/or the mother. Particularly, the bovine fetus is normally protected from the maternal immune system. In many situations, particularly with domestic animals, which are frequently bred by artificial insemination, there is substantial interest in being able to detect at an early date the existence of pregnancy. Web site: http://www.delphion.com/details?pn=US04554256__

•

Antigen for early pregnancy test and contraceptive vaccine Inventor(s): Bahl; Om P. (Williamsville, NY) Assignee(s): Research Corporation (New York, NY) Patent Number: 4,234,561 Date filed: February 6, 1978 Abstract: Antisera suitable for detecting the presence of human chorionic gonadotropin in body fluids by immunoassay are prepared by administering to a host animal an antigen comprising the.beta.-subunit of human chorionic gonadotropin which has been modified by cleaving and optionally conjugating the thus modified.beta.-subunit with a protein or hapten capable of enhancing the immunogenetic potency of the antigen. The antigens are also useful for the contraceptive purposes to terminate pregnancy. Excerpt(s): This invention relates to antisera produced by novel antigens, which are useful in testing for pregnancy in humans and more particularly to antisera having an immunological reaction with human chorionic gonadotropin, wherein the immunological cross-reactivity with human luteinizing hormone is reduced or eliminated. This further relates to the production of antigens to prepare said antisera, and which may also be used for contraceptive purposes to terminate human pregnancy. Human chorionic gonadotropin is a hormone produced by the placenta during pregnancy. Presence of the hormone in the serum and urine therefore serves as an indication of pregnancy. The presence of this hormone has been detected by its effect on the ovaries of animals and, more recently, by immunoassay. However, because the tests

Patents 87

used hitherto do not sufficiently distinguish between hCG and other hormones which are present, such as luteinizing hormone, the presence of hCG cannot be unambiguously detected until several weeks after conception, by which time the levels of hCG are high enough so that it can be detected even in the presence of interfering substances. Web site: http://www.delphion.com/details?pn=US04234561__ •

Assembly for filtering amniotic fluid Inventor(s): Romine; Lori (11735 SW. 112th Ter., Miami, FL 33186), Sholders; Ronald (7640 SW. 168th St., Miami, FL 33157), Warren; Richard (c/o 11735 SW. 112 Ter., Miami, FL 33186) Assignee(s): none reported Patent Number: 5,015,369 Date filed: January 22, 1990 Abstract: An assembly for the removal and examination of amnioytes in early pregnancy by filtering the amniotic fluid and returning the fluid to the fetus subsequent to filtering wherein a conduit structure has a filter incorporated therein and is constructed to include two different paths of fluid flow, one for drawing off said amniotic fluid through the filter means and one for returning the amniotic fluid subsequent to filtering along a path which bypasses said filter structure. Excerpt(s): A conduit structure used in combination with a syringe and a penetrating needle for the withdrawing, filtering and subsequent return of amniotic fluid of a fetus during pregnancy for the purpose of examination of amniocytes. The testing of amniotic fluid, especially during the early stages of pregnancy, has been conducted and recognized for some time as being an accurate method of determining irregularities and/or general health and well-being of the fetus. Typically, in the testing of such amniotic fluid, the fluid is withdrawn directly from the fetal sac by means of an elongated needle attached to a syringe instrument. The removed fluid is then submitted to other procedures and apparatus for laboratory testing. Based on the popularity and success of such techniques, it has become desired in the medical profession to have a more efficient means of withdrawing, filtering and subsequently returning the amniotic fluid to the fetus by means of a close system specifically wherein a preferred structure would incorporate a filter mechanism capable of filtering out the amniocytes from the amniotic fluid subsequent to returning of the fluid to the fetus. Naturally, such an apparatus including the aforementioned filter structure should be defined as a closed system in order to maintain a sterile environment. Other apparatus exists in the medical profession which incorporate certain basic structural features such as a withdrawing syringe, a penetrating needle and some type of filter apparatus. Typically, such structures are utilized in the area of blood sampling and collection. The following U.S. Patents are generally representative of known prior art structures of the type set forth above but which are not related to the removal, sampling and return of amniotic fluid to and from the fetus: U.S. Pat. Nos. 3,520,416; 3,892,226; and 4,685,472. Web site: http://www.delphion.com/details?pn=US05015369__

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Autogenic-feedback training exercise (AFTE) method and system Inventor(s): Cowings; Patricia S. (Saratoga, CA) Assignee(s): The United States of America as represented by the Administrator of the (Washington, DC) Patent Number: 5,694,939 Date filed: October 3, 1995 Abstract: The autogenic-feedback training exercise (AFTE) method of the present invention is a combined application of physiologic and perceptual training techniques, such as autogenic therapy and biofeedback. This combined therapy approach produces a methodology that is appreciably more effective than either of the individual techniques used separately. The AFTE method enables sufficient magnitude of control necessary to significantly reduce the behavioral and physiologic reactions to severe environmental stressors. It produces learned effects that are persistent over time and are resistant to extinction and it can be administered in a short period of time. The AFTE method may be used efficiently in several applications, among which are the following: to improve pilot and crew performance during emergency flying conditions; to train people to prevent the occurrence of nausea and vomiting associated with motion and sea sickness, or morning sickness in early pregnancy; as a training method for preventing or counteracting air-sickness symptoms in high-performance military aircraft; for use as a method for cardiovascular training, as well as for multiple other autonomic responses, which may contribute to the alleviaton of space motion sickness (SMS) in astronauts and cosmonauts; training people suffering from migraine or tension headaches to control peripheral blood flow and reduce forehead and/or trapezius muscle tension; training elderly people suffering from fecal incontinence to control their sphincter muscles; training cancer patients to reduce the nauseagenic effects of chemotherapy; and training patients with chronic intestinal pseudo-obstruction (CIP). Excerpt(s): The present invention generally relates to a multi-parameter physiological conditioning method and apparatus, and particularly to an autogenic-feedback training exercise method for training people to gain better control of specific physiological responses. More particularly, the present invention combines two self-regulatory techniques, biofeedback and autogenic exercises, and permits subjects to voluntarily control several of their own autonomic responses simultaneously. Space motion sickness, also referred to as Space Adaptation Syndrome (SAS), is a disorder which produces symptoms similar to those of motion sickness on Earth. This syndrome has affected a significant number of astronauts and cosmonauts exposed to microgravity in space, but it differs from what is commonly known as motion sickness in a number of critical ways. There is currently no ground-based method for predicting susceptibility to motion sickness in space. Biomedical data from past space missions indicate that some individuals who have had wide exposure to motion devices and acceleratory forces on Earth or in an aircraft, and who have never previously shown any tendency to develop motion sickness symptoms, were severely debilitated in the microgravity environment. Conversely, some individuals who had a history of susceptibility to motion sickness were unaffected by symptoms in space. Symptom episodes vary from mild discomfort to repeated vomiting, and sometimes occur suddenly, with little or no vomiting. The earliest recorded episode began within only seven minutes of orbit insertion, and malaise has been reported to last anywhere from one to five days. Two types of countermeasures have been tested extensively, anti-motion sickness drugs and preflight protective adaptation (i.e., repeated exposures to motion-sickness-inducing stimuli). Anti-motion sickness drugs have had limited success in preventing or counteracting

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SAS, and frequently have caused debilitating side effects. Some of the disadvantages of protective adaptation training are: (1) it is expensive and presents practical scheduling (of crewmen) difficulties because of requirements for other training during the preflight period, (2) individuals who are highly susceptible to motion sickness tend to adapt slowly (if at all), and (3) there is relatively little transfer of "protection" across different types of stimuli. Finding a solution to this biomedical problem has become a very high priority goal of the manned space-flight program because of its potential impact on crew safety, comfort, and operational efficiency during shuttle missions. Web site: http://www.delphion.com/details?pn=US05694939__ •

Designers fluctuation loop Inventor(s): Mooneyhan; Betty Frances (206 Washington, Ave., Richland, MS 39218), O'Conner; Mary Evelyn (3231 Old Brandon Rd., Pearl, MS 39208) Assignee(s): none reported Patent Number: 6,286,152 Date filed: June 1, 2000 Abstract: A loop for displaying a Trademark, Copyright Notice, Logo, or the like, on the waistband of a pair of pants, shorts, skirt or blue jeans of which is also used to expand the waistband by way of un-buttoning the button and looping the loop over the button to hold the waistband in an expanded position consisting of any suitable material of any length fixed into the button hole end-lip of the waistband so the wearer may use the loop for quick relief from an over eaten meal, while dieting (gaining a pound or two) without the purchase of a new garment to fit, during early pregnancy, water retention, while driving, sitting, or any uncomfortable waistband condition(s) and may have attached to the loop a chain or the like holder having a button hole plug of any suitable design attached onto the chain for the insertion of the exposed button hole when the loop is used to expand the waistband and/or decoration. Excerpt(s): The present invention relates to garment attachments for trademark and the like displays and waistband extensions that relief pressure from the waistline and fluctuates for the wearer from normal mode to loose weear. It is an object of the present invention to provide a novel waistband attachment loop for displaying Trademarks, and the like. It is another object of the present invention to provide a waistband extension for use when the wearer gains a pound (men and women), retains fluid, or the like, suffers from a large intake of food (men and women), or wants to continue wearing the garment during early pregnancy (women); giving the wearer that added inch in the waistband, when desired; and returning the garment to normal mode when the wearer loses tat extra pound and such as above. Web site: http://www.delphion.com/details?pn=US06286152__

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Early pregnancy detection by detecting enhanced blood platelet activation Inventor(s): O'Neill; Christopher (Flat 1, 83 St. Johns Rd., Glebe 2037, N.S.W., AU) Assignee(s): none reported Patent Number: 4,543,339 Date filed: March 15, 1983

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Abstract: A method and reagent system for detecting pregnancy in a mammal at an early stage by detecting enhanced activation of blood platelets. Excerpt(s): The present invention relates to the detection of pregnancy in mammals (particularly agricultural and domestic animals) at a very early stage. The invention is based on the monitoring of changes in the haemostatic system (i.e. the blood coagulation system). Traditionally, the diagnosis of pregnancy is based on missed menstrual periods (human) or a failure to return to oestrus (animal species). Depending on the mammal species, this may take from several days to several weeks. For humans, the most commonly used experimental test for detecting pregnancy is based upon the immunological detection of human chorionic gonadotrophin (HCG). HCG is a glycoprotein hormone produced by the placenta during pregnancy, and may be found in blood and urine samples of pregnant women. The latex particle test for HCG is well known and well established for use with humans. However, the HCG hormone does not appear in conveniently measurable amounts until about 2 or 3 weeks following a missed period. By this time pregnancy, if it exists, can no longer be terminated by menstrual regulation and abortion, if required, must be brought about by more complicated techniques. Web site: http://www.delphion.com/details?pn=US04543339__ •

Fetal anatomic sex assignment by ultrasonography during early pregnancy Inventor(s): Stephens; John D. (14171 Stanford Ct., Los Altos Hills, CA 94022) Assignee(s): none reported Patent Number: 4,986,274 Date filed: December 4, 1989 Abstract: A method and apparatus are disclosed for fetal anatomic sex assignment by ultrasound during early pregnancy based on pattern recognition that allows identification of external genitalia during the gestational age range of 12 to 14 weeks. The pattern recognition derives from knowledge of the embryology of the developing external genitalia of the fetus and the relationship between embryologic events and recognizing patterns specific for male and female obtained by ultrasonic imaging. Fetal anatomic sex has been accurately diagnosed using high resolution digital linear-array real-time ultrasound in over 500 pregnancies that were scheduled for ultrasound except for detected cases of sex reversal, sex chromosome mosaicism, prior to genetic amniocentesis, and ambiguous sex chromosomes, except as noted, ultrasonic imaging of the penile or clitoral structure corresponded to later sex determination by karyotype. Imaging of the external genitalia can be included as part of a complete fetal anatomic survey, which includes gestational age dating and inspection for gross abnormalities. Sex assignment requires 30 seconds to 10 minutes. Fetal anatomic sex assignment can be performed by ultrasound early in pregnancy, that is, during the twelfth to fourteenth weeks from the last menstrual period of the mother, yet the results are as accurate as those obtained by chromosome analysis from genetic amniocentesis which can be safely performed only after the sixteenth week of pregnancy. Fetal anatomic sex assignment is particularly useful in genetic counseling with regard to X-linked disorders and can be clinically important when either sex reversal, sex chromosome mosaicism, or ambiguous sex chromosomes are detected by prenatal diagnosis. Other features are also disclosed. Excerpt(s): This invention relates to ultrasonography and, more particularly, to medical techniques which employ ultrasonography. Specifically, the invention is directed to the

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use of ultrasonic imaging for assigning the anatomic sex of a human fetus during early pregnancy, that is, in the period between the twelfth week and the fourteenth week of gestation. Technological progress continues to improve the spatial resolution of images obtained using linear-array real-time ultrasound in obstetrical genetics. The change from analog to digital ultrasound systems has contributed to this improvement. With the improvement in resolution in digital linear-array real-time ultrasound systems has come marked improvement in identification of specific parts of fetal anatomy at an increasingly earlier stage of gestation. The use of ultrasound, or high-frequency sound waves, to produce an image on a screen of a developing fetus and surrounding tissues has increased dramatically in recent years, not only in hospitals, but in doctors' offices. A panel recently convened by the National Institutes of Health concluded that there are more than two dozen medical reasons which warrant the use of ultrasound scans in some cases, including the detection of abnormalities in a fetus, when a doctor has evidence that a medical problem exists; the detection of the presence of twins; the collection of information for the evaluation of fetal growth, activity, and position; and the determination of fetal age for better management of the pregnancy. National Institutes of Health, Consensus Development Conference Consensus Statement, "The Use of Diagnostic Ultrasound Imaging in Pregnancy," Feb. 6-8, 1984. Web site: http://www.delphion.com/details?pn=US04986274__ •

Gravidity detection method and apparatus Inventor(s): Hautaniemi; B. Wendell (Ithaca, NY), Jorgensen; Hans G. (Ithaca, NY) Assignee(s): Ithaco, Incorporated (Ithaca, NY) Patent Number: 4,111,054 Date filed: August 22, 1977 Abstract: Ultrasonic detection of early pregnancy in sows and like animals is enhanced by basing an assumption of pregnancy upon detection of a substantially echo-free animal zone of predetermined width or greater which may occur over a substantial range of animal depths, combined with detection of a distinct echo from a greater depth than the echo-free zone. Excerpt(s): This invention relates to detection of pregnancy in sows and like animals early in the gestation period, and more particularly, to improved ultrasonic pregnancy detection method and apparatus which are readily usable by unskilled operators to detect early pregnancy in a more foolproof or reliable manner. Early detection of a gravid condition, say within 15 to 45 days after mating, can be of substantial economic importance to a hog breeder. It will allow non-pregnant sow to be promptly culled for slaughter, thereby saving feed costs. The use of ultrasonic apparatus for detecting pregnancy is well known, and one form of device useful for such a purpose is shown in our prior U.S. Pat. No. 3,964,297, although that device has wider utility than pregnancy detection and is often used to determine the thickness of animal fat layers and the like, for selective breeding purposes. When the probe or transducer of that device is placed against the flank of a sow which may or may not be in the early stages of a pregnancy, the pattern of illuminated and unilluminated lights appearing on the display of that device will indicate the presence and location of density changes within the animal, and will afford a rather reliable indication of whether the animal is pregnant to an operator having experience in interpreting such displays. However, it is desirable that such detection not require an experienced operator, but fall within the capability of unskilled labor, and one object of the present invention is to provide improved ultrasonic

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pregnancy detection method and apparatus having a simpler form of display, preferably of a go, no-go type, readily interpretable by unskilled operators. The broad idea of providing a simple go, no-go type of display, wherein pregnancy or the absence thereof is indicated simply by the illumination or non-illumination of one or two lights, or the operation or non-operation of a buzzer or bell, is not per se new. However, previous devices of that nature of which we are aware suffer from several defects affecting their reliability or accuracy which the present invention is intended to overcome. Thus another object of the invention is to provide improved ultrasonic pregnancy detection method and apparatus having a simple go, no-go type of indicator which is also more accurate and reliable than prior devices. Web site: http://www.delphion.com/details?pn=US04111054__ •

Implantation rates after in vitro fertilization, treatment of infertility and early pregnancy loss with a nitric oxide donor alone or in combination with progesterone, and a method for contraception with nitric oxide inhibitors Inventor(s): Chwalisz; Krzysztof (Berlin, DE), Garfield; Robert E. (Friendswood, TX) Assignee(s): Schering Aktiengesellschaft (Berlin, DE), The Board of Regents, Univ. of Texas System (Austin, TX) Patent Number: 6,040,340 Date filed: May 7, 1996 Abstract: A method is provided for the improvement of implantation rates and/or pregnancy rates in a female mammal, comprising administering to a female mammal in whom pregnancy is desired an effective amount of(a) a nitric oxide synthase substrate, a nitric oxide donor, or both, optionally in combination with(b) a progestin, and,(c) optionally, in further combination with an estrogen.A method is also provided for fertility control for a female mammal, comprising administering to a female mammal in whom pregnancy is not desired and at risk for becoming pregnant an effective amount of nitric oxide synthase inhibitor in combination with an antiprogestin. Pharmaceutical compositions are also provided. Excerpt(s): This invention relates to a method for the improvement of implantation rates after in vitro fertilization (IVF), for the treatment of infertility and for the treatment and prevention of early pregnancy loss in women with a nitric oxide synthase substrate (Larginine), a nitric oxide donor or both, alone or in combination with progesterone and/or estrogen. Human in vitro fertilization is surprisingly unsuccessful. The overall birth rate per IVF treatment cycle is approximately 14% in USA (Medical Research International Society for Assisted Reproductive Technology [SART], The American Fertility Society [1992]. Fertil Steril 5:15 ), and 12.5% in UK (The Human Fertilization and Embryology Authority. Annual Report, London 1992). Success is greater when more than one embryo is transferred simultaneously. However, simultaneous transfer of multiple embryos increases the incidence of multiple pregnancy and the possibility of miscarriage and prematurity. The reasons for the low pregnancy rates after IVF are still not completely understood. The quality of both the embryo and the uterine environment affects success. Generally, there is a high rate of spontaneous early abortion in fertile cycles in women. After natural conception, possibly as many as 50-60% of very early pregnancies are lost (Winston M L, Handyside A H [1993], New challenges in human in vitro fertilization. Science 260:932-935). This may be due to both conceptus abnormalities and dysynchrony between embryo and endometrium at the time of embryo transfer.

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Web site: http://www.delphion.com/details?pn=US06040340__ •

Method of determining pregnanediol in female urine and test device for use therein Inventor(s): Chatterton; Robert T. (River Forest, IL) Assignee(s): Northwestern University (Evanston, IL) Patent Number: 4,450,239 Date filed: September 23, 1981 Abstract: A method is provided for determining the concentration of pregnanediol glucuronide (PG) in a woman's urine which is characterized by utilization of the reagent 20.alpha.-hydroxy-4-pregnen-3-one (20-.alpha. reagent) in a form in which it reacts with antibodies binding to PG. The method is adaptable to a visual color indication test which can be performed by the woman herself as well as by laboratory analysis. The method can be used to define the period in which conception can occur, to define a postovulation safe period in which conception is prevented, and as an early pregnancy indicator. Excerpt(s): The field of this invention relates to measurement of the concentration of the hormone pregnanediol in women's urine. In urine, this hormone occurs in the form of pregnanediol glucuronide (PG) and is detected in that form. The amount of PG in a woman's urine rises rapidly at the time of ovulation, and declines rapidly at the time of menstruation. However, if conception has occurred, the PG level remains high. Therefore, measurement of pregnanediol levels in urine is a potential usable procedure for either preventing or diagnosing pregnancy. Although ovulation may be detected by characteristic in basal body temperature or in physical properties of cervical mucus, these methods are subject to variability from body functions unrelated to ovarian function and therefore not sufficiently reliable for detecting ovulation in many women. Although pregnanediol is the major urinary product of progesterone, pregnanediol assays have not been widely utilized for assessment of luteal function. There are basically two reasons for this. First, earlier methods have required the collection of 24hour urine specimens, an unreasonable request for even highly motivated patients when, to be most useful, collections should be made daily for at least 10 days during the middle of the menstrual cycle. Second, the assay procedure has been laborious, requiring usually two days for completion, and is subject to errors from several sources; the necessity for enzymatic or acid hydrolysis of the glucuronide moiety for colorimetry or gas chromatography is the most difficult and variable aspect of the assay. Web site: http://www.delphion.com/details?pn=US04450239__

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Therapeutic polypeptides from.beta.-hCG and derivatives Inventor(s): Bryant; Joseph (732 Ivy League La., Rockville, MD 20850), Gallo; Robert C. (8513 Thornden Ter., Bethesda, MD 02817), Lunardi-Iskandar; Yanto (226 Lee St., Gaithersburg, MD 20877) Assignee(s): none reported Patent Number: 6,583,109 Date filed: December 24, 1998

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Abstract: The present invention relates to peptides of one or more portions of the human chorionic gonadotropin.beta.-chain peptides containing a sequence of one or more portions of the.beta.-chain of human chorionic gonadotropin and derivatives and analogues thereof. The invention further relates to fractions of sources and or preparations of human chorionic gonadotropin, such as fractions of human early pregnancy urine, which fractions have anti-HIV activity, anti-cancer activity, and/or pro-hematopoietic activity. The present invention further relates to pharmaceutical compositions for treating and/or preventing HIV infection, cancer, and/or for promoting hematopoiesis. Excerpt(s): The present invention relates to peptides of one or more portions of the human chorionic gonadotropin.beta.-chain as well as methods for treatment and prevention of diseases, including HIV infection, cancer and wasting syndrome, and methods of promoting hematopoiesis using human chorionic gonadotropin, employing the.beta.-chain of human chorionic gonadotropin, peptides containing a sequence of one or more portions of the.beta.-chain of human chorionic gonadotropin and derivatives and analogues thereof. The invention further relates to fractions of sources and or preparations of human chorionic gonadotropin, such as fractions of human early pregnancy urine, which fractions have anti-HIV activity, anti-cancer activity, antiwasting activity, and/or pro-hematopoietic activity. The present invention further relates to pharmaceutical compositions for treating and/or preventing HIV infection, cancer, and/or wasting, and/or for promoting hematopoiesis. The human immunodeficiency virus (HIV) has been implicated as the primary cause of the slowly degenerative immune system disease termed acquired immune deficiency syndrome (AIDS) (Barre-Sinoussi, F., et al., 1983, Science 220:868-870; Gallo, R., et al., 1984, Science 224:500-503). There are at least two distinct types of HIV: HIV-1 (Barre-Sinoussi, F., et al., 1983, Science 220:868-870; Gallo, R., et al., 1984, Science 224:500-503) and HIV-2 (Clavel, F., et al., 1986, Science 233:343-346; Guyader, M., et al., 1987, Nature 326:662-669). Further, a large amount of genetic heterogeneity exists within populations of each of these types. In humans, HIV replication occurs prominently in CD4.sup.+ T lymphocyte populations, and HIV infection leads to depletion of this cell type and eventually to immune incompetence, opportunistic infections, neurological dysfunctions, neoplastic growth, and ultimately death. The HIV viral particle comprises a viral core, composed in part of capsid proteins, together with the viral RNA genome and those enzymes required for early replicative events. Myristylated gag protein forms an outer shell around the viral core, which is, in turn, surrounded by a lipid membrane envelope derived from the infected cell membrane. The HIV envelope surface glycoproteins are synthesized as a single 160 kilodalton precursor protein which is cleaved by a cellular protease during viral budding into two glycoproteins, gp41 and gp120. gp41 is a transmembrane glycoprotein and gp120 is an extracellular glycoprotein which remains non-covalently associated with gp41, possibly in a trimeric or multimeric form (Hammarskjold, M., & Rekosh, D., 1989, Biochem. Biophys. Acta 989:269-280). Web site: http://www.delphion.com/details?pn=US06583109__

Patent Applications on Early Pregnancy 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 9

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

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several years.) The following patent applications have been filed since December 2000 relating to early pregnancy: •

Bovine pregnancy test Inventor(s): Colgin, Mark; (Castle Rock, CO), Hurst, Roger; (Castle Rock, CO), Landmann, Cathy; (Highlands Ranch, CO), Newman, Diane; (Littleton, CO), Roth, J.W.; (Golden, CO) Correspondence: Greenlee Winner And Sullivan P C; 5370 Manhattan Circle; Suite 201; Boulder; CO; 80303; US Patent Application Number: 20030073248 Date filed: September 24, 2002 Abstract: This invention provides bovine pregnancy test methods and devices. The test is also suitable for other ruminant and/or ungulate animals. Antigens from Group A (early pregnancy antigens), and/or Group B (mid-pregnancy antigens), and Group C (early, mid- and late pregnancy antigens) are detected in a fluid from the animal, and pregnancy is reliably determined. The pregnancy assays of this invention are preferably carried out using immunoassay devices which provide immediate results in the field. Excerpt(s): This application claims priority to U.S. Patent Application No. 60/325,663 filed Sep. 28, 2001, U.S. Patent Application No. 60/337,871 filed Nov. 8, 2001, U.S. Patent Application Nos. 60/337,987, 60/377,166, 60/380,043, 60/377,921, 60/377,165, 60/377,355, 60/377,829, and 60/380,042 filed May 2, 2002, all of which are incorporated herein by reference to the extent not inconsistent herewith. There are over nine million dairy cows in the United States and Canada, and over twenty million worldwide. The dairy industry is a very competitive marketplace, and the pregnancy status of the herd is critical to maximizing profits. It is estimated that a non-pregnant cow costs the industry approximately five dollars per day. An accurate, rapid test for determining the pregnancy status of a herd would have a very important economic impact on ranch or farm operations and would increase milk production of the dairies, resulting in increased profitability for the dairy. A number of antigens are known to be present in cows and sheep during pregnancy, and pregnancy has been evaluated by a variety of methods. Bovine Antigen Glycoprotein (U.S. Pat. No. 4,755,460, issued Jul. 5, 1988, and U.S. Pat. No. 4,895,804, issued Jan. 23, 1990) can be measured about 12-15 days after breeding. Early Pregnancy Factor (EPF) (U.S. Pat. No. 4,877,742, issued Oct. 31, 1989, and WO 00/51520, published Sep. 8, 2000) levels can be measured at about 20-40 days after breeding, such as with KEMS BioTest Ltd. (Littleton, Colo.) Animal Rapid Test for Bovine Pregnancy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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METHOD OF TREATMENT AND PREVENTION OF NITRIC OXIDE DEFICIENCYRELATED DISORDERS WITH CITRULLINE AND CITRULLINE DERIVATIVES Inventor(s): CHWALISZ, KRISTOF; (BERLIN, DE), GARFIELD, ROBERT E.; (FRIENDSWOOD, TX), SHI, SHAO-QUING; (GALVESTON, TX) Correspondence: Millen, White, Zelano & Branigan, P.C.; 2200 Clarendon BLVD.; Suite 1400; Arlington; VA; 22201; US Patent Application Number: 20010056068 Date filed: March 4, 1998

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Abstract: The invention provides methods for control, management, treatment and prevention of conditions related to nitric oxide deficiency such as hypertension, cardiovascular disease, osteoporosis, diabetes mellitus, preeclampsia HELLP, syndrome and fetal growth retardation; uterine contractility disorders such as preterm labor and dysmenorrhea, cervical dystocia, infertility and early pregnancy loss; male impotence; urinary incontinence; intestinal tract disorders (e.g. altered motility and pyloric stenosis), respiratory system diseases (e.g. asthma, neonatal respiratory distress syndrome, pulmonary hypertension, and adult respiratory distress syndrome); inflammatory diseases (e.g. acute inflammation, resistance to infection, SLE-lupus, anaphylactic reaction, allograft rejection); Alzheimer's disease, stroke, growth hormone disorders, and behavior changes; dermatological conditions such as atopic eczema, topical hair loss, and burn injury; by administering citrulline or a citrulline analogue, optionally in combination with other enhancing or modulating agents, e.g., an estrogenic, partial estrogenic, progestagenic, or androgenic agent, and pharmaceutical preparations for such uses. Excerpt(s): This invention concerns a method and agents for control, management, treatment and prevention of disorders and diseases related to nitric oxide deficiency or those disorders or diseases which can be improved by enhancing endogenous nitric oxide synthesis by providing to a mammal citrulline or a citrulline analogue alone or in combination with other enhancing or modulating agent. This invention relates to nitric oxide dependent disorders and diseases including, hypertension, cardiovascular disease, atherosclerosis, myocardial ischemia, preeclampsia, HELLP (severe preeclampsia (Hemolysis+Elevated Liver enzymes+Low Platelets) syndrome), and fetal growth retardation, osteoporosis, uterine contractility disorders, such as preterm labor and dysmenorrhea, cervical dystocia, male impotence, urinary incontinence, renal arterial stenosis. In addition, this invention relates to a method and agents for treatment of infertility by improving implantation rates or controlling ovulation. Furthermore, this invention relates to a method and agents for hormone replacement therapy (HRT) alone or in combination with steroid hormones or other enhancing or modulating agents in females during the menopause to prevent climacteric disorders such as hot flushes, abnormal clotting patterns, urogenital discomfort, increased incidence of cardiovascular diseases, etc., associated with the reduction in ovarian function in middle-aged women. This invention also concerns a method and agents for HRT alone or in combination with steroid hormones or other enhancing or modulating agents in males to prevent cardiovascular disease, osteoporosis and impotence. There are also other potential uses of citrulline or citrulline analogues in those clinical situations in which nitric oxide plays a modulatory role. For example (1) regarding the cardiovascular system: regulation of vascular conductance, regulation of blood flow, regulation of blood pressure, (2) regarding the gastrointestinal tract and pancreas pathology: altered motility, pyloric stenosis, diabetes mellitus, (3) regarding respiratory system: asthma, treatment of premature babies to increase lung function (neonatal respiratory distress syndrome), pulmonary hypertension, adult respiratory distress syndrome, (4) in inflammation: autoimmune and immune diseases, acute inflammation, resistance to infection, SLElupus, anaphylactic reaction, allograft rejection, within the central nervous system: Alzheimer's disease, stroke, growth hormone disorders, behavior changes, (5) in dermatological conditions: atopic eczema, topical hair loss, and burn injury. One of the most exciting recent advances in biology and medicine is the discovery that the diffusible molecule nitric oxide is produced by endothelial cells and that it is involved in the regulation of vascular tone, plate-let aggregation, peripheral nitrergic transmission at smooth muscle, intra-cellular communication in the CNS, and macrophage defense mechanisms following exposure to bacterial products (Furchgott R F, Zawadzki J V. The

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obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetycholine. Nature 1980; 288:373-376.; Moncada S and Higgs E A. The L-arginine-nitric oxide pathway. New Engl J Med 1993; 329:2002-2012). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

METHODS FOR PREDICTING PREGNANCY OUTCOME IN A SUBJECT BY HCG ASSAY Inventor(s): BIRKEN, STEVEN; (DUMONT, NJ), O'CONNOR, JOHN; (NEW ROCHELLE, NY) Correspondence: John P White; Cooper And Dunham Llp; 1185 Avenue OF The Americas; New York; NY; 10036 Patent Application Number: 20030003597 Date filed: May 13, 1999 Abstract: The present invention provides a method of predicting pregnancy outcome in a subject by determining the amount of an early pregnancy associated molecular isoform of hCG in a sample. The present invention further provides a method for determining the amount of early pregnancy associated molecular isoforms of human chorionic gonadotropin (hCG) in a sample. The present invention also provides a diagnostic kit for determining the amount of early pregnancy associated hCG in a sample. The present invention additionally provides an antibody which specifically binds to an early pregnancy associated molecular isoform of human chorionic gonadotropin. Finally, the present invention provides methods for detecting trophoblast or non-trophoblast malignancy in a sample. Excerpt(s): This application is a continuation-in-part application of International Application No. PCT/US99/02289 which is a continuation-in-part of U.S. Ser. No. 09/017,976, filed Feb. 3, 1998, the contents of which are hereby incorporated by reference into this application. Throughout this application, various publications are referenced by author and date. Full citations for these publications may be found listed alphabetically at the end of the specification immediately preceding the claims. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art. Early pregnancy loss (EPL) is a widespread, but largely undiagnosed problem. In order to adequately diagnose and develop treatments for EPL it is essential to be able to detect and measure the rate of occurance of EPL. This is critically important in epidemiological studies, some of which are related to exposures to known or suspected reproductive toxins in the workplace, in the environment or by personal use. These early pregnancy losses are often not recognized by women or physicians and are detected solely by the measurement of hCG in the urine at the time between implantation and expected menses. They are sometimes termed "chemical pregnancies" or "occult pregnancies." A landmark epidemiological study established that the incidence of EPL was 22% in a population of healthy women attempting to conceive (Wilcox, A. J., et al., 1988). This investigation employed a very sensitive (0.01 ng/ml hCG) assay which detected only the intact hCG molecule with the unique beta subunit carboxyterminal peptide present. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with early pregnancy, 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 “early pregnancy” (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 early pregnancy. You can also use this procedure to view pending patent applications concerning early pregnancy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON EARLY PREGNANCY Overview This chapter provides bibliographic book references relating to early pregnancy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on early pregnancy 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 “early pregnancy” (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 early pregnancy: •

Kids having kids: Economic costs and social consequences of teen pregnancy Source: Washington, DC: Urban Institute Press. 1997. 361 pp. Contact: Available from University Press of America, 4270 Boston Way, LanhamSeabrook, MD 20706. Telephone: (410) 459-3366 or (800) 462- 6420. $22.95 plus $3.00 shipping and handling for first book, $0.75 for each additional book; make checks payable to University Press of America. Summary: This book consists of a background study of the historical and international trends in adolescent pregnancy and the effects of early pregnancy on the mother's and, eventually, the child's education, work history, and life-long earnings. Seven coordinated studies then focus on specific elements in the data and use statistical projections that take into account other social factors, such as education, race, marital status, cultural background, and neighborhood crime incidence, to estimate the

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consequences of early pregnancy for the mothers, for the fathers, for the children (health, abuse, incarceration, life chances), and for society. Numerous tables and graphs illustrate the data.

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

Clinical Management of Early Pregnancy by Walter Prendiville, James R. Scott (1999); ISBN: 0340741007; http://www.amazon.com/exec/obidos/ASIN/0340741007/icongroupinterna

•

Developmental effects of methyl benzimidazolecarbamate following exposure during early pregnancy (SuDoc EP 1.23:600/J-92/116) by U.S. Environmental Protection Agency; ISBN: B00010DM8G; http://www.amazon.com/exec/obidos/ASIN/B00010DM8G/icongroupinterna

•

Early Pregnancy (Trophoblast Research, V. 10) by Jean-Michel Foidart (Editor) (1998); ISBN: 1580460178; http://www.amazon.com/exec/obidos/ASIN/1580460178/icongroupinterna

•

Early Pregnancy Factors: Proceedings (Reproductive and Perinatal Medicine, Vol 1) by Franz Ellendorff; ISBN: 091685907X; http://www.amazon.com/exec/obidos/ASIN/091685907X/icongroupinterna

•

Early Pregnancy Failure (Clinical Obstetrics and Gynecology) by T. Lind (Editor), H. J. Huisjes (Editor) (1997); ISBN: 0443037752; http://www.amazon.com/exec/obidos/ASIN/0443037752/icongroupinterna

•

Early Pregnancy Loss (1988); ISBN: 3540195300; http://www.amazon.com/exec/obidos/ASIN/3540195300/icongroupinterna

•

Early Pregnancy Loss: Mechanisms and Treatmant by R.W. Beard (Editor), F. Sharp (Editor); ISBN: 0902331434; http://www.amazon.com/exec/obidos/ASIN/0902331434/icongroupinterna

•

Early Pregnancy Loss: Mechanisms and Treatment by F. Sharp (Editor), Richard W. Beard; ISBN: 0387195300; http://www.amazon.com/exec/obidos/ASIN/0387195300/icongroupinterna

•

Implantation and Early Pregnancy in Humans: A Combined Research and Clinical Approach by Eytan R. Barnea, Jerome H. Check; ISBN: 1850705135; http://www.amazon.com/exec/obidos/ASIN/1850705135/icongroupinterna

•

Ovulation and Early Pregnancy by S. Ratnam (Editor), E. Teoh (Editor); ISBN: 1850701512; http://www.amazon.com/exec/obidos/ASIN/1850701512/icongroupinterna

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Ovulation: And Early Pregnancy/With Special Supplement on Adolescent Sexuality (Advances in Fertility and Sterility Series, Vol 1) by S. Shan/ Wong, Peng-Cheang World Congress on Fertility and Sterility 1986 Singapore)/ Ratnam (Editor) (1987); ISBN: 0940813165; http://www.amazon.com/exec/obidos/ASIN/0940813165/icongroupinterna

•

Placental Molecules in Hemodynamics, Transport and Cellular Regulation: Early Pregnancy/2 Volumes in 1 (Trophoblast Research, V. 9) by Toshio Hata (Editor), et al (1997); ISBN: 158046016X; http://www.amazon.com/exec/obidos/ASIN/158046016X/icongroupinterna

•

Problems in Early Pregnancy: Advances in Diagnosis and Management by J. Gedis Grudzinskas (Editor), P.M. Shaughn O'Brien (Editor) (1997); ISBN: 1900364018; http://www.amazon.com/exec/obidos/ASIN/1900364018/icongroupinterna

•

Proteins and Steroids in Early Pregnancy by H. M. Beier; ISBN: 0387104577; http://www.amazon.com/exec/obidos/ASIN/0387104577/icongroupinterna

•

The Management of Early Pregnancy Loss: A Statement of Good Practice (1997); ISBN: 0114958432; http://www.amazon.com/exec/obidos/ASIN/0114958432/icongroupinterna

•

The Study of Ovulation-And Early Pregnancy (Recent Developments in Fertility and Sterility, Vol 2) by Morocco)/ Gzouli, A. World Congress on Fertility and Sterility 1989 Marrakech (Editor) (1991); ISBN: 1850702853; http://www.amazon.com/exec/obidos/ASIN/1850702853/icongroupinterna

•

Ultrasonics in Early Pregnancy: Diagnostic Scanning and Fetal Motor Activity by E. Reinold (1976); ISBN: 3805523327; http://www.amazon.com/exec/obidos/ASIN/3805523327/icongroupinterna

•

Ultrasound and Early Pregnancy by D. Jurkovic (Editor), E. Jauniaux (Editor); ISBN: 1850706158; http://www.amazon.com/exec/obidos/ASIN/1850706158/icongroupinterna

•

Uterine and Embryonic Factors in Early Pregnancy (Reproductive Biology) by Jerome F. Strauss, C. Richard Lyttle (Editor) (1991); ISBN: 0306440423; http://www.amazon.com/exec/obidos/ASIN/0306440423/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “early pregnancy” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10

10

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created

102 Early Pregnancy

•

Alpha-fetoprotein (AFP) in early pregnancy Author: Kjessler, Berndt.; Year: 1977; Stockholm: Scandinavian Assn. of Obstetricians and Gynaecologists: distributed by Almqvist; Wiksell, 1977

•

An evaluation of the Pregnostican Dri-Dot test in early pregnancy Author: Edelman, D. A.; Year: 1974; [1974]

•

An investigation of human chorionic gonadotropin in early pregnancy. Author: Smith, Reginald Armitage,; Year: 1950; [Minneapolis] 1950

•

Early pregnancy Author: Exalto, Nicolaas,; Year: 1983; [S.l.]: Boehringer Ingelheim, c1983; ISBN: 9080001554

•

Early pregnancy and childbearing in Guatemala, Brazil, Nigeria and Indonesia: addressing the consequences Author: Edmunds, M.; Year: 1984; Chestnut Hill, Mass., Pathfinder Fund, 1984

•

Early pregnancy detection in a planned parenthood facility Author: Johnson, M. R.; Year: 1979; 1979

•

Early pregnancy interruption with 2 15-ME-PGF2alpha suppositories Author: Lauersen, N. H.; Year: 1979; [1979]

•

Epidemiology of early pregnancy wastage; biological and social correlates of abortion. An investigation based on materials collected within Uppsala county, Sweden. Statistical advisor: Gunnar Eklund. Author: Pettersson, Folke.; Year: 1968; [Stockholm] Svenska Bokförlaget [1968]

•

Estrogen-progesterone withdrawal bleeding in diagnosis of early pregnancy Author: Vengadasalam, D.; Year: 1975; Paper presented at the 19th All India Congress in Obstetrics and Gynaecology, Jamshedpur, India, December 27-30, 1975. Chapel Hill, North Carolina, International Fertility Research Program, 1975

•

In vitro fertilization, embryo transfer, and early pregnancy: themes from the XIth World Congress on Fertility and Sterility, Dublin, June 1983, held under the auspices of the International Federation of Fertility Societies Author: Harrison, R. F. (Robert Frederick); Year: 1984; Lancaster; Boston: MTP Press, c1984; ISBN: 0852008090 http://www.amazon.com/exec/obidos/ASIN/0852008090/icongroupinterna

•

Menstrual regulation and early pregnancy termination performed by paraprofessionals under medical supervision Author: Scotti, R. J.; Year: 1973; Paper presented at the Menstrual Regulation Conference, Honolulu, Hawaii, 1973

•

Proteins and steroids in early pregnancy Author: Beier, H. M.; Year: 1982; Berlin; New York: Springer-Verlag, 1982; ISBN: 3540104577

•

Reducing late abortions: access to NHS services in early pregnancy: proceedings of a conference Author: Roe, Jane,; Year: 1988; [London]: Birth Control Trust, 1988

•

Report on maternal health and early pregnancy wastage in Peninsular Malaysia Author: Persekutuan Persatuan-Persatuan Perancangan Keluarga Maylaysia.; Year: 1977; Kuala Lumpur: Federation of Family Planning Associations, Malaysia, 1977

•

The baby manual. A practical guide from early pregnancy through the second year of life. Author: Bundesen, Herman Niels,; Year: 1944; New York, Simon and Schuster [c1944]

•

The effect of post pituitary gland extract on the activity of the human uterus; experimental investigations in vitro and in vivo, particularly from the menstrual cycle and early pregnancy. Author: Dahle, Thor.; Year: 1950; Oslo, 1950

between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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The management of early pregnancy: folk concepts of fertility control in Cali, Colombia Author: Browner, C.; Year: 1979; 1979

•

Ultrasonics in early pregnancy: diagnostic scanning and fetal motor activity Author: Reinold, E.; Year: 1976; Basel; New York: Karger, 1976; ISBN: 0805523327

•

Ultrasound in the diagnosis of early pregnancy and its complications; a comparative study of the A-, B- and Doppler methods. Author: Jouppila, Pentti.; Year: 1971; Oulu, 1971

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

Pregnancy in Preexisting Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 719-733. 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: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on pregnancy in preexisting diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Data from birth certificates in the United States indicate that maternal diabetes (preexisting and gestational) complicates 2 to 3 percent of all pregnancies, but the author cautions that these data may underestimate the true prevalence of maternal diabetes in pregnancy. Prevalence rates for pregestational diabetes appear to be in the range of 0.1 percent to 0.3 percent of all pregnancies. These pregnancies are at risk for both maternal and fetal complications. Fetal complications of maternal diabetes can arise from the effects of maternal diabetes on early fetal development and include spontaneous abortions and major congenital malformations. In the absence of special preconceptional diabetes management, spontaneous abortions occur in 7 to 17 percent of diabetic pregnancies and major malformations occur in 7 to 13 percent. Rates of both complications are highest in women with the most marked hyperglycemia during the first trimester, and the rates of malformations appear to be decreasing in countries and medical centers where standards of diabetes care result in improved maternal blood glucose control prior to and during early pregnancy. The most prominent fetal complications that can arise during the second and third trimesters are stillbirth and macrosomia (an excessively large infant). Macrosomia appears to be the most frequent fetal complication, affecting 10 to 33 percent of infants, depending on the defining criteria. Macrosomia increases the risk of birth trauma and has been associated with a longterm risk of obesity in offspring.

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Maternal risks in diabetic pregnancies are greatest in the presence of preexisting microvascular disease (retinopathy and nephropathy). Diabetic retinopathy is present in 15 to 66 percent of women early in pregnancy, and the retinopathy frequently worsens during gestation, especially when severe background or proliferative changes are present early on. Laser photocoagulation therapy prior to pregnancy can reduce the risk that proliferative retinopathy will worsen during gestation. Overt diabetic nephropathy is present before pregnancy in 5 to 10 percent of patients; of these, two-thirds manifest hypertensive disorders during gestation. Overt diabetic nephropathy in mothers increases the prevalence of intrauterine growth retardation and prematurity in infants; fetal morbidity and mortality increase as well. The longterm impact of pregnancy on diabetic retinopathy and nephropathy in mothers is not known. 9 figures. 5 tables. 81 references. (AA-M).

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to early pregnancy have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:11 •

Women's health on the Internet Source: New York, NY: Haworth Press. 2000. 153 pp. Contact: Available from Haworth Press, 10 Alice Street, Binghamton, NY 13904-1580. Telephone: (800) 342-9678 / fax: (607) 722-1424. $34.95 cloth, $24.95 paper, plus shipping and handling. Summary: This book shows searchers how the Internet can be used to locate information about the diagnosis, treatment, and prognosis of women's health problems. Topics included are Web resources and how to evaluate and search Web sites, a case study of NOAH (New York Online Access to Health), a women's health site, and women as health care consumers. Additionally provided are sections on specific women's health issues such as physical fitness, pregnancy, childbirth and early pregnancy resources, caregiving, menopause, and diabetes. Each section begins with an abstract and keywords, and an index concludes the book.

11

You will need to limit your search to “Directory” and “early pregnancy” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “early pregnancy” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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CHAPTER 7. MULTIMEDIA ON EARLY PREGNANCY Overview In this chapter, we show you how to keep current on multimedia sources of information on early pregnancy. 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.

Bibliography: Multimedia on Early Pregnancy The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in early pregnancy (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on early pregnancy: •

Early pregnancy (Online) Early pregnancy [electronic resource]: biology and medicine. Year: 9999; Format: Electronic resource; Cherry Hill, NJ: Society for the Investigation of

•

Intrauterine diagnosis in early pregnancy [videorecording]: fetal, parental and societal considerations Source: [UCLA School of Medicine]; Year: 1974; Format: Videorecording; Los Angeles: Univ. of California: [for loan or sale by its Instructional Media Library], 1974

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CHAPTER 8. PREGNANCY

PERIODICALS AND NEWS ON EARLY

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover early pregnancy.

News Services and Press Releases One of the simplest ways of tracking press releases on early pregnancy 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 “early pregnancy” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to early pregnancy. 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 “early pregnancy” (or synonyms). The following was recently listed in this archive for early pregnancy: •

Vaginosis in early pregnancy ups preterm risk Source: Reuters Health eLine Date: August 04, 2003

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•

Exercise prior to, during early pregnancy reduces risk of preeclampsia Source: Reuters Medical News Date: June 10, 2003

•

Early pregnancy activity cuts risk of preterm labor Source: Reuters Health eLine Date: November 08, 2002

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Insulin resistance in early pregnancy predicts preeclampsia Source: Reuters Medical News Date: April 04, 2002

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Early pregnancy loss with IVF predicts subsequent success Source: Reuters Medical News Date: March 12, 2002

•

Cold remedies may be harmful in early pregnancy Source: Reuters Health eLine Date: January 10, 2002

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HIV drug combo may be risky in early pregnancy Source: Reuters Health eLine Date: December 26, 2001

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Early pregnancy fevers up risk of heart defects Source: Reuters Health eLine Date: September 10, 2001

•

Alcohol in early pregnancy may harm baby: report Source: Reuters Health eLine Date: August 14, 2001

•

Failure of medical abortion may be more common in very early pregnancy Source: Reuters Industry Breifing Date: August 03, 2001

•

Elevated pulse pressure in early pregnancy linked to preeclampsia Source: Reuters Medical News Date: April 12, 2001

•

Moderate exercise in early pregnancy improves fetoplacental growth rate Source: Reuters Medical News Date: January 05, 2001

•

Famine in early pregnancy raises child's heart risk Source: Reuters Health eLine Date: November 22, 2000

•

Echinacea use in early pregnancy appears safe Source: Reuters Industry Breifing Date: November 17, 2000

•

Mom's diet in early pregnancy may affect baby health Source: Reuters Health eLine Date: September 21, 2000

•

Low iron stores in early pregnancy linked with increased placental vascularization Source: Reuters Medical News Date: August 28, 2000

Periodicals and News

•

Bacterial vaginosis in early pregnancy increases risk of miscarriage Source: Reuters Medical News Date: August 25, 2000

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Stress in early pregnancy may increase risk of preterm birth Source: Reuters Medical News Date: June 12, 2000

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Stress in early pregnancy linked to earlier delivery Source: Reuters Health eLine Date: June 09, 2000

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Mifepristone deemed approvable for early pregnancy termination Source: Reuters Medical News Date: February 21, 2000

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Asthma treatment in early pregnancy requires more scrutiny Source: Reuters Medical News Date: January 10, 2000

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Physical strain in early pregnancy may cause miscarriage Source: Reuters Health eLine Date: December 13, 1999

•

Tests Screen For Down's In Early Pregnancy Source: Reuters Health eLine Date: April 01, 1998

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Early Pregnancy Hormone Has Potential In infertility, Autoimmunity Source: Reuters Medical News Date: March 31, 1998

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Laparoscopic Surgery Safe in Early Pregnancy Source: Reuters Medical News Date: October 20, 1997

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Early Pregnancy Weight Not Crucial Source: Reuters Health eLine Date: September 12, 1997

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Vaginal Misoprostol Effective For Evacuation Of Early Pregnancy Failure Source: Reuters Medical News Date: May 13, 1997

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Drinking In Early Pregnancy Means Smaller Infants; Prepregnancy Drinking Does Not Source: Reuters Medical News Date: July 09, 1996

•

Dimeric Inhibin A: A Marker For Down's In Early Pregnancy Source: Reuters Medical News Date: May 09, 1996

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New Data On Link Between Serum Lipids In Early Pregnancy And Pre-Eclampsia Published Source: Reuters Medical News Date: February 26, 1996

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High Carbohydrate Intake In Early Pregnancy Suppresses Placental Growth Source: Reuters Medical News Date: February 16, 1996

•

Methotrexate Followed By Misoprostol Highly Effective For Early Pregnancy Termination Source: Reuters Medical News Date: August 31, 1995 The NIH

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

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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 “early pregnancy” (or synonyms).

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

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CHAPTER 9. 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 early pregnancy. 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 nonprofit 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 early pregnancy. 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.).

114 Early Pregnancy

The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to early pregnancy: Folic Acid (Vitamin B 9 ) •

Systemic - U.S. Brands: Folvite http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202250.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. 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

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

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/

12

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

118 Early Pregnancy

•

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

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

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

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

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

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

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

•

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.13 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:14 •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

13

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). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

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

•

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

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “early pregnancy” (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 40401 2343 898 404 48 44094

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 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.19 Simply search by “early pregnancy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

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

16

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). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

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

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

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Coffee Break: Tutorials for Biologists20 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.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 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 Adapted 21

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 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 early pregnancy 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 early pregnancy. 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 early pregnancy. 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 “early pregnancy”:

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•

Other guides Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Preeclampsia http://www.nlm.nih.gov/medlineplus/preeclampsia.html Pregnancy Loss http://www.nlm.nih.gov/medlineplus/pregnancyloss.html Prenatal Care http://www.nlm.nih.gov/medlineplus/prenatalcare.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 early pregnancy. 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: •

Early pregnancy Source: Providence, RI: Rhode Island Department of Health. 1994. 2 pp. Contact: Available from Richard Bolig, National Healthy Mothers, Healthy Babies Coalition, Providence Chapter, Three Capitol Hill, Room 302, Providence, RI 02908. Telephone: (401) 277-2309 / fax: (401) 277- 1442. Single copies available at no charge. Summary: This brochure, which is available in English, Spanish, and Portuguese, outlines the period of early pregnancy as well as the signs and symptoms of pregnancy. The material is directed toward pregnant women of minority, low-income, or lowliteracy status. Written at a sixth-grade reading level, the brochure was developed by a registered nurse with low-literacy training and embodies the principles and methods of reaching low-literacy audiences.

•

Early Pregnancy Loss: Miscarriage, Ectopic Pregnancy, and Molar Pregnancy Source: Washington, DC: American College of Obstetricians and Gynecologists. 1998. 6 p.

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Contact: Available from American College of Obstetricians and Gynecologists, Distribution Center, P.O. Box 4500, Kearneysville, WV 25430-4500. (800) 762-2264, ext. 931 (orders), (304) 725-8410, ext. 339 (orders), (800) 525-5562 (Fax), [email protected] (Email), http://www.acog.org (Web Site). $17.50 for a package of 50 brochures. Order No. AP090. Summary: This pamphet addresses the problem of early pregnancy loss, which is defined as the loss of a pregnancy before 20 weeks' gestation. Most often this kind of loss is a miscarriage, but ectopic pregnancy and molar pregnancy also can be causes of early pregnancy loss. Miscarriages occur in 15 to 20 percent of all pregnancies, and most occur in the first 13 weeks. A woman can miscarry without even being aware that she is pregnant. More than half of miscarriages in the first trimester of pregnancy are caused by abnormalities in the chromosomes of the fetus. Most chromosomal abnormalities are not inherited, but happen by chance and are not likely to occur again in a later pregnancy. Other causes of miscarriage are problems with the mother's health, such as an abnormally shaped uterus, an incompetent cervix, chronic disease, and genital tract infections. Lifestyle factors also can cause miscarriage, notably, smoking, heavy alcohol use, and use of illegal drugs. Bleeding is the most common sign of miscarriage. When a miscarriage occurs early in pregnancy, tissue may remain in the uterus. If this happens, the tissue will have to be removed by dilation and curettage. Generally, this does not require a hospital stay. Recovery may take some time, but a woman can ovulate and become pregnant as soon as 2 weeks after an early miscarriage. Ectopic pregnancy occurs when the fertilized egg doesn't reach the uterus and begins to grow in the fallopian tube or, rarely, attaches to an ovary or other organ in the stomach. About 1 in 60 pregnancies is ectopic. Most ectopic pregnancies occur in the fallopian tube. The tube is narrow, so the pregnancy can only grow to the size of a walnut before rupture occurs. If the tube bursts it will cause major bleeding, which is why ectopic pregnancy must be treated promptly. The symptoms of ectopic pregnancy are vaginal bleeding, abdominal pain, shoulder pain, weakness, dizziness, or fainting. Treatment for ectopic pregnancy depends on the size of the pregnancy, whether the tube has ruptured, and the amount of bleeding. If the tube bursts, there will be heavy bleeding inside the stomach and emergency surgery will be required. In many cases, a ruptured tube will have to be removed. If the tubes have been left in place, there is a good chance that the woman can have a normal pregnancy in the future. But women who have experienced ectopic pregnancy are at higher risk for having another one. In molar pregnancy, the pregnancy is not an embryo but a mass of abnormal tissue. This type of pregnancy occurs in only 1 of 1,000 to 1,200 pregnancies. A genetic error causes the abnormal cells to grow. The most common symptom of this condition is vaginal bleeding during the first trimester. Other signs, an enlarged uterus or ovaries, can only be detected by a doctor. The doctor can test for molar pregnancy by analyzing the blood for a specific hormone or doing an ultrasound. Treatment for molar pregnancy is dilation of the cervix and removal of the mole. Careful followup treatment is necessary, as abnormal cells may remain. Women who have molar pregnancies should wait 6 months to a year before getting pregnant again. For many women the emotional healing after a pregnancy loss takes longer than the physical healing. They should not blame themselves for early pregnancy loss because most early losses cannot be prevented. Most women who suffer early pregnancy loss have a healthy pregnancy later. It is important that they allow enough time for physical and emotional healing before trying to get pregnant again.

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The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “early pregnancy” (or synonyms). The following was recently posted: •

Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy Source: American College of Emergency Physicians - Medical Specialty Society; 2003 January; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3693&nbr=2919&a mp;string=early+AND+pregnancy

•

Recommendations for the evaluation and management of nausea and vomiting of early pregnancy ( Source: University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution; 2002 May; 19 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3228&nbr=2454&a mp;string=early+AND+pregnancy 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 early pregnancy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

•

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

•

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

•

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

•

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

•

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

Patient Resources

•

127

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to early pregnancy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with early pregnancy. 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 early pregnancy. 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 “early pregnancy” (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 “early pregnancy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “early pregnancy” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

128 Early Pregnancy

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 “early pregnancy” (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.23

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

23

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)24: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

24

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

132 Early Pregnancy

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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/

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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/

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

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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

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

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

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EARLY PREGNANCY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablation: The removal of an organ by surgery. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] 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] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [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] 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] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the 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] Adverse Effect: An unwanted side effect of treatment. [NIH]

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Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [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] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [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] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form

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proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amniocentesis: Percutaneous transabdominal puncture of the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal karyotype determination in order to diagnose abnormal fetal conditions. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [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] Androgenic: Producing masculine characteristics. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [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

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or other tissues are called xenograft models. [NIH] Anomalies: Birth defects; abnormalities. [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] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [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] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Approximate: Approximal [EU] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU]

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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] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] 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] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atopic Eczema: Generic term for acute or chronic inflammatory conditions of the skin, typically erythematous, edematous, papular, vesicular, and crusting; often accompanied by sensations of itching and burning. [NIH] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Autogenic: A type of succession when the developing vegetation itself is the cause for the succession. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of 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] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [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

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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]

Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [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] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Bioassay: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological Sciences: All of the divisions of the natural sciences dealing with the various aspects of the phenomena of life and vital processes. The concept includes anatomy and physiology, biochemistry and biophysics, and the biology of animals, plants, and microorganisms. It should be differentiated from biology, one of its subdivisions, concerned specifically with the origin and life processes of living organisms. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biometry: The use of statistical methods to analyze biological observations and phenomena. [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] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and

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protein structure function analysis and prediction. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Birth Certificates: Official certifications by a physician recording the individual's birth date, place of birth, parentage and other required identifying data which are filed with the local registrar of vital statistics. [NIH] Birth Rate: The number of births in a given population per year or other unit of time. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone 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] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH]

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Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsid: The outer protein protective shell of a virus, which protects the viral nucleic acid. [NIH]

Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] 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] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Aggregation: The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH]

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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 Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] 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] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Chaperonin 10: Members of the chaperonin heat-shock protein family. Chaperonin 10 purified from bacteria, plastids, or mitochondria occurs as an oligomer of seven identical subunits arranged in a single ring. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Chorion: The outermost extraembryonic membrane. [NIH]

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Chorionic Villi: The threadlike, vascular projections of the chorion which enter into the formation of the placenta. [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] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clitoral: Pertaining to the clitoris. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] 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] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes

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immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective

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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] Connexins: A group of homologous proteins which form the intermembrane channels of gap junctions. The connexins are the products of an identified gene family which has both highly conserved and highly divergent regions. The variety contributes to the wide range of functional properties of gap junctions. [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] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [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] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [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 Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [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] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU]

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Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]

fumarate.

Stimulant

proposed

as

Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]

Creatine Kinase: A transferase that catalyzes formation of phosphocreatine from ATP + creatine. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic isoenzymes have been identified in human tissues: MM from skeletal muscle, MB from myocardial tissue, and BB from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins. EC 2.7.3.2. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]

Curette: A spoon-shaped instrument with a sharp edge. [NIH] 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] Cystathionine beta-Synthase: A multifunctional pyridoxal phosphate enzyme. In the second stage of cysteine biosynthesis it catalyzes the reaction of homocysteine with serine to form cystathionine with the elimination of water. Deficiency of this enzyme leads to hyperhomocysteinemia and homocystinuria. EC 4.2.1.22. [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] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized,

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the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [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] 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] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [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 procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Diestrus: Period of sexual quiescence separating phases of the estrous cycle in polyestrous animals. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilation and curettage: D&C. A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage). [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used

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for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [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] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] 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] Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dystocia: Difficult childbirth or labor. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the

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latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [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] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [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

Dictionary 153

uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermal Growth Factor: A 6 kD polypeptide growth factor initially discovered in mouse submaxillary glands. Human epidermal growth factor was originally isolated from urine based on its ability to inhibit gastric secretion and called urogastrone. epidermal growth factor exerts a wide variety of biological effects including the promotion of proliferation and differentiation of mesenchymal and epithelial cells. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [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] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoiesis: The production of erythrocytes. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a

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peripheral sense organ. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] 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] Facial: Of or pertaining to the face. [EU] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [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] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Alcohol Syndrome: A disorder occurring in children born to alcoholic women who continue to drink heavily during pregnancy. Common abnormalities are growth deficiency (prenatal and postnatal), altered morphogenesis, mental deficiency, and characteristic facies - small eyes and flattened nasal bridge. Fine motor dysfunction and tremulousness are observed in the newborn. [NIH] Fetal Death: Death of the young developing in utero. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetal Growth Retardation: The failure of a fetus to attain its expected growth potential at any gestational stage. [NIH] Fetal Heart: The heart of the fetus of any viviparous animal. It refers to the heart in the postembryonic period and is differentiated from the embryonic heart (heart/embryology)

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only on the basis of time. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fish Products: Food products manufactured from fish (e.g., fish flour, fish meal). [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Flatus: Gas passed through the rectum. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Follicles: Shafts through which hair grows. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fornix: A bundle of nerves connected to the hippocampus. [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] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [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 through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the

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blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic 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] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestation period: The period of development of the young from the time of conception until birth. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gestational trophoblastic disease: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic tumor, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic neoplasia: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic tumor, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic tumor: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [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

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leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] 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] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] 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]

GP41: 41-kD HIV transmembrane envelope glycoprotein which mediates the fusion of the viral membrane with the membrane of the target cell. [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] Graft Rejection: An immune response with both cellular and humoral components, directed

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against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granulosa Cells: Cells of the membrana granulosa lining the vesicular ovarian follicle which become luteal cells after ovulation. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [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] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hematopoiesis: The development and formation of various types of blood cells. [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] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparan Sulfate Proteoglycan: A substance released by astrocytes, which is critical in stopping nervous fibers in their tracks. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [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]

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Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] 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] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydatidiform Mole: A trophoblastic disease characterized by hydrops of the mesenchymal portion of the villus. Its karyotype is paternal and usually homozygotic. The tumor is indistinguishable from chorioadenoma destruens or invasive mole ( = hydatidiform mole, invasive) except by karyotype. There is no apparent relation by karyotype to choriocarcinoma. Hydatidiform refers to the presence of the hydropic state of some or all of the villi (Greek hydatis, a drop of water). [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] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine betasynthase and is a risk factor for coronary vascular disease. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to

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an increase in the number of cells. [NIH] 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] Hysterosalpingography: Radiography of the uterus and fallopian tubes after the injection of a contrast medium. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [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] Immune Tolerance: The specific failure of a normally responsive individual to make an immune response to a known antigen. It results from previous contact with the antigen by an immunologically immature individual (fetus or neonate) or by an adult exposed to extreme high-dose or low-dose antigen, or by exposure to radiation, antimetabolites, antilymphocytic serum, etc. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodominant Epitopes: Subunits of the antigenic determinant that are most easily recognized by the immune system and thus most influence the specificity of the induced antibody. [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] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [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] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to

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prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [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] Incarceration: Abnormal retention or confinement of a body part; specifically : a constriction of the neck of a hernial sac so that the hernial contents become irreducible. [EU] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] 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

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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] Inhibin: Glyceroprotein hormone produced in the seminiferous tubules by the Sertoli cells in the male and by the granulosa cells in the female follicles. The hormone inhibits FSH and LH synthesis and secretion by the pituitary cells thereby affecting sexual maturation and fertility. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [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] 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] Insulin-like: Muscular growth factor. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] 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] Intestinal Pseudo-Obstruction: Obstruction of the intestines that is functional, not mechanical. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH]

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Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] 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] Involution: 1. A rolling or turning inward. 2. One of the movements involved in the gastrulation of many animals. 3. A retrograde change of the entire body or in a particular organ, as the retrograde changes in the female genital organs that result in normal size after delivery. 4. The progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. [EU] 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] Isoelectric: Separation of amphoteric substances, dissolved in water, based on their isoelectric behavior. The amphoteric substances are a mixture of proteins to be separated and of auxiliary "carrier ampholytes". [NIH] Isoelectric Point: The pH in solutions of proteins and related compounds at which the dipolar ions are at a maximum. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Karyotype: The characteristic chromosome complement of an individual, race, or species as defined by their number, size, shape, etc. [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] Killer Cells: Lymphocyte-like effector cells which mediate antibody-dependent cell cytotoxicity. They kill antibody-coated target cells which they bind with their Fc receptors. [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] Lactation: The period of the secretion of milk. [EU] 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] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [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]

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Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linkages: 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] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [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] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal 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 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] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [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

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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] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphokine: A soluble protein produced by some types of white blood cell that stimulates other white blood cells to kill foreign invaders. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [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] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [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] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Marital Status: A demographic parameter indicating a person's status with respect to marriage, divorce, widowhood, singleness, etc. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized

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facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [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] Menarche: The establishment or beginning of the menstrual function. [EU] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental deficiency: A condition of arrested or incomplete development of mind from inherent causes or induced by disease or injury. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metestrus: Short period following estrus during which the phenomena of estrus subside in those animals in which pseudopregnancy does not occur. Does not apply to humans. [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] Mice Minute Virus: The type species of parvovirus prevalent in mouse colonies and found as a contaminant of many transplanted tumors or leukemias. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only

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small quantities for normal physiologic processes to occur. [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] Mifepristone: A progestational and glucocorticoid hormone antagonist. Its inhibition of progesterone induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. As a glucocorticoid receptor antagonist, the drug has been used to treat hypercortisolism in patients with nonpituitary Cushing syndrome. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mitotic Index: An expression of the number of mitoses found in a stated number of cells. [NIH]

Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molar pregnancy: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or choriocarcinoma. [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] 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] Morphogenesis: The development of the form of an organ, part of the body, or organism. [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]

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Morula: The early embryo at the developmental stage in which the blastomeres, resulting from repeated mitotic divisions of the fertilized ovum, form a compact mass. [NIH] Mosaicism: The occurrence in an individual of two or more cell populations of different chromosomal constitutions, derived from a single zygote, as opposed to chimerism in which the different cell populations are derived from more than one zygote. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] 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] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nasal Bone: Either of two small elongated rectangular bones that together form the bridge of the nose. [NIH] Natural killer cells: NK cells. A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called large granular lymphocytes (LGL). [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] 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

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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] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] 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] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] 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] 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] Nidation: Implantation of the conceptus in the endometrium. [EU] 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]

Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] 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] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women

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during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oligo: Chemical and mineral elements that exist in minimal (oligo) quantities in the body, in foods, in the air, in soil; name applied to any element observed as a microconstituent of plant or animal tissue and of beneficial, harmful, or even doubtful significance. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] 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]

Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] 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] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovarian Cysts: General term for cysts and cystic diseases of the ovary. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovarian Hyperstimulation Syndrome: Syndrome composed of a combination of ovarian enlargement and an acute fluid shift out of the intravascular space. The enlargement is caused by ovarian cyst formation and the fluid shift may result in ascites, hydrothorax, or generalized edema. The syndrome is most usually seen as a complication of ovulation induction, a treatment for infertility. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovulation Induction: Techniques for the artifical induction of ovulation. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Ovum Implantation: Endometrial implantation of the blastocyst. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the

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

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Particle: A tiny mass of material. [EU] Parturition: The act or process of given birth to a child. [EU] Parvovirus: A genus of the family Parvoviridae, subfamily Parvovirinae, infecting a variety of vertebrates including humans. Parvoviruses are responsible for a number of important diseases but also can be non-pathogenic in certain hosts. The type species is mice minute virus. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] 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]

Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] 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] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH]

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Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [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] 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 teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylates: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] 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] 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] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other

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nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plaque Assay: Method for measuring viral infectivity and multiplication in cultured cells. Clear lysed areas or plaques develop as the viral particles are released from the infected cells during incubation. With some viruses, the cells are killed by a cytopathic effect; with others, the infected cells are not killed but can be detected by their hemadsorptive ability. Sometimes the plaque cells contain viral antigens which can be measured by immunofluorescence. [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] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand

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as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Pregnancy Complications: The co-occurrence of pregnancy and a disease. The disease may precede or follow conception and it may or may not have a deleterious effect on the pregnant woman or fetus. [NIH] Pregnancy Maintenance: Physiological mechanisms that sustain the state of pregnancy. [NIH]

Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Diagnosis: Determination of the nature of a pathological condition or disease in the postimplantation embryo, fetus, or pregnant female before birth. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases

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in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [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] Proestrus: Phase of the estrous cycle preceding estrus during which the Graafian follicle undergoes maturation. Applies to animals. [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 emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Proliferative Retinopathy: A disease of the small blood vessels of the retina of the eye. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophylaxis: An attempt to prevent disease. [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] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some

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cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins F: (9 alpha,11 alpha,13E,15S)-9,11,15-Trihydroxyprost-13-en-1-oic acid (PGF(1 alpha)); (5Z,9 alpha,11,alpha,13E,15S)-9,11,15-trihydroxyprosta-5,13-dien-1-oic acid (PGF(2 alpha)); (5Z,9 alpha,11 alpha,13E,15S,17Z)-9,11,15-trihydroxyprosta-5,13,17-trien-1oic acid (PGF(3 alpha)). A family of prostaglandins that includes three of the six naturally occurring prostaglandins. All naturally occurring PGF have an alpha configuration at the 9carbon position. They stimulate uterine and bronchial smooth muscle and are often used as oxytocics. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] 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] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [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] 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] Pseudopregnancy: Any abdominal condition resembling pregnancy. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

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]

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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 hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [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]

Pupil: The aperture in the iris through which light passes. [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] Pyloric Stenosis: Obstruction of the pyloric canal. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [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] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptivity: The condition of the reproductive organs of a female flower that permits effective pollination. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relaxin: Hormone produced by the ovaries during pregnancy that loosens ligaments that hold the hip bones together. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the

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extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal cysts: Abnormal fluid-filled sacs in the kidney that range in size from microscopic to much larger. Many simple cysts are harmless, while other types can seriously damage the kidneys. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [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] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [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] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [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] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and

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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 create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Seafood: Marine fish and shellfish used as food or suitable for food. (Webster, 3d ed) shellfish and fish products are more specific types of seafood. [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] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female

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

Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [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] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the

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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] 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] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] 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] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Stabilization: The creation of a stable state. [EU] 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]

Steady state: Dynamic equilibrium. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] 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] Stillbirth: The birth of a dead fetus or baby. [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]

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Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] 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] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [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] Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] 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]

Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [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] Synchrony: The normal physiologic sequencing of atrial and ventricular activation and contraction. [NIH] Syncytium: A living nucleated tissue without apparent cellular structure; a tissue composed of a mass of nucleated protoplasm without cell boundaries. [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

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the heart. [EU] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [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] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]

Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [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] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures

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preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] 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] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH]

Trophic: Of or pertaining to nutrition. [EU] Trophoblast: The outer layer of cells of the blastocyst which works its way into the endometrium during ovum implantation and grows rapidly, later combining with mesoderm. [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] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH]

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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] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterine Rupture: A tearing of uterine tissue; it may be traumatic or spontaneous due to multiple pregnancy, large fetus, previous scarring, or obstruction. [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] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Smears: Collection of pooled secretions of the posterior vaginal fornix for cytologic examination. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Varicella: Chicken pox. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vasodilators: Any nerve or agent which induces dilatation of the 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]

186 Early Pregnancy

Venous: Of or pertaining to the veins. [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] Ventricular: Pertaining to a ventricle. [EU] Vertebral: Of or pertaining to a vertebra. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villous: Of a surface, covered with villi. [NIH] Villus: Cell found in the lining of the small intestine. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [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] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

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] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [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]

Dictionary 187

Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH]

189

INDEX A Abdomen, 137, 143, 153, 160, 164, 171, 182, 186 Abdominal, 125, 137, 145, 171, 172, 176 Abdominal Pain, 125, 137 Aberrant, 8, 10, 21, 137 Ablation, 20, 137 Abscess, 137, 179 Acceptor, 137, 164, 171 Acetylcholine, 137, 145, 169 Acetylcholinesterase, 62, 137 Adaptability, 137, 144, 145 Adaptation, 88, 137 Adenovirus, 22, 137 Adjustment, 13, 137 Adolescence, 10, 137, 145 Adrenal Cortex, 137, 149, 153, 175 Adverse Effect, 137, 180 Afferent, 18, 138 Affinity, 138, 141 Agar, 138, 173 Agonist, 54, 58, 138 Albumin, 138, 173 Algorithms, 138, 142 Allogeneic, 46, 138, 158 Allograft, 17, 96, 138 Alpha-fetoprotein, 102, 138, 155 Alternative medicine, 110, 138 Alveolar Process, 138, 178 Amino Acid Sequence, 138, 140 Amino Acids, 138, 139, 171, 174, 176, 179 Amniocentesis, 90, 139 Amnion, 139 Amniotic Fluid, 43, 46, 66, 87, 139, 156 Amygdala, 18, 139, 164 Anaemia, 51, 139, 166 Anaerobic, 139, 185 Anaesthesia, 139, 161 Anal, 139, 154, 164 Analog, 20, 91, 139 Anaphylactic, 96, 139 Anaphylatoxins, 139, 147 Anaphylaxis, 139 Anaplasia, 139 Anatomical, 139, 141, 161 Androgenic, 96, 139 Anemia, 139, 155 Angiogenesis, 8, 16, 30, 139

Animal model, 10, 14, 139 Anomalies, 6, 53, 66, 67, 69, 140 Antibodies, 13, 30, 52, 93, 140, 160, 165, 173 Antibody, 35, 97, 138, 140, 147, 159, 160, 161, 163, 165, 181 Antidepressant, 140, 149 Antiemetic, 45, 140 Antigen, 6, 53, 86, 95, 138, 139, 140, 147, 156, 159, 160, 161, 165 Antigen-Antibody Complex, 140, 147 Antihistamine, 67, 140 Anti-inflammatory, 58, 140, 157 Antioxidant, 140, 171 Anxiety, 36, 140 Apoptosis, 4, 17, 20, 21, 140 Approximate, 86, 140 Arachidonic Acid, 140, 175 Arginine, 92, 97, 139, 140, 169 Arterial, 51, 57, 59, 64, 96, 140, 159, 176, 182 Arteries, 140, 141, 143, 148, 166, 168, 177 Arterioles, 141, 143, 168 Ascites, 141, 170 Aspiration, 32, 55, 141, 155 Assay, 24, 93, 97, 141, 160 Astrocytes, 141, 158 Asymptomatic, 39, 40, 66, 141 Atopic, 96, 141 Atopic Eczema, 96, 141 Atrial, 141, 182 Atrioventricular, 29, 141 Atrium, 141, 186 Attenuated, 13, 141 Autogenic, 88, 141 Autoimmune disease, 60, 141 Autonomic, 88, 137, 141 B Bacteria, 63, 140, 141, 145, 152, 154, 166, 167, 184, 185 Bacterial Physiology, 137, 141 Bacteriophage, 141, 173, 184 Bacteriuria, 40, 141 Base, 141, 150, 163, 183 Basement Membrane, 142, 154 Basophils, 142, 158, 163 Benign, 12, 142, 168 Bifida, 142

190 Early Pregnancy

Bilateral, 142, 180 Bile, 142, 155, 164, 181 Binding Sites, 21, 142 Bioassay, 55, 142 Biochemical, 13, 31, 46, 142, 163 Biological response modifier, 142, 162 Biological Sciences, 23, 142 Biological therapy, 142, 158 Biometry, 65, 142 Biophysics, 20, 142 Biopsy, 58, 142 Biosynthesis, 53, 140, 142, 149, 179 Biotechnology, 14, 15, 26, 27, 101, 110, 119, 142 Biphasic, 10, 143 Birth Certificates, 103, 143 Birth Rate, 92, 143 Bladder, 143, 161, 169, 185 Blastocyst, 7, 9, 14, 17, 24, 143, 147, 152, 170, 173, 184 Blood Coagulation, 90, 143, 144 Blood Coagulation Factors, 143 Blood Glucose, 103, 143, 158, 162 Blood Platelets, 90, 143 Blood pressure, 63, 66, 96, 143, 144, 159, 167, 177 Blood vessel, 139, 143, 144, 145, 152, 164, 166, 171, 172, 175, 180, 182, 183, 185 Body Fluids, 86, 143, 144 Bone Marrow, 16, 143, 153, 160, 165, 167, 180, 182 Bone scan, 143, 179 Bowel, 139, 143, 169, 172, 182 Bradykinin, 143, 169, 173 Branch, 133, 143, 171, 176, 181, 183 Breakdown, 143, 150, 155 Breeding, 91, 95, 143 Buccal, 144, 164 Bypass, 22, 144 C Calcium, 144, 147, 180 Capsid, 94, 144 Carbohydrates, 144, 145 Carbon Dioxide, 144, 156, 173 Carcinogenesis, 5, 12, 144 Carcinogenic, 144, 162, 175, 181 Carcinogens, 12, 144 Cardiac, 65, 66, 144, 153, 168, 181 Cardiovascular, 15, 88, 96, 144 Cardiovascular disease, 96, 144 Cardiovascular System, 96, 144 Carrier Proteins, 144, 173

Case report, 44, 52, 144 Case series, 40, 54, 144 Cell Aggregation, 144, 170 Cell Death, 16, 140, 144, 157, 168 Cell Differentiation, 17, 26, 145, 180 Cell Division, 141, 145, 158, 167, 173, 179 Cell membrane, 94, 144, 145, 150, 155, 172 Cell proliferation, 12, 20, 22, 25, 145, 180 Cell Survival, 4, 145, 158 Central Nervous System, 6, 96, 137, 145, 157 Cerebral, 145, 148, 152, 153, 155, 176, 183 Cerebrovascular, 144, 145 Cervical, 9, 18, 93, 96, 145, 150 Cervix, 18, 125, 145, 150 Cesarean Section, 39, 145 Chaperonin 10, 49, 145 Character, 145, 150 Chemotactic Factors, 145, 147 Chemotherapy, 79, 88, 145 Child Development, 56, 145 Cholesterol, 20, 142, 145, 148, 181 Choline, 137, 145 Choriocarcinoma, 145, 156, 159, 167 Chorion, 145, 146 Chorionic Villi, 24, 146 Chromatin, 21, 140, 146, 152, 169 Chromosomal, 15, 41, 125, 146, 168 Chromosome, 70, 90, 146, 163, 164, 179, 184 Chronic, 16, 88, 125, 141, 146, 151, 152, 161, 173, 182 Chronic Disease, 125, 146 Chronic renal, 146, 173 Cleft Palate, 51, 146 Climacteric, 96, 146 Clinical Medicine, 49, 146, 174 Clinical trial, 4, 16, 119, 146, 148, 151, 177 Clitoral, 90, 146 Cloning, 142, 146 Coagulation, 61, 143, 146, 158, 173, 183 Cofactor, 146, 176 Collagen, 35, 142, 146, 155, 156, 173, 175 Comorbidity, 19, 146 Complement, 8, 139, 146, 147, 163, 165, 173 Complementary and alternative medicine, 79, 81, 147 Complementary medicine, 80, 147 Computational Biology, 119, 147 Computed tomography, 147, 179 Computerized axial tomography, 147, 179

Index 191

Conception, 3, 5, 33, 34, 63, 65, 87, 92, 93, 145, 147, 148, 155, 156, 167, 174, 181 Cone, 147, 182 Connective Tissue, 18, 143, 146, 147, 148, 156, 165, 166, 178, 182 Connective Tissue Cells, 148 Connexins, 63, 148, 155 Constriction, 148, 161 Consultation, 23, 148 Consumption, 5, 54, 62, 148 Contraception, 32, 43, 49, 51, 57, 92, 148 Contraceptive, 62, 86, 148 Contractility, 96, 148 Contraindications, ii, 148 Control group, 9, 148 Controlled study, 47, 148 Convulsions, 148, 151, 174 Cornea, 148, 182 Coronary, 144, 148, 159, 166, 168 Coronary Arteriosclerosis, 148, 168 Coronary heart disease, 144, 148 Coronary Thrombosis, 148, 166, 168 Corpus, 18, 20, 22, 30, 37, 55, 56, 148, 164, 175, 183 Corpus Luteum, 18, 20, 22, 30, 37, 55, 56, 148, 164, 175 Cortex, 148, 153, 155 Cortisol, 37, 138, 149 Cotinine, 67, 149 Creatine, 40, 149 Creatine Kinase, 40, 149 Creatinine, 149 Credentialing, 80, 149 Cultured cells, 21, 149, 173 Curative, 149, 183 Curettage, 149, 150 Curette, 149, 150 Cutaneous, 149, 164 Cyclic, 4, 149, 158, 169, 175 Cyst, 149, 170 Cystathionine beta-Synthase, 149, 159 Cytokine, 6, 149 Cytoplasm, 140, 142, 145, 149, 152, 158, 167, 169 Cytotoxic, 44, 149, 180 D Data Collection, 10, 149 Databases, Bibliographic, 119, 149 Decidua, 20, 28, 37, 43, 44, 50, 53, 68, 149, 167, 173 Decision Making, 10, 150 Defense Mechanisms, 96, 150

Degenerative, 94, 150, 178 Deletion, 140, 150 Dendrites, 150, 169 Density, 47, 91, 150, 170, 181 Depolarization, 150, 180 Diabetes Mellitus, 45, 53, 96, 150, 157, 158 Diabetic Retinopathy, 104, 150, 172 Diagnostic procedure, 85, 110, 150 Diastolic, 150, 159 Diencephalon, 150, 160, 183 Diestrus, 5, 37, 150 Diffusion, 150, 161 Digestion, 142, 143, 150, 164, 182 Dihydrotestosterone, 150, 177 Dilatation, 150, 175, 185 Dilation, 125, 143, 150 Dilation and curettage, 125, 150 Diploid, 150, 173, 184 Direct, iii, 12, 17, 113, 146, 150, 177 Disease Progression, 9, 150 Distal, 20, 151, 176 Dizziness, 125, 151 Dose-dependent, 9, 151 Double-blinded, 28, 151 Drive, ii, vi, 12, 25, 73, 151 Drug Interactions, 114, 151 Drug Tolerance, 151, 183 Duodenum, 142, 151, 182 Dysmenorrhea, 96, 151 Dysplasia, 9, 151 Dystocia, 96, 151 E Eclampsia, 109, 151, 174 Ectopic, 124, 125, 151 Ectopic Pregnancy, 124, 125, 151 Edema, 61, 150, 151, 170, 174 Effector, 44, 137, 147, 151, 163 Efficacy, 39, 79, 151 Elastin, 146, 151 Elective, 28, 151 Electrocoagulation, 146, 151 Electrons, 140, 142, 151, 163, 171, 177 Embryo, 5, 7, 9, 14, 17, 23, 25, 26, 46, 49, 55, 56, 69, 92, 102, 125, 139, 143, 145, 152, 154, 161, 166, 168, 174, 181 Embryo Transfer, 55, 56, 69, 92, 102, 152, 174 Embryology, 90, 92, 152, 154 Encephalocele, 152, 169 Endocrine System, 152, 169 Endocrinology, 18, 31, 44, 45, 54, 55, 56, 60, 63, 152

192 Early Pregnancy

Endometrial, 17, 21, 25, 28, 33, 40, 47, 50, 51, 152, 170 Endometriosis, 21, 152 Endometrium, 17, 21, 24, 33, 41, 45, 53, 55, 63, 92, 149, 152, 166, 167, 169, 184 Endothelial cell, 8, 96, 152 Endothelium, 152, 169 Endothelium-derived, 152, 169 Endotoxin, 152, 184 End-stage renal, 146, 152, 173 Environmental Health, 32, 41, 118, 120, 152 Enzymatic, 19, 93, 144, 147, 152, 155, 159, 178 Enzyme, 30, 137, 149, 151, 152, 158, 163, 172, 173, 176, 177, 180, 182, 186 Enzyme Inhibitors, 30, 152, 173 Eosinophils, 152, 158, 163 Epidemic, 9, 153 Epidemiological, 97, 153 Epidermal, 7, 153 Epidermal Growth Factor, 7, 153 Epidermis, 153 Epidural, 47, 153 Epidural block, 47, 153 Epigastric, 153, 171 Epinephrine, 153, 185 Epithelial, 4, 8, 17, 25, 37, 149, 153 Epithelial Cells, 5, 17, 37, 153 Epithelium, 4, 7, 13, 17, 25, 65, 83, 142, 145, 152, 153 Erythrocytes, 139, 143, 153 Erythropoiesis, 32, 153 Erythropoietin, 32, 153 Esophagus, 153, 182 Estradiol, 13, 25, 153 Estrogen, 17, 19, 24, 25, 83, 92, 102, 153, 175 Estrogen receptor, 25, 153 Eukaryotic Cells, 153, 161, 185 Evoke, 153, 181 Exocrine, 154, 171 Exogenous, 13, 20, 154 Extracellular, 12, 74, 75, 94, 141, 148, 154, 155 Extracellular Matrix, 12, 74, 75, 148, 154, 155 Extracellular Space, 154 Eye Infections, 137, 154 F Facial, 6, 154 Fallopian Tubes, 154, 160

Family Planning, 102, 119, 154 Fat, 5, 91, 140, 143, 148, 154, 164, 180 Fathers, 100, 154 Fatigue, 61, 154 Fatty acids, 138, 154, 175 Fecal Incontinence, 88, 154, 161 Feces, 154, 182 Fertilization in Vitro, 154, 174 Fetal Alcohol Syndrome, 5, 154 Fetal Death, 20, 154 Fetal Development, 103, 154, 169 Fetal Growth Retardation, 96, 154 Fetal Heart, 57, 154 Fetoprotein, 155 Fetus, 14, 15, 20, 26, 86, 87, 90, 91, 125, 138, 145, 153, 154, 155, 160, 172, 174, 181, 185 Fibrin, 143, 155, 183 Fibrinogen, 155, 173 Fibrinolysis, 61, 155 Fibroblasts, 17, 19, 148, 155 Filtration, 14, 155 Fish Products, 155, 179 Fissure, 146, 155 Flatus, 154, 155 Folate, 47, 77, 155 Folic Acid, 47, 67, 74, 76, 77, 114, 155 Follicles, 155, 162 Forearm, 143, 155 Fornix, 155, 185 Fungi, 154, 155, 158, 166, 167, 187 G Gallbladder, 58, 137, 155 Gap Junctions, 148, 155 Gas, 93, 144, 150, 155, 159, 169, 177, 178, 182 Gas exchange, 155, 178 Gastric, 44, 153, 156, 159 Gastrin, 156, 159 Gastrointestinal, 96, 143, 153, 156, 182 Gastrointestinal tract, 96, 156 Gelatin, 156, 157, 182, 183 Gene, 8, 12, 17, 20, 21, 23, 24, 25, 40, 59, 101, 137, 142, 148, 156, 170, 179 Gene Expression, 12, 23, 24, 156 Genetic Counseling, 90, 156 Genetics, 29, 38, 41, 51, 52, 68, 70, 91, 156 Genital, 9, 30, 125, 156, 163, 185 Genitourinary, 156, 185 Genotype, 156, 172 Germ Cells, 156, 170, 180, 183 Gestation, 5, 6, 13, 24, 39, 61, 91, 104, 125, 156, 171, 173, 181

Index 193

Gestation period, 91, 156 Gestational, 26, 37, 44, 45, 90, 103, 154, 156, 167 Gestational Age, 90, 156 Gestational trophoblastic disease, 156, 167 Gestational trophoblastic neoplasia, 156, 167 Gestational trophoblastic tumor, 156, 167 Giant Cells, 26, 156 Ginger, 45, 51, 81, 157 Gland, 4, 12, 28, 137, 145, 157, 165, 171, 172, 179, 181, 182, 183 Glucocorticoid, 157, 167 Glucose, 3, 45, 143, 150, 157, 158, 162, 178 Glucose Intolerance, 150, 157 Glucuronic Acid, 157, 158 Glutamic Acid, 155, 157, 175 Glycine, 157, 179 Glycoprotein, 90, 94, 95, 153, 155, 156, 157, 184 Gonad, 157 Gonadal, 8, 157, 181 Gonadotropin, 20, 22, 29, 36, 46, 48, 64, 86, 94, 97, 102, 145, 157 Governing Board, 157, 174 Gp120, 94, 157 GP41, 94, 157 Grade, 16, 64, 124, 157 Graft, 157, 159, 161 Graft Rejection, 157, 161 Grafting, 158, 161 Granulocytes, 158, 180, 186 Granulosa Cells, 11, 22, 158, 162, 164 Grasses, 155, 158 Growth factors, 14, 21, 158 Guanylate Cyclase, 158, 169 H Health Status, 7, 158 Heart attack, 144, 158 Hematopoiesis, 94, 158 Hemoglobin, 3, 139, 153, 158 Hemorrhage, 151, 158, 182, 186 Hemostasis, 63, 158 Heparan Sulfate Proteoglycan, 74, 75, 158 Heparin, 7, 158 Hereditary, 158, 172 Heredity, 156, 158 Herpes, 42, 62, 159 Herpes Zoster, 42, 159 Heterogeneity, 44, 94, 138, 159 Histamine, 139, 140, 159 Homologous, 148, 159, 179, 182

Hormonal, 9, 25, 159 Hormone Replacement Therapy, 96, 159 Host, 86, 141, 159, 160, 185, 186 Hydatidiform Mole, 67, 145, 159 Hydrogen, 137, 142, 144, 159, 164, 167, 171 Hydrolysis, 93, 137, 159, 172, 174, 176 Hydroxylysine, 146, 159 Hydroxyproline, 146, 159 Hyperglycemia, 103, 159 Hyperhomocysteinemia, 49, 69, 149, 159 Hyperplasia, 4, 159 Hypertension, 66, 96, 144, 159, 174 Hypertrophy, 159 Hypothalamus, 150, 160, 164, 172, 183 Hysterosalpingography, 67, 160 Hysterotomy, 145, 160 I Id, 77, 80, 126, 132, 134, 160 Immune response, 9, 140, 141, 157, 160, 165, 182, 185, 186 Immune system, 15, 86, 94, 142, 160, 165, 185, 186 Immune Tolerance, 17, 160 Immunization, 160 Immunoassay, 86, 95, 160 Immunodeficiency, 94, 160 Immunodominant Epitopes, 6, 160 Immunofluorescence, 8, 160, 173 Immunoglobulins, 160, 173 Immunohistochemistry, 8, 24, 160 Immunologic, 9, 145, 156, 160 Immunology, 7, 9, 28, 37, 44, 46, 48, 57, 138, 160 Immunosuppressive, 36, 157, 160 Immunosuppressive therapy, 160 Immunotherapy, 42, 142, 160 Impairment, 25, 154, 161 Implantation, 7, 8, 9, 22, 23, 24, 30, 32, 40, 48, 50, 92, 96, 97, 100, 147, 161, 169, 170 Impotence, 96, 161 In situ, 8, 21, 24, 26, 161 In Situ Hybridization, 8, 24, 161 In vitro, 8, 14, 16, 19, 24, 26, 49, 55, 69, 92, 102, 144, 152, 161, 183 In vivo, 8, 15, 17, 19, 22, 24, 26, 102, 158, 161 Incarceration, 100, 161 Incision, 160, 161, 163 Incompetence, 94, 161 Incontinence, 96, 161 Incubation, 161, 173 Indicative, 62, 100, 161, 171, 185

194 Early Pregnancy

Induction, 8, 11, 12, 16, 18, 25, 60, 161, 170, 175 Infancy, 54, 161 Infarction, 161 Infection, 6, 9, 16, 36, 41, 69, 94, 96, 137, 142, 145, 154, 160, 161, 164, 165, 170, 182, 186 Infertility, 8, 11, 17, 21, 22, 37, 92, 96, 109, 161, 170 Infiltration, 28, 161 Inflammation, 63, 96, 138, 140, 154, 159, 161, 178 Infusion, 17, 162 Inhibin, 46, 51, 56, 109, 162 Initiation, 17, 18, 24, 162, 184 Inorganic, 162, 168 Insight, 17, 162 Insulin, 3, 12, 21, 44, 108, 162 Insulin-dependent diabetes mellitus, 162 Insulin-like, 21, 44, 162 Interferon, 6, 14, 162 Interferon-alpha, 162 Interleukin-1, 32, 162 Interleukin-2, 162 Internal Medicine, 152, 162 Intestinal, 13, 88, 96, 162 Intestinal Pseudo-Obstruction, 88, 162 Intestines, 137, 154, 156, 162 Intoxication, 162, 186 Intracellular, 6, 12, 22, 161, 162, 169, 175, 180 Intravascular, 163, 170 Intravenous, 7, 162, 163 Invasive, 12, 70, 159, 163, 165 Involuntary, 154, 163, 168 Involution, 5, 163 Ions, 141, 159, 163 Isoelectric, 86, 163 Isoelectric Point, 86, 163 Isoenzyme, 149, 163 J Joint, 23, 163 K Karyotype, 63, 90, 139, 159, 163 Kb, 118, 163 Killer Cells, 163 Kinetics, 13, 65, 163 L Labile, 146, 163 Lactation, 5, 13, 163, 171, 175 Lectin, 53, 163 Lesion, 163, 164

Leukocytes, 48, 51, 142, 143, 145, 152, 158, 162, 163, 167, 169, 172, 184 Library Services, 132, 163 Life cycle, 143, 155, 163 Ligaments, 148, 164, 177 Ligands, 9, 164 Limbic, 139, 164 Limbic System, 139, 164 Linkages, 158, 164 Lip, 30, 89, 164 Lipid, 94, 145, 162, 164, 171 Lipid Peroxidation, 164, 171 Liver, 96, 137, 138, 140, 142, 153, 154, 155, 157, 158, 164, 179 Liver scan, 164, 179 Localization, 50, 53, 55, 160, 164 Localized, 24, 161, 164, 173 Longitudinal study, 13, 28, 164 Loop, 89, 164 Lupus, 96, 164 Luteal Phase, 18, 22, 65, 164, 167 Lutein Cells, 164, 175 Lymph, 145, 152, 164, 165, 182 Lymph node, 145, 164, 165 Lymphatic, 152, 161, 164, 165, 166, 180 Lymphocyte, 17, 33, 94, 140, 163, 165 Lymphoid, 17, 140, 165 Lymphokine, 43, 165 M Macrophage, 55, 96, 162, 165 Magnetic Resonance Imaging, 165, 179 Major Histocompatibility Complex, 6, 165 Malaise, 88, 165 Malformation, 69, 165 Malignancy, 97, 165 Malignant, 16, 145, 165, 168, 178 Mammary, 4, 12, 165 Mandible, 138, 165, 178 Manifest, 104, 165 Marital Status, 99, 165 Medial, 18, 165 Mediate, 10, 25, 163, 165 Mediator, 25, 162, 165 Medical Staff, 151, 165 Medicament, 166, 182 MEDLINE, 119, 166 Megaloblastic, 155, 166 Melanin, 166, 172, 185 Membrane, 86, 94, 139, 141, 145, 147, 150, 152, 153, 157, 166, 168, 172, 178, 180, 184 Memory, 6, 56, 166 Menarche, 4, 12, 166

Index 195

Meninges, 145, 166 Menopause, 4, 12, 96, 104, 166, 174 Menstrual Cycle, 4, 22, 33, 41, 45, 48, 50, 51, 53, 55, 60, 64, 65, 67, 68, 93, 102, 164, 166, 175 Menstruation, 93, 150, 151, 164, 166 Mental deficiency, 154, 166 Mental Health, iv, 4, 10, 19, 118, 120, 166, 176 Mesenchymal, 31, 153, 159, 166 Mesoderm, 166, 184 Meta-Analysis, 49, 166 Metastasis, 166 Metestrus, 5, 166 MI, 21, 32, 125, 135, 166 Mice Minute Virus, 166, 171 Microbiological, 30, 166 Microbiology, 7, 137, 141, 166 Micronutrients, 13, 166 Microorganism, 146, 167, 186 Microscopy, 8, 13, 35, 142, 167 Mifepristone, 28, 32, 37, 39, 47, 51, 68, 109, 167 Migration, 55, 167 Miscarriage, 34, 69, 70, 92, 109, 124, 125, 167 Mitochondria, 145, 167 Mitosis, 140, 167 Mitotic, 25, 167, 168 Mitotic Index, 25, 167 Modification, 167, 177 Molar pregnancy, 125, 156, 167 Molecular, 7, 8, 10, 12, 20, 21, 22, 26, 48, 51, 53, 56, 68, 74, 75, 86, 97, 119, 121, 139, 142, 147, 155, 158, 167, 175, 184 Molecule, 23, 38, 52, 96, 97, 140, 142, 147, 151, 152, 157, 159, 163, 167, 171, 177, 180, 185 Monitor, 30, 66, 149, 167, 169 Monocytes, 162, 163, 167 Mononuclear, 49, 167, 184 Morphogenesis, 154, 167 Morphological, 42, 152, 167 Morphology, 6, 25, 167 Morula, 143, 168 Mosaicism, 42, 90, 168 Motility, 96, 168 Motion Sickness, 88, 168 Motor Activity, 62, 101, 103, 148, 168 Mucosa, 164, 168, 175, 182 Mucositis, 168, 183 Mucus, 93, 168

Muscle tension, 88, 168 Mydriatic, 150, 168 Myocardial infarction, 148, 166, 168 Myocardial Ischemia, 96, 168 Myocardium, 166, 168 N Nasal Bone, 40, 168 Natural killer cells, 53, 168 Nausea, 29, 51, 57, 58, 59, 61, 66, 74, 75, 76, 79, 83, 88, 126, 140, 168 Necrosis, 140, 161, 166, 168 Need, 3, 13, 19, 24, 99, 103, 104, 127, 146, 168, 183 Neonatal, 25, 34, 67, 96, 168 Neoplasia, 168, 169 Neoplasm, 168, 178 Neoplastic, 16, 94, 139, 168 Nephropathy, 104, 169 Nerve, 150, 165, 169, 170, 174, 178, 181, 184, 185 Nervous System, 138, 145, 165, 169, 182 Neural, 18, 62, 74, 76, 138, 152, 155, 169 Neural tube defects, 62, 74, 76, 155, 169 Neuroendocrine, 18, 169 Neuromuscular, 137, 169 Neuromuscular Junction, 137, 169 Neurons, 18, 150, 169, 182 Neutrophils, 158, 163, 169 Nidation, 152, 169 Nitric Oxide, 60, 92, 96, 169 Nuclear, 11, 22, 152, 153, 164, 168, 169, 183 Nuclei, 139, 151, 164, 165, 167, 169 Nucleic acid, 144, 161, 169, 177 Nucleus, 18, 140, 142, 146, 149, 152, 153, 167, 169 Nulliparous, 12, 169 O Occult, 97, 170 Oligo, 16, 170 Oophorectomy, 4, 170 Opacity, 150, 170 Operon, 170, 178 Opportunistic Infections, 94, 170 Optic Disk, 150, 170 Oral Health, 9, 170 Orbit, 88, 170 Orbital, 62, 170 Organ Culture, 170, 183 Osteoporosis, 96, 170 Ovarian Cysts, 59, 170 Ovarian Follicle, 64, 148, 158, 170

196 Early Pregnancy

Ovarian Hyperstimulation Syndrome, 50, 60, 64, 170 Ovaries, 86, 125, 154, 170, 177, 179 Ovary, 17, 53, 125, 148, 153, 157, 170, 182 Ovulation, 11, 20, 22, 60, 93, 96, 100, 101, 158, 164, 170 Ovulation Induction, 170 Ovum, 60, 148, 149, 156, 163, 168, 170, 175, 184, 186, 187 Ovum Implantation, 170, 184 Oxidation, 71, 137, 140, 164, 170, 171 Oxidative Stress, 59, 171 Oxytocin, 18, 60, 171 P Palate, 146, 171 Palliative, 171, 183 Pancreas, 96, 137, 162, 171 Particle, 90, 94, 171, 181, 184 Parturition, 170, 171, 175 Parvovirus, 41, 166, 171 Pathogenesis, 16, 171 Pathologic, 140, 142, 148, 171, 178, 180 Pathologic Processes, 140, 171 Pathologies, 25, 171 Patient Education, 124, 130, 132, 135, 171 Pelvic, 152, 171 Peptide, 6, 16, 18, 97, 171, 174, 176 Perfusion, 51, 171 Perinatal, 7, 63, 69, 100, 171 Peripheral blood, 47, 49, 88, 162, 171 Peritoneal, 60, 141, 171 Peritoneum, 171, 172 Peroxidase, 71, 164, 172 Peroxide, 164, 172 Pharmaceutical Preparations, 14, 96, 156, 172 Pharmacologic, 172, 184 Phenotype, 11, 17, 26, 172 Phenylalanine, 172, 185 Phospholipases, 172, 180 Phospholipids, 154, 172 Phosphorus, 144, 172 Phosphorylates, 11, 172 Phosphorylation, 8, 11, 13, 172 Photocoagulation, 104, 146, 172 Physical Examination, 156, 172 Physical Fitness, 104, 172 Physiologic, 88, 138, 142, 146, 154, 166, 167, 172, 175, 177, 178, 182 Physiology, 8, 20, 22, 25, 40, 65, 74, 75, 142, 152, 172 Pituitary Gland, 102, 172

Placenta, 23, 26, 33, 56, 65, 86, 90, 146, 153, 172, 175, 176 Plants, 142, 143, 144, 145, 157, 163, 167, 173, 178, 184 Plaque, 6, 173 Plaque Assay, 6, 173 Plasma, 3, 29, 37, 40, 60, 75, 76, 138, 140, 145, 155, 156, 157, 158, 173 Plasma cells, 140, 173 Plasma protein, 29, 138, 173 Plastids, 145, 173 Platelet Activation, 32, 89, 173, 180 Platelet Aggregation, 139, 169, 173 Platelets, 32, 96, 169, 173, 183 Platinum, 164, 173 Poisoning, 162, 168, 173 Polycystic, 22, 173 Polymerase, 173, 178 Polymorphism, 61, 174 Polypeptide, 138, 146, 153, 155, 174, 175 Polysaccharide, 140, 174 Posterior, 139, 171, 174, 185 Postmenopausal, 12, 170, 174 Postnatal, 12, 154, 174, 181 Postoperative, 79, 174 Postsynaptic, 174, 180 Potentiates, 162, 174 Potentiation, 174, 180 Practice Guidelines, 120, 126, 174 Precursor, 94, 140, 145, 151, 152, 172, 174, 184, 185 Preeclampsia, 36, 40, 46, 66, 96, 108, 124, 174 Pregnancy Complications, 39, 174 Pregnancy Maintenance, 10, 174 Pregnancy Outcome, 15, 30, 56, 58, 68, 69, 97, 174 Pregnancy Tests, 156, 174 Prenatal, 5, 13, 38, 41, 42, 50, 61, 62, 66, 69, 90, 124, 152, 154, 174 Prenatal Diagnosis, 38, 41, 42, 50, 61, 62, 66, 69, 90, 174 Prevalence, 15, 61, 103, 174 Probe, 91, 175 Problem Solving, 10, 175 Proestrus, 5, 175 Progesterone, 13, 17, 19, 20, 22, 25, 29, 35, 65, 92, 93, 102, 167, 175, 181 Progression, 9, 139, 175 Progressive, 145, 146, 151, 158, 163, 168, 173, 175 Projection, 150, 175

Index 197

Prolactin, 18, 20, 175 Proliferative Retinopathy, 104, 175 Proline, 146, 159, 175 Promoter, 21, 175 Prophylaxis, 175, 185 Prospective study, 9, 28, 34, 164, 175 Prostaglandin, 55, 83, 175 Prostaglandins A, 175, 176 Prostaglandins F, 167, 176 Protease, 9, 20, 94, 176 Protein S, 101, 143, 176 Proteinuria, 174, 176 Proteolytic, 147, 155, 176 Protozoa, 166, 167, 176 Proximal, 18, 20, 151, 176, 179 Pseudopregnancy, 18, 83, 166, 176 Psychic, 146, 176 Psychomotor, 54, 152, 176 Public Health, 15, 61, 120, 176 Public Policy, 119, 176 Publishing, 7, 26, 176 Puerperium, 170, 176 Pulmonary, 96, 143, 148, 177, 178, 186 Pulmonary Artery, 143, 177, 186 Pulmonary hypertension, 96, 177 Pulmonary Ventilation, 177, 178 Pulse, 108, 167, 177 Pupil, 148, 150, 168, 177 Purines, 177, 179 Pyloric Stenosis, 96, 177 Q Quality of Life, 9, 177 R Race, 99, 163, 167, 177 Radiation, 74, 75, 160, 177, 179, 186 Radioactive, 143, 159, 161, 164, 169, 177, 179 Radiography, 156, 160, 177 Randomized, 19, 28, 29, 151, 177 Reagent, 40, 90, 93, 177 Receptivity, 10, 17, 25, 177 Receptor, 12, 17, 20, 25, 37, 137, 140, 147, 157, 167, 177, 180 Recombinant, 22, 177, 185 Rectum, 155, 161, 177, 182 Reductase, 56, 177 Refer, 1, 144, 146, 151, 155, 159, 164, 177 Regimen, 151, 177 Relaxin, 18, 53, 177 Reliability, 63, 92, 177 Renal cysts, 57, 178 Repressor, 22, 170, 178

Reproduction Techniques, 174, 178 Research Design, 7, 178 Resorption, 20, 178 Respiratory distress syndrome, 96, 178 Respiratory System, 96, 178 Retina, 150, 175, 178 Retinal, 147, 150, 170, 178 Retinopathy, 104, 150, 178 Retrograde, 163, 178 Retrospective, 64, 178 Risk factor, 30, 40, 44, 47, 49, 54, 59, 63, 159, 175, 178 S Saponins, 178, 181 Sarcoma, 14, 16, 64, 178 Scans, 91, 178 Schizoid, 179, 186 Schizophrenia, 179, 186 Schizotypal Personality Disorder, 179, 186 Screening, 7, 53, 146, 179 Seafood, 54, 179 Secretion, 14, 18, 145, 153, 159, 162, 163, 168, 179 Secretory, 17, 21, 62, 179 Segregation, 141, 179 Sella, 172, 179 Seminiferous tubule, 162, 179 Senile, 170, 179 Senna, 81, 179 Septal, 29, 164, 179 Sequencing, 16, 179, 182 Serine, 12, 149, 179 Serologic, 160, 179 Sex Characteristics, 137, 179, 183 Sex Determination, 42, 90, 179 Sexually Transmitted Diseases, 10, 180 Shock, 27, 139, 145, 180, 184 Shoulder Pain, 125, 180 Side effect, 80, 89, 113, 137, 142, 180, 184 Signal Transduction, 21, 180 Signs and Symptoms, 124, 180 Skeletal, 149, 180 Skeleton, 163, 175, 180 Skull, 152, 169, 170, 180, 183 Small intestine, 151, 159, 162, 180, 186 Smooth muscle, 96, 139, 148, 159, 176, 180, 182 Social Environment, 177, 180 Social Support, 9, 180 Soft tissue, 143, 180 Solid tumor, 139, 180 Soma, 180, 181

198 Early Pregnancy

Somatic, 6, 137, 146, 164, 167, 181 Sound wave, 91, 181 Spatial disorientation, 151, 181 Specialist, 127, 150, 181 Species, 90, 138, 153, 163, 166, 167, 171, 177, 181, 182, 184, 186 Specificity, 25, 138, 160, 181 Sperm, 146, 179, 181 Sphincter, 88, 181 Spina bifida, 74, 76, 169, 181 Spinal cord, 141, 145, 153, 166, 169, 181 Spontaneous Abortion, 21, 28, 35, 42, 66, 70, 103, 174, 181 Stabilization, 30, 181 Staging, 178, 181 Steady state, 24, 181 Stem Cells, 153, 181 Sterile, 87, 181 Sterility, 30, 34, 41, 48, 49, 63, 67, 69, 101, 102, 161, 181 Steroid, 12, 13, 19, 20, 24, 25, 96, 149, 178, 181 Stillbirth, 103, 174, 181 Stimulus, 25, 148, 151, 181, 183 Stomach, 125, 137, 153, 156, 159, 162, 168, 180, 182 Stool, 161, 182 Stress, 4, 15, 16, 37, 109, 149, 168, 171, 182 Stroke, 64, 96, 118, 144, 182 Stroma, 7, 25, 182 Stromal, 7, 17, 21, 25, 152, 182 Stromal Cells, 7, 17, 21, 182 Subacute, 161, 182 Subclinical, 161, 182 Subcutaneous, 151, 182 Submaxillary, 153, 182 Subspecies, 181, 182 Substance P, 179, 182 Substrate, 12, 92, 152, 182 Suction, 155, 182 Supplementation, 13, 69, 182 Suppositories, 102, 156, 182 Synaptic, 180, 182 Synchrony, 17, 182 Syncytium, 156, 182 Synergistic, 175, 182 Systemic, 65, 114, 139, 143, 153, 161, 182 Systolic, 159, 182 T Temporal, 8, 24, 139, 183 Temporal Lobe, 139, 183 Testis, 8, 145, 153, 183

Testosterone, 43, 177, 183 Thalamus, 52, 150, 164, 183 Therapeutics, 114, 183 Third Ventricle, 160, 183 Threonine, 12, 179, 183 Threshold, 6, 39, 159, 183 Thrombosis, 56, 176, 182, 183 Thrombus, 148, 161, 168, 173, 183 Thymidine, 25, 183 Thyroid, 183, 185 Thyroid Gland, 183 Thyroxine, 54, 138, 172, 183 Tissue Culture, 14, 183 Tolerance, 45, 137, 157, 183 Tooth Preparation, 137, 183 Topical, 96, 184 Torsion, 52, 59, 161, 184 Toxaemia, 174, 184 Toxic, iv, 16, 158, 184 Toxicity, 151, 184 Toxicology, 58, 120, 184 Toxins, 97, 140, 157, 161, 184 Transcription Factors, 8, 21, 184 Transduction, 180, 184 Transfection, 142, 184 Translational, 7, 184 Transmitter, 137, 141, 165, 184 Transplantation, 58, 146, 152, 160, 165, 184 Trauma, 103, 168, 184 Trisomy, 42, 184 Trophic, 22, 184 Trophoblast, 7, 21, 23, 24, 26, 35, 47, 49, 70, 97, 100, 101, 143, 184 Tryptophan, 146, 184 Tuberculosis, 148, 164, 184 Tumor Necrosis Factor, 6, 32, 184 Tyrosine, 8, 185 U Ubiquitin, 53, 185 Ultrasonography, 42, 67, 90, 156, 185 Unconscious, 150, 160, 185 Urethra, 185 Urinary, 39, 67, 93, 96, 141, 156, 161, 185 Urinary tract, 141, 185 Urinary tract infection, 141, 185 Urine, 14, 16, 63, 64, 86, 90, 93, 94, 97, 141, 143, 149, 153, 161, 176, 185 Urogenital, 96, 156, 185 Uterine Contraction, 171, 185 Uterine Rupture, 55, 185 V Vaccination, 68, 185

Index 199

Vaccine, 86, 185 Vagina, 50, 145, 160, 166, 185 Vaginal, 28, 35, 36, 39, 63, 65, 66, 68, 109, 125, 185 Vaginal Smears, 35, 185 Vaginosis, 30, 31, 63, 107, 109, 185 Varicella, 42, 68, 69, 185 Vascular, 8, 15, 28, 59, 60, 64, 68, 96, 139, 146, 152, 159, 161, 169, 170, 172, 183, 185 Vascular endothelial growth factor, 28, 68, 185 Vasodilators, 169, 185 Vector, 8, 22, 184, 185 Vein, 163, 169, 185 Venous, 3, 176, 186 Ventricle, 139, 141, 177, 182, 183, 186 Ventricular, 182, 186 Vertebral, 142, 181, 186 Vesicular, 141, 158, 159, 186 Veterinary Medicine, 119, 186 Villi, 159, 186 Villous, 33, 186 Villus, 159, 186

Viral, 6, 94, 144, 156, 157, 173, 184, 186 Virulence, 141, 184, 186 Virus, 6, 94, 141, 144, 156, 157, 162, 173, 184, 186 Viscera, 181, 186 Vital Statistics, 143, 186 Vitreous Hemorrhage, 150, 186 Vitro, 14, 16, 17, 46, 48, 63, 69, 92, 158, 186 Vivo, 17, 22, 186 W Weight Gain, 45, 186 White blood cell, 140, 163, 165, 168, 173, 186 Withdrawal, 4, 102, 186 Womb, 185, 186 X Xenograft, 25, 140, 186 X-ray, 147, 169, 179, 186 Y Yeasts, 155, 172, 187 Z Zygote, 147, 168, 187

200 Early Pregnancy