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

HEMATOCRIT A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET R EFERENC...

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HEMATOCRIT A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET

R EFERENCES

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Hematocrit: 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: 0-497-00523-9 1. Hematocrit-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 hematocrit. 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 HEMATOCRIT ............................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hematocrit .................................................................................... 7 E-Journals: PubMed Central ....................................................................................................... 37 The National Library of Medicine: PubMed ................................................................................ 38 CHAPTER 2. NUTRITION AND HEMATOCRIT .................................................................................. 85 Overview...................................................................................................................................... 85 Finding Nutrition Studies on Hematocrit ................................................................................... 85 Federal Resources on Nutrition ................................................................................................... 86 Additional Web Resources ........................................................................................................... 86 CHAPTER 3. ALTERNATIVE MEDICINE AND HEMATOCRIT ............................................................ 89 Overview...................................................................................................................................... 89 National Center for Complementary and Alternative Medicine.................................................. 89 Additional Web Resources ........................................................................................................... 90 General References ....................................................................................................................... 91 CHAPTER 4. PATENTS ON HEMATOCRIT ......................................................................................... 93 Overview...................................................................................................................................... 93 Patents on Hematocrit ................................................................................................................. 93 Patent Applications on Hematocrit............................................................................................ 108 Keeping Current ........................................................................................................................ 130 CHAPTER 5. BOOKS ON HEMATOCRIT .......................................................................................... 131 Overview.................................................................................................................................... 131 Book Summaries: Federal Agencies............................................................................................ 131 Chapters on Hematocrit ............................................................................................................. 132 CHAPTER 6. PERIODICALS AND NEWS ON HEMATOCRIT ............................................................ 135 Overview.................................................................................................................................... 135 News Services and Press Releases.............................................................................................. 135 Newsletter Articles .................................................................................................................... 137 Academic Periodicals covering Hematocrit................................................................................ 138 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 143 Overview.................................................................................................................................... 143 NIH Guidelines.......................................................................................................................... 143 NIH Databases........................................................................................................................... 145 Other Commercial Databases..................................................................................................... 147 APPENDIX B. PATIENT RESOURCES ............................................................................................... 149 Overview.................................................................................................................................... 149 Patient Guideline Sources.......................................................................................................... 149 Finding Associations.................................................................................................................. 156 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 159 Overview.................................................................................................................................... 159 Preparation................................................................................................................................. 159 Finding a Local Medical Library................................................................................................ 159 Medical Libraries in the U.S. and Canada ................................................................................. 159 ONLINE GLOSSARIES................................................................................................................ 165 Online Dictionary Directories ................................................................................................... 167 HEMATOCRIT DICTIONARY................................................................................................... 169

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INDEX .............................................................................................................................................. 235

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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 hematocrit 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 hematocrit, 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 hematocrit, 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 hematocrit. 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 hematocrit, 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 hematocrit. 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 HEMATOCRIT Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hematocrit.

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

Quality of Life and Hematocrit Level Source: American Journal of Kidney Disease. 20(1 Supplement 1): 16-20. July 1992. Summary: As the anemia that accompanies chronic renal failure (CRF) is successfully treated with recombinant human erythropoietin (epoetin), striking improvements in overall quality of life have been noted in several clinical studies of patients receiving chronic hemodialysis. This article reviews the available clinical data to provide insight into what improvements in quality of life can reasonably be expected following treatment of anemia. Topics include symptoms of anemia associated with end-stage renal disease (ESRD), physiologic changes in the anemia of ESRD, the effect of epoetin therapy, exercise tolerance, and quality of life. The author concludes that the degree of improvement in overall quality of life may be a function of the baseline level of impairment and the potential for reversal. 4 figures. 1 table. 26 references. (AA-M).

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Increasing Hematocrit Reduces Early Posttransplant Cardiovascular Risk in Diabetic Transplant Recipients Source: Transplantation. 76(5): 816-820. September 2003. Summary: Cardiovascular disease remains epidemic in transplant recipients, despite aggressive treatment of cardiovascular risk factors. Thus, novel risk factors could play a role in the development of cardiovascular events in this population. This article reports on a study that evaluated the impact of early posttransplant anemia on cardiovascular events. The authors examined rolling average hematocrit values at 30 day intervals and determined the effect of increasing hematocrit on the risk for cardiovascular (CV) events in a population of 404 patients with type 1 diabetes and end stage renal disease (ESRD), all of whom underwent either cadaveric kidney transplantation alone or simultaneous pancreas-kidney transplantation. Greater than 60 percent of the individuals in the study cohort had hematocrit less than or equal to 30 percent at least once during the first 30 days posttransplant. Forty-two individuals (10.4 percent of the study population) had at least one 30-day rolling hematocrit less than or equal to 30 percent and a CV event during the first 26 weeks of the posttransplant course. Increasing hematocrit (greater than 30 percent) led to a reduction in the risk ratio for a CV event. The association between anemia and CV events remained statistically significant. The authors conclude that their data suggest that anemia is an important risk factor for early posttransplant CV events in a high risk population. 1 figure. 3 tables. 25 references.

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Adequacy of Dialysis and Differences in Hematocrit Among Dialysis Facilities Source: American Journal of Kidney Diseases. 36(6): 1166-1174. December 2000. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Despite the clearly established relationship between adequacy of dialysis and response to erythropoietin, recent guidelines on anemia management in end stage renal disease (ESRD) omit mention of dialysis adequacy while advocating the use of large amounts of intravenous iron. This article reports on a study undertaken to determine the relative effects of adequacy of dialysis and intravenous iron on hematocrit (levels of oxygen carrying blood components, lower levels indicate anemia). The authors studied 309 hemodialysis patients and analyzed data from 141 hemodialysis facilities in New York state (ESRD Network 2), as well as data from all 18 ESRD Networks in the United States, for the last quarter of 1997. Among the 309 subjects, mean hematocrit differed between quartiles of urea reduction ratio (URR, a measure used to indicate adequacy of dialysis). Patients with URRs greater than 70 percent were 2.6 times more likely to have hematocrits greater than 33 percent, after adjustment for other factors. Mean dialysis facility hematocrits correlated directly with mean URRs. Facilities with a mean URR greater than 70 percent were three times more likely to have a mean hematocrit greater than 33 percent. The percentage of patients in each of the 18 ESRD Networks with hematocrits of 33 percent or greater correlated inversely with the percentage of patients administered intravenous iron, after adjustment for dose of erythropoietin. The authors conclude that adequacy of dialysis predicts the response to erythropoietin at both patient and dialysis facility levels. Patients with low hematocrits primarily because of inadequate dialysis may inappropriately be administered excess intravenous iron intended as a corrective measure. 2 figures. 5 tables. 48 references.

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Impact of Hematocrit on Morbidity and Mortality Source: Seminars in Nephrology. 20(4): 345-349. July 2000.

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Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: In the 10 years since epoetin alpha (human recombinant erythropoietin, rHuEPO) was approved by the FDA for use in patients with end stage renal disease (ESRD), clinical studies have shown a relationship between the correction of anemia and improved cardiac function, cognitive ability, sexual function, and exercise capacity. This article reviews studies of the impact of hematocrit (a measure of red blood cells) level on morbidity and mortality. Recent large epidemiological studies have shown that mortality and morbidity are reduced when the hematocrit (Hct) level is in the range 33 to 36 percent. The National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF DOQI) guidelines recommend a target Hct of 33 to 36 percent to enhance patient outcomes. The most recent mortality studies who that Hcts less than 30 percent are associated with an 18 percent to 40 percent increased associated risk of death and hospitalizations. Higher Hcts in the 33 to 36 percent range appear to be associated with a 7 percent reduced risk of death and hospitalizations compared with patients with Hcts of 30 percent to less than 33 percent. Patients with sustained Hcts of 33 to 36 percent over 1 year appear to have the best outcome compared with patients with Hcts that fall. These studies suggest that the factors that may influence patients' ability to move into higher Hct ranges need to be determined to enhance patient outcomes. Dramatic improvement in hemodialysis patient Hct levels has occurred since 1989. Mortality and hospitalization studies support the NKF DOQI target Hct range of 33 to 36 percent as providing the best associated outcomes. 25 references. •

Normalization of Hematocrit in Hemodialysis Patients with Cardiac Disease Does Not Increase Blood Pressure Source: Renal Failure. 22(4): 435-444. 2000. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Since the earliest reports of the use of Epoetin alfa (erythropoietin) in hemodialysis patients, it has been noted that Epoetin alfa may worsen preexisting hypertension (high blood pressure) or induce hypertension in patients with end stage renal disease (ESRD) who were not previously hypertensive. This article reports on a study undertaken to determine if the correction of anemia in ESRD patients with cardiac disease with the use of Epoetin alfa would result in increased blood pressure. The target was to increase hematocrit levels from 30 plus or minus 3 percent to 42 plus or minus 3 percent with the use of Epoetin alfa. Patients (n = 31) were randomized into two groups: Group A received slowly increasing doses of Epoetin alfa to 42 plus or minus 3 percent; Group B was maintained with a hematocrit of 30 plus or minus 3 percent throughout the course of the study. There was no difference in mean daytime, mean nighttime, or 24 hour systolic or diastolic blood pressure between Groups A and B at either baseline or followup (30 weeks later). Neither was there a difference in mean predialysis systolic or diastolic blood pressure between Groups A or B at baseline or followup. Four patients in Group A and 4 patients in Group B required an increase in their antihypertensive medication during the course of the study. The authors conclude that it is possible to increase hematocrit to normal levels in hemodialysis with the administration of Epoetin alfa. The increase in hematocrit is not associated with increased blood pressure. 5 figures. 3 tables. 17 references.

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Increasing the Hematocrit Has a Beneficial Effect on Quality of Life and Is Safe in Selected Hemodialysis Patients Source: JASN. Journal of the American Society of Nephrology. 11(2): 335-342. February 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: Target hematocrit and hemoglobin values in dialysis patients are still controversial. This article reports on a 6 month prospective study conducted by the Spanish Cooperative Renal Patients Quality of Life Study Group (including 34 hemodialysis units) on the effect of patient functional status and quality of life using epoetin to achieve normal hematocrit in hemodialysis patients with anemia. The possible adverse effects of increased hematocrit, patient hospitalization, and epoetin requirements were also studied. The study included 156 patients (age range, 18 to 65 years). Quality of life was measured with the Sickness Impact Profile (SIP) and Karnofsky scale. Patients completed questionnaires at home at onset and conclusion of the 6 month study. Mean hematocrit increased from 30.9 to 38.4 percent and hemoglobin from 10.2 to 12.5 g per dl during the study. Health indicator scores improved significantly; functional status and quality of life improved with increased hematocrit. No deaths occurred. Three patients (2 percent) were censored for hypertension and nine (5.7 percent) for thrombosis of the vascular access. The number of patients hospitalized decreased and hospital lengths of stay were shorter during the study period than in the same patients in the 6 month period preceding the study. The authors conclude that normalization of hematocrit in selected hemodialysis patients, i.e. nondiabetic patients without severe cardiovascular or cerebrovascular comorbidities, improves quality of life and decreases morbidity without significant adverse effects. 2 figures. 5 tables. 37 references.

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Clinical Efficacy of Higher Hematocrit Levels in Children with Chronic Renal Insufficiency and Those Undergoing Dialysis Source: Seminars in Nephrology. 21(5): 451-462. September 2001. Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: The optimal hematocrit (the measurement used to determine the volume of red blood cells, i.e., the ability of the blood to carry oxygen) target range in children with end stage renal disease (ESRD), who are receiving recombinant human erythropoietin, is ambiguous due to the lack of compelling, age appropriate studies. This article explores the clinical effectiveness of higher hematocrit levels in children with chronic renal insufficiency (CRI) and in those undergoing dialysis. There are many adult and pediatric studies which show that physical performance as well as morbidity (associated illness) and mortality (death) are positively influenced by partial normalization of the hematocrit to 30 volume percent to 35 volume percent. Cognition studies performed in adults similarly show improvement with partial correction of hematocrit. Normalization of hematocrit studies show lower mortality rates, incremental further improvement in cognition, and greater resolution of cardiac (heart) anomalies when compared with patients with partial correction of anemia. Conversely, cardiac death rates may increase in adult patients receiving hemodialysis who have preexisting cardiac disease, and there are concerns about the effect of recombinant human erythropoietin on catheter or shunt or fistula patency and on blood pressure. The authors stress that the rationale of using adult derived hematocrits in children with

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ESRD needs to be reexamined in the context of the unique growth and developmental requirements of children. 1 table. 140 references.

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

Project Title: AGING AND COGNITION AFTER CARDIAC SURGERY Principal Investigator & Institution: Newman, Mark F.; Professor of Medicine; Anesthesiology; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 15-FEB-1991; Project End 31-JAN-2004 Summary: Elderly patients are increasingly undergoing cardiac surgery and this trend is forecasted to continue. A very common and disturbing consequence of this surgery is deterioration in cognitive function. This impairment can be as high as 83% in the hospital and continue in up to 30% or more of patients for over a year. Elderly patients are particularly susceptible to this neurocognitive consequence of life- preserving surgery. This cause of cognitive dysfunction is postulate to be a result of cerebral emboli that occur during cardiac surgery. The cause of cognitive dysfunction is postulated to be a result of cerebral emboli that occur during cardiac surgery, which are impossible to prevent, and therefore strategies to protect the brain must be developed. It has become standard practice in cardiac surgery to allow the hematocrit advantages to blood flow during hypothermic cardiopulmonary bypass and fear of adverse consequences of transfusion. It is not known whether this hemodilution (50% reduction in oxygen carrying capacity of the blood) contributes to brain injury and cognitive impairment. We will test the hypothesis that preserving oxygen carrying capacity of the blood by limiting the amount of hemodilution during cardiopulmonary bypass improves cerebral protection. A prospective, randomized trial in 370 patients will be conducted in which half of the patients will be assigned to moderate hemodilution (hematocrit of greater than or equal to 27%-treatment group) and other half to profound hemodilution (hematocrit 15-18%-current practice group). Change in cognitive function over the first year after surgery will be compared between the groups. A secondary aim is to determine if serum markers of glial (S100beta) and neuronal (neuron-specific enolase)

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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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brain injury predict the changes in cognitive function. A positive association of brain injury markers with cognitive change will allow earlier detection and support the hypothesis that the cognitive changes are a result of brain ischemia. New knowledge gained in this study would be immediately transferred to clinical practice and could reduce the severity of cognitive impairment. The new information regarding cerebral protection would also have application in all ischemic brain syndromes including stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AN ELECTRICAL IMPEDANCE MONITOR Principal Investigator & Institution: Clark, Justin S.; Medical Physics, Inc. 825 North 300 West, Ste 420 Salt Lake City, Ut 84103 Timing: Fiscal Year 2004; Project Start 21-MAY-2004; Project End 20-NOV-2004 Summary: (provided by applicant): Knowledge of Hematocrit (Hct) is important in several chronic and critical care situations. Presently, Hct measurement requires finger sticks, heel sticks, and blood withdrawals, causing patient trauma as a result of such blood sampling. The development of noninvasive Hct measurement instrument is proposed which will eliminate the trauma of present invasive measurement methods as well as provide immediate results. The method relies upon the sensitivity of the electrical impedance of blood to hematocrit, which differs at high and low frequencies. This principle has been used successfully to measure hematocrit in vitro and in pulse oximetry. The method should be ideal as a screening tool for prospective blood donors as well as for applications in doctors' offices. Since this is a monitoring instrument that provides a continuous measurement, patients in surgery or critical care would benefit from the immediacy of the results compared to the time taken in waiting for lab test results. The tasks of Phase I are directed toward the development and validation of the method. Assuming a successful Phase I, a commercial prototype instrument will be designed and tested in the Phase II. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ASSESSING FUNCTIONAL OUTCOMES IN ADOLESCENT WITH ESRD Principal Investigator & Institution: Furth, Susan L.; Associate Professor; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 31-MAR-2004 Summary: provided by applicant): Dr. Furth is seeking the Small Grant Award to expand the study of clinical outcomes for children with end stage renal disease (ESRD) initiated under her KO8 Award DK 02586-01A1. With the support of the KO8 funding, Dr. Furth has completed her PhD in Clinical Investigation and has begun the transition to an independent research career. She has published a number of manuscripts using her training in epidemiology and clinical investigation: examining how clinical and socio-economic factors affect access to different treatment regimens for children with kidney failure, and how clinical experience with ESRD care for children affects treatment decisions. She has examined how poor growth, a crucial pediatric issue, affects mortality, hospitalization rates and educational achievement. She has also initiated a multi-center, cross-sectional study comparing functional outcomes/ health related quality of life (HRQL) for pediatric patients with chronic renal failure or ESRD treated with hemodialysis, peritoneal dialysis or transplant. Resources provided by the RO3 award will allow Dr. Furth to expand the multi-center study of health related

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quality of life in adolescents with ESRD to a prospective study. A prospective study will allow Dr. Furth to determine whether specific measures of health related quality of life are sensitive to clinical changes, as patients proceed from dialysis to transplantation. The supplementary funding of the R03, additionally will allow Dr. Furth to examine the link between clinical measures such as hematocrit, serum albumin, and dialysis adequacy (Kt/V) and functional outcome/HRQL. Furthermore, the prospective study will assess whether high risk behavior characterized by patterns of response on an adolescent health status questionnaire can predict non-compliance with therapy, increased hospitalization rates, acute rejection or transplant failure. The measures of functional outcome studied will include the Child Health and Illness Profile-Adolescent Edition, and the Child Health Questionnaire (Parent report). This research will provide an indepth analysis of a measure of functional outcome in children with ESRD, and will provide valuable information regarding optimal treatment choices for children with kidney disease. If assessments of high risk behavior predict increased rates of hospitalization, rejection or transplant failure, results of this study will allow identification of a high risk population of adolescents with ESRD, who can be targeted for early intervention and close follow-up to improve long term outcomes of care. The proposal addresses several priority areas for Clinical Research highlighted in the NIH Task Force publication, Research Needs in Pediatric Kidney Disease: 2000 and beyond. During this project, Dr. Furth will gain new skills in organizing and coordinating a prospective multi-center clinical research study. This experience will give Dr. Furth the tools she needs to develop into an independent clinical investigator in a nurturing academic environment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOPHYSICAL BASIS OF FUNCTIONAL BRAIN FMRI Principal Investigator & Institution: Gore, John C.; Professor; Diagnostic Radiology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 01-JUN-1995; Project End 30-JUN-2002 Summary: The overall purpose of the work proposed is to better understand the physical and physiological factors that affect the BOLD (blood oxygenation level dependent) signals detected in functional magnetic resonance imaging (fMRI). FMRI is a very important addition to the methods available for non-invasive mapping of the human brain, and is being widely used in clinical medicine as well as in basic studies of cognition. Although there is general agreement about how BOLD signals originate, there are still many features of the BOLD effect that are uncertain, and the influence of several factors is unknown, especially for so-called event-related fMRI. These deficits in understanding limit our ability to interpret fMRI data quantitatively. Furthermore, we do not understand well what limits the sensitivity of fMRI in practice, nor what gains may be possible as higher field strength magnets become more widely available. In the next phase of this grant we will quantify the effects of several technical and physical factors that modify the shape and amplitude of transient event-related fMRI responses. In both a rat model of somatosensory activation and human cortex, we will quantify the effects of field strength, pulse sequence, stimulation parameters, and intrinsic blood susceptibility, on the latency, magnitude and duration of event related responses, and verify these may add non-linearly when closely spaced. We will also quantify the effects of several physiological and pharmacological factors that commonly vary in humans subjects on the event-related responses, including the effects of altered basal flow, mild hypoglycemia, reduced hematocrit, levels of blood carbon monoxide, nicotine and caffeine, and estrogen, on the characteristics of the event-related BOLD signal. In order

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to clarify the validity of current models that are used to relate BOLD signals to underlying metabolic and physiological changes, we will measure the relationship between cerebral blood volume and flow in a rat model with graded hypercapnia and with neural stimulation, Finally, we will quantify and characterize the sources of noise that affect the fMRI signal. We will measure the contributions to signal variance that may arise from cardiac, respiratory, movements and vasomotor effects, and assess how these affect the fMRI signal/noise ratio, for different choices of technical factors including field strength, pulse sequence, echo time, and spatial resolution. These studies will further our efforts to understand and interpret data provided from fMRI better, and provide important insights into how to improve the quality of information obtainable by fMRI in diverse applications at different field strengths. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BLOOD RHEOLOGY AND LEUKOCYTE MECHANICS Principal Investigator & Institution: Munn, Lance L.; Assistant Professor; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Physical contact between circulating cells and the vessel wall is of central importance in immune surveillance, metastasis and atherosclerosis. But little is known about the mechanical interactions between adhering leukocytes and the red blood cells that constitute most of the blood volume. We have recently discovered that red blood cells (RBCs) play an important role in leukocyteendothelial (L-E) interactions, both in vitro and in vivo through the unique suspension rheology characteristics that they impart to blood. We found a 10-fold increase in the number of bound leukocytes when the hematocrit of the cell suspension in a flow chamber was increased from 0 to 30%. We have also discovered that this enhancement of cell adhesion in the presence of RBCs is due to physical, rather than chemical interactions between the adherent lymphocytes and RBCs. Although the role of RBCs in platelet deposition onto the vessel wall has been studied extensively, little attention has been given to the role of RBCs in promoting L-E interactions. The proposed study will quantify the physical forces and rheological parameters that cause enhanced L-E interactions in blood flow using both experimental and theoretical approaches. Flow chamber studies will be carried out in the parallel plate flow chamber, a device that allows precise control over flow rates and solution rheology as cells flow through a rectangular chamber. Theoretical studies will employ the Lattice-Boltzmann method, a novel approach we recently adapted to the field of blood rheology and particle interactions. The unique combination of experimental and theoretical approaches will form the basis of my independent scientific career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELL/CELL INTERACTIONS IN NEUTROPHIL ADHESION Principal Investigator & Institution: Hammer, Daniel A.; University of Rochester Orpa Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002 Summary: This project will focus on the chemical and physical mechanisms that control the accumulation of neutrophils at a site of inflammation. The previous focus of this project was on the role of the physical chemistry of selectins and their carbohydrate ligands in mediating neutrophil rolling. We developed a "cell-free" system to recreate leukocyte rolling with carbohydrate ligand-coated hard spheres adhering to selectin-

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coated surfaces in a flow chamber. Selectin-mediated leukocyte rolling is inherently noisy, both in cellular and cell-free systems. Our hypothesis is that the period of pauses during rolling facilitates firm neutrophils adhesion via b/2-integrins, and ultimately extravasation during inflammation. Furthermore, we hypothesize that both receptor chemistry (density, identify of ligands) and cell-cell interactions contribute to the dynamics of rolling, and thus to firm adhesion, but the quantitative contribution of each of these factors is poorly understood. To address these hypothesis, we will perform flow chamber adhesion experiments, micropipette aspiration experiments, and computer simulations. We will extend measurements of leukocyte adhesion under flow through experiments at higher cell or particle densities, examining the role of particle concentration (using hard spheres), hematocrit (using erythrocytes), and neutrophilneutrophils interactions (using different concentrations of neutrophils), on the dynamics of rolling and firm arrest on substrates coated with selectin and integrin ligands. To understand better the mechanism of cell-cell adhesion under flow, we will use the same chemistries to measure the kinetics of activation and the strength of adhesion between cell-cell pairs using a novel micropipette aspiration technique. In addition, we will develop a novel calculational method, combining cell-cell and cell-surface interactions to calculate, predict, and confirm the relative contribution of chemical (receptor-mediated) and hydrodynamic interactions in the control of the dynamics of neutrophil rolling and firm adhesion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CELL-FREE 02 CARRIERS: CEREBROVASCULAR CONTROL & STROKE Principal Investigator & Institution: Koehler, Raymond C.; Professor; Anesthesiology/Crit Care Med; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JAN-2000; Project End 31-DEC-2003 Summary: Anemia results in increased cerebral blood flow attributable to decreased blood viscosity and O2 carrying capacity. Attenuating the decrease in O2 carrying capacity by exchange transfusion with cell-free tetrameric crosslinked hemoglobin attenuates the increase in blood flow at reduced hematocrit independent of potential nitric oxide scavenging. During focal cerebral ischemia, in contrast, blood flow is promoted in the ischemic regions. In the present proposal, cell-free polymeric hemoglobin, which has a higher O2 carrying capacity than tetrameric hemoglobin, will be used as a physiologic tool to dissociate effects of viscosity from O2 carrying capacity on cerebrovascular regulation. Further, experimental studies of anemia are largely based on acute reductions in hematocrit, yet clinical anemia is usually a chronic condition. The overall goals of the proposal are to determine a) the mechanisms of changes in cerebral blood flow, baseline arteriolar diameter and vascular reactivity during acute and chronic reductions in hematocrit with and without reductions in O2 carrying capacity, and b) the role of heme oxygenase in ameliorating focal ischemic injury when plasma-based hemoglobin is exchanged for red cell- based hemoglobin. Specifically, the role of cytochrome p450 omega-hydroxylase activity, ATP-sensitive potassium channels and endothelin in the differential pial arteriolar diameter responses to albumin versus hemoglobin exchange transfusions will be determined pharmacologically. P450 omegahydroxylase activity is O2 dependent in the physiological range and produces 20-HETE, a potent constrictor, whereas K-ATP channels are involved in hypoxic vasodilation. Endothelin has been reported to increase after tetrameric hemoglobin transfusion and may contribue to cerebral vasoconstriction. The role of P450 metabolites and endothelin

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in depressed vascular CO2 reactivity two days after hemoglobin transfusion will be studied. The contribution of heme oxygenase to endothelial dependent dilation and potential upregulation of this contribution during chronic anemia will be investigated both pharmacologically and in transgenic animals deficient in heme oxygenase -2. Reduction of infarct volume by hemoglobin transfusion at reduced hematocrit during focal cerebral ischemia may depend on adequate amounts of heme oxygenase to metabolize extravasated hemoglobin into antioxidant bilirubin. This mechanism will be investigated by using transgenic animlas deficient constitutive heme oxygenase -2 and inducible heme oxygenase -1, by infusion or bilirubin, and by prior hemoglobin transfusion as a preconditioning stimulus to upregulate heme oxygenase -1 before ischemia. These studies will render new insights into cerebrovascular regulation during anemia and into novel methodologies for hemodynamically ameliorating injury from stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CEREBRAL OXYGENERATION DURING CARDIOPULMONARY BYPASS Principal Investigator & Institution: Jonas, Richard A.; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2002; Project Start 15-JUL-1998; Project End 31-MAY-2005 Summary: (Provided by Applicant): Brain damage including focal and global cerebral injury as well as suboptimal cognitive developmental outcome continue to be important problems after pediatric heart surgery. Previous work in this area has focused on deep hypothermic circulatory arrest (DHCA) which is now used infrequently. As an alternative to DHCA reduced flow hypothermic cardiopulmonary bypass (CPB) is employed. However in the absence of a validated method for real time monitoring of brain oxygenation there are no guidelines for minimal safe flow and pressure under specific CPB conditions of pH, hematocrit and temperature. The proposed study will employ the new techniques of near infrared spectroscopy (NIRS) and intravital microscopy (IVM) to defme a minimal safe flow rate for specific perfusion conditions. The study will be conducted using a juvenile piglet model exposed to various degrees of flow reduction with survival for 4 days postoperatively. Survival allows assessment of functional evidence of brain injury through behavioral assessment by a blinded veterinarian observer as well as meaningful histology determined by a blinded neuropathologist. These functional and structural endpoints will be correlated with indices of brain oxygenation measured by NIRS (Tissue Oxygenation Index (TOl), Oxyhemoglobin nadir time (Hb02 nadir time)) as well as indices of microvascular perfusion measured by IVM (functional capillary density (FCD), NADH fluorescence). The second phase of the proposed study will test the hypothesis that critically reduced low flow perfusion causes hypoxic endothelial injury of cerebral blood vessels. This results in reduced constitutive endothelial nitric oxide synthase (eNOS) activity resulting in microvascular regional ischemia previously described as the "no reflow phenomenon." Acute studies will be undertaken in the piglet model using Western immunoblotting and immunocytochemistry as well as resistance vessel myography to measure eNOS activity. eNOS activity will be manipulated by substrate enhancement and inhibition. The role of inducible NOS (iNOS) in causing neurotoxicity in this setting will also be explored. The proposed study has the potential to reduce the risk of brain injury in children undergoing heart surgery by defining the margin of safety achieved with various perfusion conditions. By enhancing understanding of mechanisms of

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cardiopulmonary bypass-related brain injury it will facilitate development of novel pharmacologic methods to further reduce the risk of brain damage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC PSYCHOSOCIAL STRESS, METABOLIC SYNDROME, AND CHD Principal Investigator & Institution: Vitaliano, Peter P.; Professor; Psychiatry and Behavioral Scis; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2001; Project Start 30-SEP-1997; Project End 30-APR-2005 Summary: (Adapted from the Applicant's Abstract): This study will use the chronic stress of caregiving as a natural experiment to examine relationships among psychobehavioral processes, race, the metabolic syndrome, and Coronary Heart Disease (CHD) that could not be ethically manipulated in a laboratory. Caregiving is associated with psychosocial (anger/hostility, hassles, depression) problems, which are, in turn, associated with metabolic, cardiovascular, and physical health problems. We have observed that insulin independently distinguishes spouse caregivers and controls (caregivers greater controls) better than other physiological variables and that caregivers greater controls on CHD prevalence. Accordingly, we will compare 130 spouse caregivers of persons with Alzheimer's disease (AD) (n=100 Caucasians, n=30 Blacks) to 130 spouses of non-demented controls matched on sex, race, age, and family history of cardiovascular disease. Assessments will occur at: Time 1, Time 2 (15-18 months after Time 1), and Time 3 (27-30 months after Time 1). We will focus on psychophysiological mediators to understand why chronic stress may increase metabolic problems and CHD in caregivers relative to controls. Our multiple measures will include: medical records (ICD-codes), physical exams, physiology and self reports. A biopsychosocial model will be used to examine 5 aims: Aim 1: To determine whether spouse caregivers of AD victims exhibit more: psychobehavioral, metabolic (greater intraabdominal fat (IAF), insulin, C-peptide, glucose), stress hormone (greater cortisol, catecholamines), plasma viscosity (greater hematocrit), and cardiovascular (greater blood pressure (BP) problems and higher rates of CHD relative to spouses of non-demented controls. Aim 2: To determine whether Blacks have greater problems than do Caucasians; and whether Black caregivers have greater problems than Caucasian caregivers. Aim 3: To determine whether BP differences in caregivers are greater at home than in the laboratory and whether race and psychosocial variables modify such differences. Aim 4: To determine whether psychophysiological changes in caregivers are greater when measured over a longer period (27-30 months) than we studied originally (15-18 months); and whether CHD at Time 1 amplifies these changes. Aim 5: To determine whether over 27-30 months, IAF trajectories are associated with changes in psychophysiological/health variables; and whether such relationships are mediated by insulin changes. This research should elucidate psychophysiological mediators of chronic stress and CHD and, therefore, have clinical implications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL PLACENTAL BLOOD

AND

IMMUNOHEMATOLOGIC

EFFECTS

OF

Principal Investigator & Institution: Strause, Ronald G.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002

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Summary: The hypothesis to be tested is that transfusion of autologous placental/cord blood at birth will benefit preterm infants both sort- term, due to blood volume expansion and to the red blood cells (RBCs) infused, and long-term due to hematopoietic/immunologic progenitor cells (HIPC) infused. Many premature infants are born with a low RBC volume that is sometimes inapparent because the blood hematocrit can be falsely elevated by plasma volume under constriction. The consequent insufficient filing of the systemic and pulmonary vasculature impairs tissue perfusion and oxygenation and leads to RBC transfusions- particularly during the first hours and days of life. At the moment of birth, about 67% of fetal-placental blood is located within the infant's vasculature, compared to 80% when umbilical cord clamping is delayed until 60 seconds post-delivery. Current obstetrical practice is to clamp the umbilical cord immediately following delivery to prevent over- transfusion of term neonates and to permit prompt resuscitation of distressed neonates. Immediate cord clamping denies neonates the potential benefits of an autologous transfusion of RBCs and HIPC. Three specific hypotheses will be tested: 1) transfusion of autologous placental blood and RBCs will increase neonatal circulating blood volume and RBC volume and will improve cardiovascular hemodynamics to provide clinical benefit; and 3) transfusion of autologous HIPC will enhance hematologic development. These hypothesis will be tested by performing a randomized clinical study of preterm neonates, in which the results of relevant laboratory studies and clinical outcomes will be compared between control infants with standard immediate clamping (< 15 seconds) of the umbilical cord versus test infants--the latter divided into two groups depending on gestational age, with either 60 seconds delayed clamping of the cord (larger infants) of immediate clamping followed by resuscitation (smaller infants) and subsequent transfusion (within 24 hours) of autologous following delayed clamping of the umbilical cord will be collected and studies performed to assess its suitability for either later autologous RBC transfusion or HIPC banking and transplantation. These goals will be achieved by the collaborative efforts of investigators with expertise in pediatric hematology and transfusion medicine, neonatology, biochemistry and biostatistics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL STUDIES WITH PHOSPHOLIPID-ASSOCIATED NSAIDS Principal Investigator & Institution: Lichtenberger, Lenard M.; Integr Biol/Pharm/Physiology; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2005 Summary: (adapted from the application) The major objective of the proposed clinical trial will be to evaluate the gastroduodenal toxicity and biological activity of a formulation of aspirin (ASA) and another non-steroidal anti-inflammatory drug (NSAID), diclofenac, chemically associated with the zwitterionic phospholipid, phosphatidylcholine (PC). This will be accomplished first, by comparing the effects of unmodified ASA (administered at a dose of 650 mg, t.i.d.) to that of the ASA-PC test compound, over a one month study period, in healthy human subjects with no history of gastrointestinal or inflammatory disease and who are not frequent NSAID users. The subjects will initially receive either the ASA or the ASA-PC based upon a randomized program, and after a washout period of no less than 6 weeks will enter the second arm of the study where they will receive the alternate medication. Endoscopic procedures will be performed by the professional staff, who are blinded to which test-drug the subject is taking, at the beginning (baseline) and end (follow-up) of the study period, at which time the number, size and location of gastroduodenal ulcers/erosions will be

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scored under video-endoscopy, biopsies will be taken for surface hydrophobicity (contact angle analysis), cyclo-oxygenase (COX) activity (radioimmunoassay/RIA) and blood collected for assessment of platelet aggregability, thromboxane (TXB2) conc. and hematocrit. A second study will be designed in a similar manner to the above, to compare the gastroduodenal toxicity and biological activity of diclofenac (75 mg b.i.d.) with diclofenac-PC, except in this case we will add a third arm of the study in which the subjects are administered the COX- inhibitor, Celecoxib, at a dose (200 mg b.i.d.) having equivalent therapeutic efficacy to diclofenac. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL TRIAL OF HEMATOCRIT STRATEGY IN HEART SURGERY Principal Investigator & Institution: Newburger, Jane W.; Associate Cardiologist-InChief; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2002; Project Start 05-JUL-2000; Project End 30-JUN-2005 Summary: The optimal degree of hemodilution during profoundly hypothermic cardiopulmonary bypass (CPB) remain controversial, and widely disparate hemodilution protocols have evolved at centers undertaking infant cardiac surgery. Higher hematocrit (hct) exposes patients to the risks of microvascular occlusion, while lower hct may critically limit oxygen delivery to the brain and other organs. Preliminary data suggest that a higher hct provides superior brain and myocardial protection, but no randomized trials of outcome after use of higher vs. lower hct have been reported. In a single-center, prospective, randomized trial, hemodilution to a hct of 30 percent vs. 20 percent will be compared with respect to neurodevelopmental outcome and early postoperative course in a homogeneous population of infants with d-transposition of the great arteries undergoing the arterial switch operation. Specific Aim 1 will test the hypothesis that hemodilution to a hct of 30 percent, compared to 20 percent, will be associated with superior central nervous system protection. Our primary outcome variable will be developmental outcome at age 1 year, assessed with the Bayley Scales of Infant Development. Secondary outcome variables include 1) tissue release of S-100 protein as a measure of cerebral cellular injury; 2) cerebral hemodynamics and oxygenation, determined by near infrared spectroscopy (NIRS); 3) intrinsic cerebral vasoregulation, measured by NIRS and transcranial Doppler; and 4) at age 1 year, neurologic examination, the MacArthur inventory, and structural and volumetric findings on MRI. Specific Aim 2 will test the hypothesis that hemodilution to a hct of 30 percent, compared to 20 percent, will be associated with better early postoperative cardiovascular status. Our primary outcome measure will be the minimum cardiac index over the first postoperative 24 hours. Secondary outcome measures will include 1) the duration of postoperative endotracheal intubation, ICU stay, and hospital stay; 2) serum lactate levels; 3) the PaO2/FiO2 ratio; 4) levels of circulating pro-inflammatory cytokines; and 5) the percent change in total body water, estimated by bioelectrical impedance. The structure of the study will allow assessment of whether 1- year outcomes can be predicted by perioperative variable other than the hct strategies and, through the use of novel techniques such as NIRS and volumetric MRI, may provide insight into mechanisms by which hct and other perioperative variables affect the brain. The inferences reached in this study population should be broadly generalized to infants with other forms of congenital heart disease undergoing early repair and thus should have substantial impact on clinical practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COINFECTION W/ SIV & MALARIA Principal Investigator & Institution: Martin, Louis N.; Senior Research Scientist; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002 Summary: Regions where HIV infection is prominent frequently overlap malaria endemic regions. However, the impact of coinfection with HIV and malaria is not clear. We inoculated a monkey with Plasmodium knowlesi. 57 days after SIV inoculation, a time when the SIV infection had already caused a decrease in the percentage of CD4+ cells. Maximum parasitemia (11.6%) occurred 9 days after malaria inoculation andwas treated by chloroquine. After treatment the hematocrit recovered steadily through day 26, when malaria re-emerged and a single chloroquine treatment was given. The parasitemia and accompanying decrease in hematocrit rapidly resolved. Malaria reemerged on day 46 and was again treated. After this third recrudescence and treatment, the parasite did not reappear, so the monkey was reinoculated with malaria. Nine days later the parasite was detected but did not require treatment, remaining a chronic low level infestation. The coinfection with malaria did not affect the progress of SI V infection. The percentage of cells expressing CD4, CD8, CD2, or CD20 did not differ in the malaria-infected monkey compared to other monkeys inoculated with SIV at the same time. No conclusions can be drawn based on 1 monkey, but the feasibility of the SIV/malaria coinfection has been demonstrated. An additional SIV-infected monkey was recently inoculated with malaria 327 days after SIV, a point when the percentage of CD4+ cells had declined markedly. A naive control monkey was inoculated at the same time. It will be interesting to see if the SIV-infected monkey inoculated with malaria at a much later stage of SIV infection will still be able to contain the parasite after 3 treatments, and to see if the ability to control the parasite differs in the control monkey. FUNDING NIH-N01-AI-65310 PUBLICATIONS NONE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COLOR DOPPLER IMAGING OF THE RETINA AND CHOROID Principal Investigator & Institution: Glucksberg, Matthew R.; Professor and Chairman; Biomedical Engineering; Northwestern University 633 Clark Street Evanston, Il 602081110 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2004 Summary: Defects in the regulation of retinal and choroidal flow are part of the etiology of diabetic retinopathy, glaucoma, and other vision-threatening disorders, yet the physics and physiology controlling of blood flow to the retina is poorly understood, at least in part because of the limitations of current methods of measuring blood flow. The goal of this research is to quantitatively study the control of flow and the hemodynamics in the choroidal and retinal circulations and their relationships to retinal disease. The hypothesis is that blood flow in the retinal and choroidal circulations is not homogeneous and that increased heterogeneity in blood flow may be an early indicator of dysfunction of the retinal and choroidal circulations. As part of this work simultaneous, continuous and quantitative measurements of tissue perfusion in the choroidal and retinal circulations will be made to allow study of how the retina and choroidal circulations interact in response to physiological conditions. Previous investigations of the role of the vasculature in health and disease have been hampered by the limits of technology. In this project Color Doppler Optical Coherence Tomography (CDOCT), a novel non-invasive imaging technology, will be adapted to measure hemodynamic parameters in the circulations that serve the retina. The specific

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aims will first address the instrumentation and quantification of blood flow and then validate the results using in-vivo comparison to Laser Doppler Flowmetery, the most commonly used current method of assessing perfusion. The method will then be used in animal experiments to determine the effects of perfusion pressure and blood gasses on the regional distribution of blood flow and local hematocrit in the retinal and choroidal circulations, with and without ganglionic blockade and other maneuvers which act differently on the two circulations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMMUNITY INTERVENTION FOLLOW UP OF COLOMBIAN CHILDREN Principal Investigator & Institution: Goodman, Karen J.; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2003; Project Start 08-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Little is known about the short-term consequences of persistent H. pylori infection in apparently healthy children. Short-term consequences such as impacts on growth, nutritional status and susceptibility to co-infections may influence overall health status throughout life as well as risk of cancer and other chronic disease in adulthood. Such short-term consequences can be examined in a community intervention approach that begins with two comparable populations of H. pyloriinfected children, eliminates the infection in one of the populations and follows both groups over time to observe differences between children whose infection persists and those who remain uninfected. The proposed study will undertake such an intervention in two rural communities in the Andean region of Narino, Colombia, where H.pylori infection is nearly universal by adolescence and gastric cancer rates are among the highest in the world. The design of this study will also facilitate secondary aims of identifying factors that predict successful elimination of infection in a high prevalence population, as well as identifying determinates of persistence and reinfection. Another secondary aim will be to study the histopathologic features of H.pylori infection in pediatric gastroenterology patients form this geographic region. Accessibility to biopsies form such patients will also permit validation of diagnostic cutoff values for noninvasive H. pylori detection methods in our study population. In addition, we will pursue supplemental studies to evaluate methods for obtaining bacterial specimens form the community-based population of children in order to investigate the role of strain differences in the shortterm consequences of infection. The major specific aim of this study are: 1) To conduct a community intervention in two rural Andean populations (children in the Narino-Genoy community will be maintained clear of H.pylori infection with anti-H.pylori therapy and monitored for H.pylori status and selected health indicators during a period of four years; children in the La LagunaCabrera community will receive no anti-H.pylori therapy and will be monitored for H.pylori status and selected health indicators during a period of four years); 2) To compare anthropometric health-status indicators in children with persistent H.pylori infection and those who remain free of H.pylori infection; 3) To compare hematocrit levels in children with persistent H.pylori infection and those who remain free of H.pylori infection; 4)To compare the incidence of diarrheal disease in children with persistent H.pylori infection and those who remain free of H.pylori infection; 5) To compare the occurrence of the following coinfections in children with persistent H.pylori infection and those who remain free of H.pylori infection: ova and parasites (in particular, Giardia lamblia, Entamoeba histolytica and Ascaris lumbricoides); 6) To investigate whether the presence of co-infections modifies the effect of H.pylori

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persistence on general health status and diarrheal disease. In addition the proposed study has the following secondary aims; 1) To identify predictors of successful elimination of H.pylori infection in children from a high prevalence population as well as determinants of persistence and reinfection; 2) To describe the histopathologic features of H.pylori infection in pediatric gastroenterology patients from this geographic region; 3) To assess the accuracy of noninvasive diagnostic methods for H.pylori infection (urea breath test; stool antigen test) against biopsy-based diagnosis in the local pediatric population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF AN ULTARSONIC HEMATOCRIT DEVICE Principal Investigator & Institution: Corey, Francis S.; Principal Owner; Key Technologies, Inc. 1414 Key Hwy, Ste 300 Baltimore, Md 21230 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-DEC-2003 Summary: (Provided by Applicant):.Key Technologies will develop a portable, rugged device that wili determine hematocrit of a blood sample accurately and rapidly. The device will be handheld and will require a small blood draw of less than 10 cc. No special sample preparation will be required. The test results will be available in less than one minute, and will be accurate to within 2 percent of the values determined by a laboratory cell counter. Phase I of the hematocrit meter project conclusively demonstrated that the proposed techniques can be used to measure hematocrit precisely. During Phase II, the product development phase, Key Technologies will work with the ultimate users to develop a handheld prototype device. Correlations developed in Phase I will be verified using the new configuration. Testing will include freshly drawn blood samples, and a broad base of patients and pathologies. Key Technologies will determine and report the accuracy and precision of the system. PROPOSED COMMERCIAL APPLICATION: Hematocrit is widely used by medical personnel for diagnostic and monitoring purposes. Existing devices that measure hematocrit are costly, immobile, and slow, or inaccurate. The UltraCrit will be accurate, portable, and affordable, giving it a significant advantage over the existing technologies and allowing it to penetrate new markets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF HYDROTHERAPY ON ANXIETY AND PAIN IN LABOR Principal Investigator & Institution: Benfield, Rebecca D.; Parent-Child Nursing; East Carolina University 1000 E 5Th St Greenville, Nc 27858 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): The candidate's long-term goals include: 1) testing and refining two theoretical models to explain the psychophysiological effects of anxiety and pain in labor and the effectiveness of hydrotherapy, and 2) gaining consultation and collaboration with other researchers and students using physiological measurement techniques in the laboratory and clinical settings. Immediate goals are to increase knowledge and skill in: (1) physiology, including general, neural/hormonal, and immersion; (2) physiological instrumentation, including radioimmunoassay (RIA), immunoenzymatic assay (EIA), high performance liquid chromatography (HPLC) and electromyography (EMG); (3) statistics, both general and repeated measures; and (4) professional growth, including preparation of manuscripts and grants, with the goal of becoming an independent scientist. The effects of intervention with hydrotherapy in labor are poorly understood though use has escalated. The proposed study will focus on

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the psychophysiological effects of hydrotherapy during labor and the physiological indicators of sympathetic nervous system and adrenocortical inhibition associated with immersion and the relaxation response. Using a repeated measures correlational design, data will be gathered from 15 healthy patients, immersed to the xiphoid in 37 degrees C water for 1 hour. Data will be collected prior to and at 15 and 45 minutes of hydrotherapy. Visual analogue scales (VAS) will measure anxiety and pain; physiological measures will include plasma catecholamines, cortisol, beta endorphin, oxytocin, plasma volume shift, and uterine contractility, and will be analyzed using HPLC, EIA, RIA, hemoglobin (HGB) and hematocrit (HCT), and abdominal EMG respectively. Statistical analyses will include a one-way within-subjects analysis of variance and Pearson r technique. While these physiological measures, excluding plasma volume shift, have not been previously used to study hydrotherapy in labor, it is anticipated that post intervention measures will reflect a decrease in parturient anxiety and pain, as will subjective measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXTERNAL REGULATION OF TRANSGENES OF GENETICALLY MODIFIED CELLS OF THE SKIN Principal Investigator & Institution: Kohan, Donald E.; Associate Professor; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002 Summary: The broad objective of this proposal is to develop proof of principle and establish the parameters for the external regulation of transgenes of genetically modified cells of the skin. Transplantation to the skin of keratinocytes containing transgenes has resulted in local and systemic delivery of transgene products. This approach is limited by the lack of control over the amount and the timing of release of the transgene product. To address this problem, transgene expression will be placed under control of a promoter whose activity is tightly modulated by exogenously administered tetracycline. It is hypothesized that keratinocytes transfected with this system can be transplanted to the skin and their transgene activities controlled by externally applied tetracycline analogs. The ultimate goal of this proposal is to use this methodology to correct deficient gene expression in disease states. Accordingly, the specific aims are: 1) Establishment of an in vitro system for tetracycline regulated gene expression in immortalized human keratinocytes in order to establish that tetracycline can regulate gene expression in immortalized human keratinocytes in order to establish that tetracycline can regulate gene expression in human keratinocytes; 2) Development of tetracycline-regulated lacZ expression by immortalized human keratinocytes in vivo. These studies will define the [parameters necessary for topically and systematically administered tetracycline regulation of transgene expression in transplanted human keratinocytes in vivo; 3) Characterization of tetracycline-regulated expression of transgene products in transplanted immortalized human keratinocytes by regulating keratinocyte expression of transgenes having local (keratinocyte growth factor modulation of hair growth) or systematic (erythropoietin control of hematocrit) effects; and 4) Reconstitution of deficient gene expression in vivo by treating the anemia due to renal insufficiency (5/6 nephrectomy) with transplanted immortalized human keratinocytes containing the erythropoietin gene under tetracycline control. These experiments will demonstrate the feasibility of correcting and regulating local and/or system disease with genetically modified keratinocytes; experience gained can be applied to other cells and other organs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FATIGUE INTERVENTION

&

BREAST

CANCER-A

BEHAVIORAL

SLEEP

Principal Investigator & Institution: Berger, Ann M.; Associate Professor; Adult Health and Illness; University of Nebraska Medical Center Omaha, Ne 681987835 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 30-APR-2007 Summary: (provided by applicant) Higher fatigue levels are found in women with stage I or II breast cancer receiving adjuvant chemotherapy (CT) who adopt patterns of daytime inactivity and nighttime restlessness and have more symptom and psychological distress. Interventions that improve sleep quality and reduce daytime fatigue in persons with insomnia may also benefit women receiving adjuvant CT. Using selected factors from Piper's Integrated Fatigue Model (IFM), a randomized, controlled clinical trial will compare women with breast cancer who receive a four component behavioral sleep intervention to women in the attentional control group during and after adjuvant CT. The intervention is designed to reduce fatigue in these women by promoting daytime activity, improving sleep quality and decreasing symptom and psychological distress. The aims of this study are to: 1) Compare the immediate (sleep/wake, activity/exercise, symptoms, psychological distress) and consequent (fatigue) outcomes of a four component behavioral sleep intervention (sleep hygiene counseling, relaxation therapy, sleep restriction, and stimulus control) in an experimental group (n=110) with outcomes in an attentional control group (n=110) in women with stage I or II breast cancer during 4 or 8 cycles of adjuvant CT, at 30, 60, and 90 days after their last treatment, and 1 year after their first baseline; 2) Determine the extent to which factors selected from the IFM influence fatigue intensity levels a) in the total sample and 1 year after the first treatment and 3) Evaluate the adherence to the refined behavioral sleep intervention and preferences for sleep hygiene and relaxation therapy techniques in the experimental group over time. Women will be randomized on the basis of good or poor sleeping history and intent to treat (4 versus 8 cycles of CT) to an experimental or attentional control group. Using the co-scientist model, the experimental group will follow an Individual Sleep Promotion Plan negotiated with the investigator with regularly scheduled reinforcements and revisions. The control group will receive equal time and attention regarding general topics and nutrition. Established instruments include the Piper Fatigue scale, Hospital Anxiety and Depression Scale, SF36 Health Survey, Symptoms Experience Scale, Daily Diary and Insomnia Severity Index. Objective measures include wrist actigraphs, hemoglobin/hematocrit, white blood count, T4 and TSH, and body mass index. Statistical analyses include RMANOVA, generalized estimation equation methodology and multiple regression analysis. Results may inform development of clinical guidelines for fatigue management during adjuvant CT. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FATIGUE, PAIN, AND SLEEP PROBLEMS DURING RADIATION Principal Investigator & Institution: Miaskowski, Christine A.; Professor and Chair; Physiological Nursing; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 30-JUN-2004 Summary: Fatigue and pain are two of the most common and troublesome problems experienced by oncology outpatients. Clinical experience and our pilot data suggest that sleep disturbances occur in this patient population and can influence daytime fatigue and daytime activity. This descriptive correlational study will be the first to describe the

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patterns of change in fatigue, pain, and sleep disturbances over the course of radiation therapy (RT) in oncology outpatients with four specific diagnoses (i.e., breast cancer, prostate cancer, brain tumors, and lung cancer). In addition, these same symptoms will be evaluated in the patient's family caregiver. Participants will be recruited at the time of the patient's simulation visit in the RT department. Patient/caregiver dyads will be followed over the course of RT and for four months following the completion of RT (i.e., a total of 17 assessments). In addition to describing the patterns of change in these three symptoms, the relationships between fatigue severity and salient physiological (i.e., hemoglobin, hematocrit, interleukin-6 levels) and psychological variables (i.e., anxiety, depression, quality of life, caregiver strain (only in the family caregivers)) will be determined. Patients and family caregivers will be asked to list the self-care behaviors they use to manage pain, fatigue, and sleep disturbances over the course of RT and following treatment. These data will provide important information to begin to plan intervention studies for patients who are undergoing RT. Inclusion of family caregivers in this research is extremely important given the shift in oncology services from the inpatient to the outpatient setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FETAL GLOBIN INDUCTION IN BETA THALASSEMIA Principal Investigator & Institution: Perrine, Susan P.; Associate Professor of Medicine; None; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-JUL-2004 Summary: The beta thalassemias are characterized by a deficiency of adult (beta) globin chains of adult hemoglobin (Hb), an excess of toxic, unmatched alpha globin chains, and intramedullary hemolysis. The resulting anemia develops only after fetal (gamma) globin synthesis and Hb F is suppressed in infancy. Induction of fetal (gamma) globin to levels which improve globin chain balance by even 10 percent can prolong red blood cell survival and diminish clinical morbidity. 5-Azacytidine has increased hemoglobin (Hb) levels by 1.8-3 gmd/d1 in thalassemia, but also causes general cytopenias and carries carcinogenicity risks. Fatty acids induce (gamma) globin experimentally. Arginine Butyrate, a prototype fatty acid, has been most effective when given intermittently or Pulsed, inducing Hb F to a mean level of 22 percent in 7/9 adults with sickle cell disease and increasing total hemoglobin by 3 gm/dl over baseline levels in 5/6 beta thalassemia patients. Two clinical pilot studies are proposed to test the hypotheses that therapy with Pulsed Butyrate, or rhu-EP0 + Pulsed Butyrate, will induce gamma globin chain synthesis sufficiently to improve non alpha: alpha globin chain balance and red blood cell survival, and increase total Hb in a significant proportion of patients with beta thalassemia intermedia. Baseline hematologic levels will be assayed four times over a two-month period. Butyrate will then be administered during an Induction Phase, to determine a patient's optimal dose, followed by a "Maintenance Phase" of therapy for 3 months. Pulsed Butyrate will also be tested with rhu-EPO. The proportions of patients on each study in whom the following endpoints are achieved, compared to baseline levels, will be analyzed: 1) an increase in total Hb of at least 2.0 grams/dl, 2) an increase in hematocrit of at least 5 percent, 3) a decrease in hemolysis, measured by LDH and bilirubin, 4) improvement in globin chain synthesis by 10 percent. Whether specific genotypes and in vitro response to Butyrate correlate with clinical responses will also be analyzed. These studies should determine the proportion and some genotypes of beta thalassemia patients which can benefit from Pulsed Butyrate plus/minus rhu-EP0 therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Hematocrit

Project Title: FMRI BOLD CONTRAST RELATIONSHIP TO CEREBROVASCULAR TONE Principal Investigator & Institution: Parrish, Todd B.; Professor; Radiology; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2003; Project Start 27-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Functional magnetic resonance imaging (fMRI) relies on the coupling of blood flow changes to neuronal activity. These blood flow changes in turn alter the concentration of oxygen in the local blood pool surrounding the neurons. Because the susceptibility of oxyhemoglobin and deoxyhemoglobin are different, it is possible to make the MR signal sensitive to oxygen concentration; this is termed blood oxygenation level dependent (BOLD) signal. The BOLD signal change from the rest condition to the active condition is approximately 1-3%. Detection of the BOLD signal requires a robust paradigm, preprocessing of the signal, and statistical modeling to generate activation maps. All of this is necessary because of the weak BOLD contrast that exists in hemodynamically normal subjects. When a subject has compromised vasculature and impaired vasoreactivity from a carotid stenosis or occlusion, we have demonstrated that the BOLD signal response is absent or severely altered beyond normal detection. This is a very important issue as fMRI moves into the clinical setting and is used to study stroke recovery or aging populations. For example, in stroke recovery one may detect activation increases over time and assume they are due to neuronal recruitment or rehabilitation; however, the activations may be the result of developing collateral flow or recovery of vasoreactivity. One of the goals of this proposal is to investigate and characterize the BOLD response in the face of altered hemodynamics. A limitation to the field of functional MRI is the small difference in BOLD signal used to detect activations. We have shown that the physiologic interaction of caffeine signigicantly increases the BOLD contrast (-40% at 1,5T and 80-170% at 3T). In this proposal, the mechanisms of caffeine will be explored in normal subjects using fMRI, MR based perfusion and transcranial Doppler ultrasound to characterize the BOLD signal and the cerebral blood flow response. Individual components will be invesitgated in order to create a simple model of the interations with BOLD contrast. The improvement in BOLD contrast can be used to improve the temporal and spatial resolution or to allow the investigation of more subtle cognitive paradigms.The theme of this proposal is to investigate the impact of physiologic mechanisms (reactivity, flow, hematocrit, neuronal activity) on the generation of BOLD signal and more importantly BOLD contrast. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FOCUS Principal Investigator & Institution: Carson, Jeffrey L.; Richard C. Reynolds Professor of Medicin; Medicine; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 088545635 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant); Red blood cell transfusions are an extremely common medical intervention in both the United States and worldwide; over 11 million units are transfused in the United States. Between 60% and 70% of all blood is transfused in the surgical setting. Despite the common use of red blood cell transfusions, the threshold for transfusion has not been adequately evaluated and is very controversial. A decade ago the standard of care was to administer a peri-operative transfusion whenever the hemoglobin (Hgb) level fell below 10 g/dl (the "10/30 rule").

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Concerns about the safety of blood, especially with respect to HIV and hepatitis, and the absence of data to support a 10 g/dl threshold led to current standard of care today to administer blood transfusions based on the presence of symptoms and not a specific Hgb/hematocrit level. However, there are no randomized clinical trials in surgical patients that have tested the efficacy and safety of withholding blood until the patient develops symptoms or the "10/30" approach to transfusion. Patients with underlying cardiovascular disease are at greatest risk of adverse effects from reduced Hgb levels. We propose to conduct a multi-center randomized trial to test if a more aggressive transfusion strategy that maintains postoperative Hgb levels above 10 g/dl improves patient outcome as compared to a more conservative strategy that withholds blood transfusion until the patient develops symptoms of anemia. Eligible patients for the trial will have undergone surgical repair for a hip fracture and have a postoperative Hgb level below 10 g/dl within three days of surgery. Only patients with cardiovascular disease will be entered into the study. Patients will be randomized to one of the two transfusion strategies. The 10 g/dl threshold strategy will use enough red blood cell units to maintain Hgb levels at or above 10 g/dl through hospital discharge. Symptomatic transfusion strategy patients will receive red blood cell transfusions for symptoms of anemia, although transfusion is also permitted but not required if the Hgb level falls below 8 g/dl. Outcomes will include functional recovery (primary outcome: ability to walk ten feet across a room without human assistance at 60-days postrandomization), long-term survival, nursing home placement, and postoperative complications (death in hospital or within 30 days, pneumonia, myocardial infarction, thromboembolism, stroke, delirium). We will randomize 2,600 patients from 25 centers over a 3.5-year period. This will allow us to detect a 16% relative risk reduction in the loss of ability to walk independently with power about 0.90. A pilot study in 84 patients demonstrated the feasibility of the study. Ambulation at 60 days is known to be highly predictive of ultimate functional outcome as well as of mortality at one year. Because inability to walk again has such important implications for quality office, and because, unfortunately, it is a common problem, it far outweighs the remote chance of viral infection or other complications from transfusion in these elderly patients. Also, this study will measure the frequency and 95% confidence intervals of the medical errors that are important in this patient population and are poorly documented in the literature. The medical errors that will be measured are: transfusion errors (blood transfusion to the wrong patient, mislabeling of samples for type and cross match, use of whole blood instead of packed red cells), failure to use thromboembolism prophylaxis, incorrect antibiotic prophylaxis, wrong site surgery and femoral shaft fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FOCUS DATA COORDINATING CENTER Principal Investigator & Institution: Terrin, Michael L.; President; Maryland Medical Research Institute, Inc 600 Wyndhurst Ave Baltimore, Md 21210 Timing: Fiscal Year 2003; Project Start 10-JUL-2003; Project End 30-JUN-2008 Summary: (FROM THE APPLICATION): Over 11 million units are transfused in the United States. Despite the common use of red blood cell transfusions, the threshold for transfusion has not been adequately evaluated. A decade ago the standard of care was to administer a peri-operative transfusion whenever the hemoglobin level fell below 10 g/dl (the "10/30 rule"). Concerns about the safety of blood, especially with respect to HIV and hepatitis, and the absence of data to support a 10 g/dl threshold led to current standard of care to administer blood transfusions based on the presence of symptoms and not a specific hemoglobin/hematocrit level. However, there are no randomized

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clinical trials in surgical patients that have tested the efficacy and safety of withholding blood until the patient develops symptoms or the 10/30 approach to transfusion and limited evidence for patients with underlying cardiovascular disease are at greatest risk of adverse effects from reduced hemoglobin levels. We propose to conduct a multicenter randomized trial to test if a more aggressive transfusion strategy that maintains postoperative hemoglobin levels above 10 g/dl improves patient outcome as compared to a more conservative strategy that withholds blood transfusion until the patient develops symptoms of anemia. Patients eligible for the trial will have undergone surgical repair for a hip fracture and have a postoperative hemoglobin level below 10 g/dl within three days of surgery. Only patients with cardiovascular disease will be entered into the study. Symptomatic transfusion strategy patients will receive red blood cell transfusions for symptoms of anemia, although transfusion is also permitted but not required if the hemoglobin level falls below 8 g/dl. Outcomes will include functional recovery (primary outcome: ability to walk ten feet across a room without human assistance at 60-days post-randomization), long-term survival, nursing home placement, and postoperative complications (death in hospital or within 30 days, pneumonia, myocardial infarction, thromboembolism, stroke). We will randomize 2,600 patients over a 3.5-year period to detect a reduction in the loss of ability to walk independently from 43% to 36% (16% relative risk reduction) with power about 0.90. Also, this study will measure the frequency and 95% confidence intervals of the medical errors that are important in this patient population. The medical errors that will be measured are: transfusion errors (blood transfusion to the wrong patient, mislabeling of samples for type and cross match, use of whole blood instead of packed red cells), failure to use thromboembolism prophylaxis, incorrect antibiotic prophylaxis, wrong site surgery, and femoral shaft fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPOXIA-MODULATION OF EPO PDNA IN ELECTROPORATED MUSCLE Principal Investigator & Institution: De Las Alas, Maida M.; Ichor Medical Systems, Inc. 6310 Nancy Ridge Dr, Ste 107 San Diego, Ca 921213209 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JAN-2005 Summary: (provided by applicant): In vivo intramuscular delivery of plasmid DNA encoding erythropoietin (EPO) using lchor's innovative and proprietary TriGrid electroporation system has resulted in robust constitutive expression of EPO in rodents, rabbits and primates. While high EPO levels are beneficial for patients with blunted responses to EPO, such high expression is not appropriate for chronic renal failure patients who are sensitive to rapid increases in EPO. Development of a physiologically modulated EPO gene therapy with a more direct communication between a patient's anemia and the intramuscularly delivered EPO transgene would thus be of benefit for this latter patient population. The necessities of monitoring hematocrit and titrating doses of the protein would be eliminated. Toxicities could potentially be decreased. Finally, abuse by non-patients would be unlikely. Ichor has demonstrated the feasibility of utilizing anemia-related hypoxia to modulate gene expression from hypoxiaresponsive plasmids transfected into anemic mouse muscle. However, this approach must be more thoroughly investigated in a more clinically relevant animal model. Experiments will be performed using rats and will include in vivo screening of HREcontaining plasmids in anemic animals, evaluation of the effect of hypoxia induced by exercise on gene expression, and assessment of hypoxia-modulated EPO transgene expression in a disease model.

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

Project Title: IN VIVO CORRELATES OF ALTERED RED BLOOD CELL AGGREGATION Principal Investigator & Institution: Meiselman, Herbert J.; Professor and Vice-Chair; Physiology and Biophysics; University of Southern California 2250 Alcazar Street, Csc219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002; Project Start 14-JAN-2002; Project End 31-DEC-2004 Summary: (provided by applicant) This Fogarty International Research Collaboration Award (FIRCA) proposal has been designed to expand and enhance the parent grant entitled "Hemorheology Studies Related to In Vivo Blood Flow," (HL 15722, H.J. Meiselman, PI), and to enhance, expand and increase the research capacity of the foreign scientist (Dr. Oguz K. Baskurt) and the foreign institution (Akdeniz University, Antalya, Turkey). The parent grant is focussed on the in vitro hemorheological behavior and RBC aggregation mechanisms of normal and pathologic human blood, whereas both Dr. Baskurt's expertise and this FIRCA proposal deal with the use of animal blood and in vivo blood flow studies. This proposal and the parent grant thus share common longrange goals related to the physiological correlates of altered RBC aggregation, yet employ complementary methodologies to achieve these objectives. The specific aims of this FIRCA proposal are: 1) to evaluate the effects of altered RBC aggregation on in vivo flow resistance, via the use of an in situ guinea pig hind limb system and an isolated rat heart preparation, in order to test the hypothesis that there is an optimal level of RBC aggregation which minimizes overall resistance to blood flow; 2) to determine the effects of altered RBC aggregation on rat heart trans-mural myocardial hematocrit distribution to test the hypothesis that there is an optimal level of RBC aggregation which preserves the normal physiological gradient; 3) to evaluate the effects of plasma viscosity on in vivo flow resistance in order to test the hypothesis that increased plasma viscosity modulates the influence of enhanced RBC aggregation. Note that an unique and important aspect of the proposed studies is the use of the PI's recently developed technique for modifying RBC aggregation via covalent binding of polymers to the RBC surface; this new method does not require foreign polymers or proteins to be added to native plasma and thus allows RBC aggregation and medium viscosity to be varied independently. Successful completion of the major aims of this program will provide quantitative information relevant to the effects of both enhanced and decreased RBC aggregation on vascular resistance and hematocrit distribution, and should offer therapeutic insight into clinical states associated with abnormal red cell aggregation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IN CONSUMPTION

VIVO

MEASUREMENT

OF

MYOCARDIAL

OXYGEN

Principal Investigator & Institution: Poncelet, Brigitte; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 28-FEB-2005 Summary: (provided by applicant): This project focuses on developing and validating an MRI-based method to measure regional myocardial oxygen consumption (MVO2). Since regulation of myocardial blood flow in the normal heart is closely linked to oxygen demand, MVO2 represents an essential parameter for understanding the additional competing mechanisms of flow regulation in health and disease. MVO2 has been shown to provide a critical parameter for identifying potentially salvageable

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myocardium from irreversibly injured tissue in ischemic disease. Failure of the heart to convert oxygen into work is found in various forms of ventricular dysfunction unrelated to coronary disease (hypertrophy, cardiomyopathy). With the availability of new drugs for the treatment of heart failure, there is a growing need for monitoring their effects on cardiac efficiency. MVO2 measurement provides a key component for evaluating the metabolic cost of ventricular work and thus, can improve our ability to optimize drug therapy. In the proposed research, we will extend to the heart recently developed MRI methods that have been used to estimate oxygen consumption in the brain. We will implement, optimize, and validate these methods in a closed-chest porcine model of normal heart. In Aim 1, optimizations include improved fast imaging techniques to more robustly measure T1-based flow and T2-based oxygenation dependent images of the beating heart. In Aim 2, we will compare the dynamic sensitivity of intravascular contrast agent-based measurements of myocardial blood volume volume and endogenous T1-based measurements of myocardial blood flow. In Aim 3, will optimize the calibration of the T2-based oxygenation signal (BOLD) in the myocardium. In Aim 4, MRI measurements of myocardial oxygenation and hemodynamics will be combined and myocardial oxygen consumption will be examined at rest and under various cardiac workloads. The MRI-estimated MVO2 will be compared to invasive measurements of global MVO2 using radiolabeled microsphere injection (perfusion) and arterial/venous blood sampling (blood oxygenation and hematocrit) and Fick's Law. Our overall hypothesis is that MRI measurements-BOLD signal, myocardial blood flow and myocardial blood volume - can be combined together to enable regional estimation of steady-state MVO2. Although the long-term goal of our work is to use MVO2 measurement for patient studies, the scope of the present grant focuses on an animal model in order to completely characterize the physiology and permit validation using invasive methods. We believe that the proposed measurements of MVO2 will provide a critical research tool for exploring non-invasively the relationship between local metabolism and contractile function in normal and diseased states. Ultimately, the proposed method may provide both hemodynamic and metabolic components or an integrated cardiac MRI exam in the assessment of hear disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LACTATE TRANSPORT & METABOLISM IN DOG LIVER Principal Investigator & Institution: Schwab, Andreas; Associate Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: The appropriate model contains processes for influx into and efflux from both red blood cells and hepatocytes, as well as hepatocellular sequestration; however, in this case, part of the tracer emerges as labelled bicarbonate formed by the action of pyruvate dehydrogenase, whereas a presumably smaller part is incorporated into other metabolites by the action of pyruvate carboxylase. The model thus incorporates the formation of labelled bicarbonate as a metabolic product. The behavior of bicarbonate in the liver has previously been investigated using the multiple indicator dilution technique. Preliminary evaluation of the data showed that a substantial proportion of blood lactate is carried within red cells and therefore less readily available for hepatic uptake. The situation is similar to that for acetaminophen and will be treated in the same fashion. New experiments were therefore recently performed where lactate was injected in plasma alone (no red cells); the hematocrit in the bolus was re-established by simultaneously injecting blood where the hematocrit was increased by adding 51Crlabelled red cells (non-pre-equilibrated case), as previously done with thiourea.

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

Project Title: LEAD DOSE BIOMARKERS, REPRODUCTION, AND INFANT OUTCOMES Principal Investigator & Institution: Hu, Howard; Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 30-JUN-2004 Summary: Population-wide blood lead levels have been decreasing in the United States due to lead control measures begun in the 1970s. Nevertheless, in utero exposure may be continuing, or perhaps even increasing, due to the long half-life of contaminants in maternal bone during pregnancy. Furthermore, there is evidence that levels of lead in plasma, which reflect the available fraction of lead in blood, are not adequately represented by whole-blood lead levels and correlate more closely with bone lead levels. These possibilities deserve intensive investigation in light of the recent accumulation of research demonstrating a neurotoxic effect of lead at progressively low levels of exposure. The new project proposed builds on an on-going NIEHS/Superfundsupported study of lead kinetics during reproduction among women in Mexico. In the major component of this project, 5,700 newly pregnant women will be screened in their first trimester, who meet initial eligibility criteria; they will be followed through pregnancy and birth, measuring blood lead levels, hematocrit, weight, and bone resorption (measured by urinary levels of cross-linked N-telopeptide of type I collagen [NTX]); screening bone lead levels will be measured by K-x-ray fluorescence in postpartum women who meet additional eligibility criteria; a cohort of 900 postpartum women and their infant will be selected to ensure a broad distribution based on level of lead in maternal trabecular bone (the patella); the mother-infant pairs will be followed in a prospective cohort study of neurobehavioral outcomes among the infants. The following Hypotheses will be tested: 1)lead level in maternal trabecular bone (represented by the patella bone) is a predictor of adverse infant mental development after controlling for blood level at birth, infant blood lead levels, maternal IQ, maternal intake of iron, zinc, and calcium, and other potential confounders. The magnitude of this effect is greater in women with higher levels of bone resorption during pregnancy, as reflected by urinary levels of NTX. In the sub-study component of this project, we will screen bone lead levels in 120 women who are trying to become pregnant; select 30 of these women who subsequently become pregnant for a prospective study of plasma lead and whole blood analyses during each trimester and during lactation. Hypothesis 2a will also be tested: In comparison to women with low pre-pregnancy bone lead, women with high pre-pregnancy bone lead will experience a greater increase in plasma lead levels; and Hypothesis 2: The percent increase in plasma lead will be greater than the percent increase in whole blood lead. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MODEL OF THE RENAL MEDULLARY MICROCIRCULATORY FUNCTION Principal Investigator & Institution: Edwards, Aurelie; Assistant Professor; Chemical & Biological Engineering; Tufts University Medford Boston Ave Medford, Ma 02155 Timing: Fiscal Year 2002; Project Start 15-JUL-1999; Project End 30-JUN-2004 Summary: The production of maximally concentrated urine is made possible by the renal countercurrent multiplication system, which generates and maintains a hypertonic inner medulla, comprised of cortico- medullary gradients of NaCl and urea. Many

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features of the multiplication system remain to be elucidated, in particular the role of the medullary microcirculation. By modulating blood flow, vasa recta (i.e., the blood vessels in the renal medulla) can have a major effect on sodium and water homeostasis as well as on the long-term control of arterial blood pressure; their role in hypertension and congestive heart failure is thus highly relevant. Changes in renal medullary hemodynamics are also directly involved in pressure natriuresis. The overall goal of this research is to develop a comprehensive mathematical model of the renal medullary microcirculatory function in order to predict the efficiency of countercurrent exchange of water, small solutes, and macromolecules by the vasa recta. The specific aims of this project are the following. 1. To investigate the specific role of water channels (AQP-1) and urea transporters in descending vasa recta, incorporating data obtained on wildtype mice, AQP-1 deficient mice and AQP-1 deficient mice in which the AQP-1 gene has been replaced by means of an adenovirus. 2. To determine the mechanisms that control interstitial albumin concentration. The effects of albumin concentration polarization at the vessel walls will be determined as a first step. 3. To model the transport of oxygen in the renal medulla and to examine the effects of changes in blood flow rate and tubular consumption on oxygen tension. Medullary hypoxia is a consequence of the need for countercurrent exchange; however, too little oxygen can cause medullary hypoxic injury. 4. To examine how secretion of the vasoactive hormone nitric oxide into the vascular exchanger affects medullary blood flow and interstitial osmolality, and to investigate the relationship between the reduced medullary hematocrit, medullary hypoxia and the effectiveness of NO in the medulla. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODULATION OF THE ENDOTHELIAL GLYCOCALYX BY ADENOSINE Principal Investigator & Institution: Platts, Steven H.; Mol Physiol/Biological Physics; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-MAR-2002 Summary: In this application, the applicant proposes to study the effects of adenosine and other vasoactive compounds on the capillary endothelial glycocalyx. Recent work has shown the glycocalyx to be a thick layer of proteoglycans and glycoproteins that lines the endothelial vascular space and appears to be the true interface between the blood and the vascular cells. The layer has been proposed to play a role in vascular permeability, hemostasis and capillary tube hematocrit. Previous work in this lab showed that TNF-alpha (known to be released from mast cells) causes increased glycocalyx permeability. We hypothesize that adenosine will increase the permeability of FITC-dextran 70 into the glycocalyx, through degranulation of mast cells via the A3 adenosine receptors. The goals of this work are to elucidate the effects of varying doses of adenosine receptor. The goals of this work are to elucidate the effects of varying doses of adenosine (and other vasodilators) on glycocalyx permeability and thickness, compare this effect to that elicited by other vasoactive agents which act either through mast cells or independent of mast cells, and evaluate the role of the A3 adenosine receptor in this response using A3 knockout mice as well as other state of the art techniques. We believe and the endothelial glycocalyx will provide to be an important regulator of many vascular processes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MR PERFUSION IMAGING FOR FUNCTIONAL BRAIN STUDIES Principal Investigator & Institution: Conturo, Thomas E.; Associate Professor; Radiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2003; Project Start 21-DEC-1998; Project End 30-NOV-2004 Summary: We proposed to develop quantitative magnetic resonance (MR) methods of imaging cerebral blood flow (CBF) and blood volume (CBV) using combinations of magnitude- and phase-based blood and tissue signals. Quantitative CBV and CBF imaging in the human brain is of significant importance in the evaluation of a number of disease processes, especially those involving longitudinal measurements within and across subjects. Also, it is fundamental in understanding the relationship of brain function to brain metabolism in the normal brain. Compared with the quantitative method of positron emission tomography (PET), MR utilizing bolus administration of gadolinium (Gd), contrast agents has potential advantages of high spatial resolution, high signal- to-signal ratio (SNR), no ionizing radiation, high availability, and lower costs. However, the ability of MR methods to quantitate CBF and CBV has not yet been fully realized. While the magnetic susceptibility effect of bolus Gd injection on change in relaxation rate (deltaR2 or delta R*2 signals) is often used for MR perfusion imaging, these signals are likely dependent on other factors in addition to tissue GD concentration, such as compartmentation (e.g., hematocrit). CBV and CBF quantitations also require measurement of the Gd arterial input function (AIF), where temporal and spatial resolution, SNR, signal linearity with respect to concentration, and response over a wide range of doses and concentrations (dose dynamic range) are critical. We plan to utilize phase shift (delta-phi) signals in conjunction with deltaR2 and deltaR*2 to quantitate CBV and CBF. In model systems, the delta-phi signal is linear and has high SNR and dose dynamic range. As the first Aim, these signal mechanisms will be analyzed theoretically and experimentally in blood and tissue. In the second Aim, signal- concentrations relations will be experimentally determined in blood and tissue. Finally, the validity of quantitative MR CBV and CBF measurements obtained with different signal combinations will be tested against PET in baboons with normal and physiologically-altered flow. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MRI AND NIRS IN SS PATIENTS AND MICE Principal Investigator & Institution: Fabry, Mary E.; Professor of Medicine; Yeshiva University 500 W 185Th St New York, Ny 10033 Timing: Fiscal Year 2004 Summary: A primary feature of sickle cell disease are events resulting in low flow, poor perfusion, and blood and tissue hypoxia that are both pre-disposing to and the consequence of vaso-occlusion. We propose to test the limits of the hypothesis that the level of HbF, arginine in diet, and hydroxyurea all affect perfusion and blood oxygenation, albeit through different mechanisms. We will use a combination of Magnetic Resonance Imaging (MRI) and Near Infrared Spectroscopy (NIRS) to measure blood oxygenation, perfusion, and blood volume in human sickle cell patients and our new sickle transgenic mice that we have developed and characterized. At the onset of the grant period, our new Magnetic Resonance Research Center will have been in operation for more than 18 months with state-of-the-art 4 Tesla human and 9.4 Tesla animal systems. We have generated mice expressing exclusively human sickle hemoglobin with three levels of HbF using our previously described sickle constructs, mouse alpha- and beta-globin-knockouts, and three different human gamma-transgenes.

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We find that, progressive increase in HbF from <3% to 20% to 40% correlated with progressive increase in hematocrit (22% to 34% to 40%), a progressive decrease in reticulocyte count (fi'om 60% to 30% to 13%), and an increase in lifespan (from 45 to 194 to 368 days). Using BOLD-MRI or blood level oxygenation dependent magnetic resonance imaging and T2 mapping, we have demonstrated that transgenic mice expressing high levels of human and beta-s-globin have higher levels of deoxy Hb in brain, liver, and kidney, (areas showing pathology) compared to control mice. We also will measure a battery of other physiological properties including: reticulocytes, CBC, and red cell density, and, in the mice, rotorod performance (a measure of motor coordination and stamina) and urine concentrating ability. Finally, we propose !that arginine may ameliorate the symptoms of sickle cell disease and will test this in humans and mice by measurement of flow and oxygenation as described in this Project and transport measurements described in the Arginine Supplementation in Sickle Cell Disease Project. Our long range goal is to demonstrate that these technologies can used for evaluation of pathology and prediction of risk in sickle cell disease patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NETWORK CLINICAL TRIAL OF HYDROXYUREA /PHLEBOTOMY IN SCD Principal Investigator & Institution: Stuart, Marie J.; Professor; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2004 Summary: (provided by applicant): A major question posed in the decade of the eighties was related to the observation that while the SC erythrocyte contained a 50:50 proportion of HbS to HbC, with no significant difference in the tendency of HbC versus HbA to polymerize with HbS, the SC erythrocyte sickled. This led to a series of crucial studies, which demonstrated that the pathognomonic feature of HbSC is the presence of unusually high-density reticulocytes. However, these elegant laboratory studies have not yet been translated into clinical interventions and therapy that has ameliorated disease severity in patients with the HbSS genotype does not mean that the same therapy will necessarily prove efficacious for HbSC disease. Based on innovative studies at our Center related to both adhesion marker analyses, relationships between hematocrit/adhesion/vaso-occlusion, and novel statistical methods of evaluating home pain diary data, we have identified two interventions, which may be helpful for this disorder. We are therefore proposing an approach to therapy with the pleotropic drug hydroxyurea and periodic phlebotomy (HUP Trial). The goal of this clinical trial is to determine whether oral hydroxyurea (HU) therapy and periodic phlebotomy, compared to HU alone over an 28 month period will decrease self-reported pain rates in symptomatic patients > 15 years of age with HbSC disease, as measured by an increase in the median duration between painful episodes. A secondary aim is to determine whether there will be signs of amelioration of organ damage as a result of these therapies; such as a potential partial return of splenic function, or nonprogression of proliferative retinopathy and/or avascular osteonecrosis in previously affected patients. As a third aim, we hope to determine whether "responders" will be able to be differentiated from "non-responders" by specific biologic parameters. Such markers will include red cell indices, dense cell formation, assays and markers for red cell-endothelial adhesion, white cell, endothelial and hemostatic activation, and nitric oxide metabolites. These studies should provide insights into the modes of action of the pleotropic drug hydroxyurea, as well as preliminary data related to the benefits of phlebotomy. The study can be completed within a 21-month period, and will involve a sample size that

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can be realistically accomplished within the framework of the 10 Comprehensive Sickle Cell Centers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NITRIC OXIDE TRANSPORT MECHANISMS: MODEL AND EXPERIMENTS Principal Investigator & Institution: Jaron, Dov; Director; School of Biomedical Engineering, Science & Health Systems; Drexel University 3201 Arch Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): The general goal of the proposed research is to improve our understanding of the complex interaction between nitric oxide (NO), hemoglobin, oxygen, carbon dioxide, and thiols in the blood and tissue In recent years, many hypotheses have been suggested regarding the production and transport of NO in the blood and various factors that may affect these processes However, disagreement still exists over the true mechanisms of action and transport of NO. Several specific questions remain (1) How do the complex interactions of intracellular calcium, oxygen, shear stress, and thiol levels affect the amount of NO produced by the endothelium and delivered to tissue? (2) Do nitrosothiols or nitrosylhemoglobin (SNO-I-Ib) act as a facilitated carrier mechanism by storing NO and transporting it to areas where it is needed? (3) Can mathematical modeling assist in determining the most probable transport mechanisms for NO? The proposed research seeks to answer these questions using a combination of in vitro and in vivo experimental studies and mathematical modeling Experimental studies have been designed to provide vital information for the mathematical modeling and will be used to test model validity and evaluate hypothesized mechanisms of NO transport In vitro studies will be conducted in a parallel-plate flow chamber using rat endothelial cells. Nitric oxide release will be stimulated using neurohumoral mediators and measured under basal conditions. Additional conditions, including altered oxygen and carbon dioxide levels, various levels of shear stress and addition of thiols will be imposed. In vivo studies will be conducted in the arterioles and venules of the rat mesentery. NO levels will be measured under normal physiological conditions, during hypoxia and hypercapnia and under altered thiol, shear stress and hematocrit levels. The effects of these interventions on NO production, transport, and distribution will be measured, incorporated into the mathematical model, and used to test its validity under various ranges of conditions. The mathematical model will simulate the production, mass transport, feedback regulation, and biochemical mechanisms of action of NO in the microcirculation and tissue. Quantitative data obtained from the validated model will be used to predict parameters that cannot be measured in vivo, analyze the hypotheses and further the understanding of NO production and transport mechanisms, and used to shape future experimental studies. Understanding NO transport mechanisms is important clinically since altered NO regulation has been implicated in pathophysiological conditions Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: NOVEL MECHANISM OF ERYTHROCYTE NITRIC OXIDE TRANSPORT Principal Investigator & Institution: Pawloski, John R.; Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 08-APR-2002; Project End 31-MAR-2007

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Hematocrit

Summary: Circulating red blood cells (RBC) constitute the largest pool of biologically available nitric oxide (NO) in the mammalian organism. It has now been shown that NO-related bioactivity is released form human RBCs in an oxygen-dependent manner. The mechanism of NO export seems to involve a novel system whereby Snitrosohemoglobin (SNO- Hb) transnitrosylates cysteine thiols in the cytoplasmic domain of the membrane RBC anion-exchanger 1 protein (AE1). The details of this novel RBC function stand to be elucidated. To characterize this system, the following specific aims have been formulated. 1) To identify the chemical nature of released NO species and to specific the target thiols in the cytoplasmic domain of AE1. 2) Determine the effects of S-nitrosylation AE1 function. 3) Characterize the NO exporter in sickle cell RBCs, a prototypical disease model fo hemoglobin dysfunction. 4) Develop a transgenic murine model with site-directed mutagenesis of AE1 cytoplasmic domain thiols transnitrosylated SNOHb. The abiding goals of this project are to gain a greater understanding of mechanisms in the RBC in both normal and disease states. The results of these studies underscore the potential but largely unexplored role of Hb- membrane interactions in the pathogenesis of the thrombotic diathesis, ischemic syndromes, oxidative disorders and hypertensive states that are associated with altered hematocrit, hemoglobinopathies (like sickle cell disease), and RBC membrane defects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ON-LINE, NEAR-INFRARED UREA SENSOR FOR HEMODIALYSIS Principal Investigator & Institution: Olesberg, Jonathon T.; None; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 28-FEB-2007 Summary: The first component of the development award will be formal training in biochemistry, cellular biology, and physiology. This formal training will be augmented by professional interactions with clinical physicians and a mentored research effort in the development of near-infrared sensors for the monitoring of hemodialysis dose. The initial research component of this work will be the development of an all-optical sensor for the on-line measurement urea concentration in spent dialysate. An effective on-line urea sensor will allow regular, sample-free monitoring and optimization of hemodialysis dose. The sensor will also be adapted for measurements in the extracorporeal whole blood stream between the patient and the dialyzer. The measurement of urea in whole blood will provide a measurement of dose that is more directly related to current blood-based dose quantitation. Because near-infrared sensing technology permits simultaneous quantification of multiple analytes, the sensor will also be applied to quantification of other blood components, including serum albumin, serum creatinine, hematocrit, and uremic toxins, including hippuric acid and indoxyl sulfate. The capacity to monitor these additional analytes every dialysis session will be of substantial benefit to clinical physicians working with patients suffering from either end-stage or acute renal failure. Finally, the near- infrared sensor will be applied to noninvasive, in vivo measurements of urea in peripheral tissue sites. The information provided by such a measurement will be invaluable for the study of urea disequilibrium during dialysis and as a potentially rebound-free quantification of delivered dose. Initial instrument development will be performed in a laboratory environment using an in vitro model for sensor optimization. Calibration models will be generated for urea and other analytes. Sensor operation will then be validated in the clinical setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PLASMODIUM FALCIPARUM-INDUCED ANEMIA IN AOTUS MONKEYS Principal Investigator & Institution: Jones, Trevor R.; Captain, Medical Service Corps; Naval Medical Research Center 503 Robert Grant Ave Silver Spring, Md 20910 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2003 Summary: (provided by applicant): Long-Term Objective: In two recent Aotus monkey vaccine studies using DNA and/or recombinant protein vaccines based on P. falciparum blood stage antigens, an unexpectedly high incidence of severe anemia was noted in the animals after they were challenged with blood-stage P. falciparum parasites. A clear understanding of the mechanism of anemia induction in these studies is critical to evaluating the risk of immunizing humans exposed to malaria with vaccines based on P. falciparum blood stage antigens. Specific Aims: 1) Establish two anemia models in P. falciparum-immunized Aotus; one vaccine-related and one not. 2) Determine whether chronic parasitemia induced by partial drug treatment leads to the same degree of anemia as is seen in the immunized, challenged animals. 3) Determine the relative importance and mechanisms of increased erythrocyte destruction/sequestration versus decreased erythropoiesis in these models. 4) Determine whether there is any association between vaccine-induced immune responses and the risk of anemia after challenge. 5) Determine whether increasing the efficacy of the vaccines can reduce the risk of anemia. Research Design and Methods: 1) Develop a reliable P. falciparum malaria anemia model in Aotus monkeys immunized with bloodstage P. falciparum vaccines, and a control model using sub-optimal drug treatment to maintain a low-density parasitemia. 2) Characterize the anemia models to determine whether parasites cause bone marrow dysfunction by parasite density affecting reticulocyte count independently of hematocrit. Determine whether parasites cause bone marrow dysfunction that affects blood cells other than reticulocytes. Determine whether parasite density is important to any alternations to bone marrow function. Determine whether parasitized erythrocytes being sequestered, lysed, or both. 3) Discover correlates of anemia. Determine whether the presence and degree of anemia correlates with spleen size, the presence of erythrocyte surface IgG or complement C3d, serum antibodies to the vaccine, serum antibodies to whole blood-stage parasites, circulating levels of erythropoietin, TNF-a. and IL10. 4) Measure erythrocyte survival and erythrocyte volume studies by evaluating the life span of biotinylated Aotus erythrocytes in immunized and non-immunized anemic monkeys. 5) Evaluate the effect of splenectomy on maintenance of anemia. 6) Evaluate ability of heat-killed parasites to induce anemia. 7) Compare bone marrow responses in immunized animals to bone marrow responses in monkeys rendered anemic by phlebotomy (anemia unrelated to both immunity and P. falciparum infection). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POLYMER-COATED RED BLOOD CELL FOR SICKLE CELL DISEASE Principal Investigator & Institution: Fisher, Timothy C.; Physiology and Biophysics; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002; Project Start 28-SEP-2000; Project End 31-AUG-2004 Summary: (Investigator's abstract) Although red blood cell (RBC) transfusion is an essential component in the management of acute complications of sickle cell disease (SCD), and the recent "STOP" study has demonstrated that chronic blood transfusion can prevent stroke in high-risk SCD children, transfusion in SCD has associated problems: 1) high alloimmunization rates (up to 30 percent) and iron accumulation; 2)

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Hematocrit

limitation of post-transfusion hematocrit to less than 35 percent to avoid blood hyperviscosity which may precipitate a vaso-occlusive event. However, we have recently developed a technique which has the potential to mitigate these problems: covalent bonding of a thin coating of polyethylene glycol (PEG) or related polymers to the RBC surface. Results to date indicate that consequent to coating, the RBC surface is inaccessible to antibodies (i.e., the RBC blood group antigens are "masked") and RBC interactions, such as RBC aggregation, are minimized; the latter effect results in greatly reduced low-shear blood viscosity even when the hematocrit of SS blood is increased with coated RBC. The ultimate objective of this Research Program is the development of safe and effective RBC polymer coating methods which achieve antigen masking and viscosity reduction and which offer therapeutic benefits for sickle cell disease subjects. Specific aims include: 1) optimizing polymer coating techniques via evaluating linear, branched, star and dendrimer PEG molecules and various bonding chemistries and crosslinking strategies; 2) evaluation of the functional status of polymer-coated RBC in terms of RBC morphology, rheological behavior (i.e., deformability), membrane transport and oxygen binding, identification of membrane proteins affected (e.g., C-14 labeled PEGs), the storage ability of coated-cells, and in vivo survival in mice and rabbit systems; 3) evaluation of polymer-coated RBC as therapeutic agents in SCD via in vitro rheologic studies of M and SS RBC mixtures at various hematocrits and oxygen tensions, and via in vivo flow studies using rat mesocecum and cat skeletal muscle preparations; 4) evaluation of polymer coating as a means to prevent alloimmunization and/or to protect transfused RBC in alloimmunized subjects by utilizing both in vitro (e.g., antibody/complement binding, complement lysis, monocyte monolayer assay) and in vivo approaches (e.g., alloimmunized rabbit model, xenotransfusions) methods. An interactive approach to these aims is proposed; their successful achievement should yield important new data and improved health care in SCD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: QUANTITATION OF THE BOLD EFFECT IN FUNCTIONAL MRI Principal Investigator & Institution: Van Zijl, Peter Cm.; Professor of Radiology; Radiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 30-JUN-2004 Summary: (Adapted from applicant's abstract): MRI signals are sensitive to physiological alterations such as changes in cerebral blood flow (CBF), volume (CBV) and oxygenation. As a consequence, MRI methods can be designed that produce bloodoxygenation-level-dependent (BOLD) image contrast. The possibility of detecting such effects has stimulated a boon in the field of functional MRI (fMRI) of the brain, where neuronal activation is reflected in slight focal increases in signal intensity. Despite great progress in understanding some of the mechanisms of these BOLD signal changes, the technique is often criticized because no exact equations relating the measure MRI effects to basic physiological parameters, such as CBF, CBV, oxygen metabolic rate, hematocrit, and arterial oxygen saturation, have been established. The applicants have recently developed a general theory that can quantitatively explain spin-echo (SE) relaxation effects (R2) in terms of hemoglobin deoxygenation and oxygen extraction ratios (OER). This theory has to be tested rigorously using experiments in which hemoglobin deoxygenation (Aim 1) and OER (Aims 2,3) are well understood and can be controlled, after which it can be applied to determine OER effects in fMRI (Aim 4). The aim is to quantitatively measure R2 and the SE signal intensities of water as a function of the inter-echo time spacing in the NMR pulse sequence and as a function of field strength for the following conditions: At different hemoglobin oxygenation levels and

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hematocrits in isolated blood (AIM); As a function of oxygenation in vivo in the cat brain (AIM 2), and in vivo in the human brain (AIM 3). These experiments will also include simultaneous determination of arterial oxygen saturation, pH, and blood gases (AIM 1-3), as well as measurement of arteriovenous differences and absolute blood flow (microspheres) in the animals (AIM 2). Finally, these relaxation rates and arterial oxygenation and blood gases will be measured during visual stimulation in humans at field strengths of 1.5T and 4.0T (AIM 4). These efforts should lead to a better understanding of the physiological mechanisms underlying the fMRI signal changes in neuronal activation and allow quantitation of cerebro-haemodynamic parameters to be utilized for high resolution mapping of structure/function relationships in intact brain. This understanding should facilitate optimal design of fMRI experiments in terms of the most suitable MRI pulse sequence parameters to obtain maximum effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTION

RHEOLOGICAL

DETERMINANTS

OF

MICROVASCULAR

Principal Investigator & Institution: Lipowsky, Herbert H.; Professor & Chair; Bioengineering; Pennsylvania State University-Univ Park 110 Technology Center University Park, Pa 16802 Timing: Fiscal Year 2002; Project Start 01-JAN-1989; Project End 30-NOV-2004 Summary: The overall goal of this research is to elucidate the role of blood rheology as a determinant of microvascular function in health and disease. To this end, techniques of intravital microscopy will be applied to evaluate the extent to which red blood cell (RBC) deformability and aggregation, and white blood cell (WBC) deformability and adhesion to the endothelium, affect the resistance to blood flow in vessels ranging from the true capillaries, to the arterioles and venules which serve them. Quantitative indices of microvascular function will be derived from direct in situ measurements of hemodynamic variables in exteriorized tissues such as the mesentery, omentum and cremaster muscle. Specific aims are to elucidate the relationship between blood flow and blood coli mechanical properties within individual microvessels, at branch points throughout the microvascular network and regionally throughout the succession of major microvascular divisions. A major emphasis of the research will be to elucidate microvascular function in the low flow state by either mechanical obstruction of the arterial inflow, hemorrhagic hypotension or pharmacological intervention. Specific studies on RBCs will delineate the role of red cell aggregation in the margination of WBCs, regional resistance to blood flow and recovery from prolonged ischemic episodes. Studies on RBC deformability will seek to elucidate the effect of its decrease on the process of capillary recruitment during tissue hypoxia, its effect on regional resistance to flow and on the resistance to flow in single unbranched microvessels. Studies on RBC concentration will aim to elucidate the relationship between average tissue hematocrit, determined by the dynamics of red cell flux through the microvasculature, and the tube hematocrit, obtained by direct measurements in individual microvessels. The role of WBC deformability will be examined as a determinant of WBC adhesion to the endothelium and resistance to flow. Techniques of optical sectioning microscopy will be applied to elucidate the role that irregularities in the microvessel lumen play in affecting the resistance to blood flow. It is anticipated that the results of these studies will provide insight into the role of mechanical and biochemical properties of blood cells in affecting microvascular function and aid development of therapeutic strategies to treat a variety of pathologies such as anemia,

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polycythemia, the low flow state, shock, inflammation and blood cell disorders, to name a few. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTOSTERONE REPLACEMENT & PHYSICAL FUNCTION IN HIV+MEN Principal Investigator & Institution: Bhasin, Shalender; Professor and Chief; Internal Medicine; Charles R. Drew University of Med & Sci 1731 East 120Th Street Los Angeles, Ca 900593025 Timing: Fiscal Year 2002; Project Start 30-SEP-1994; Project End 30-JUN-2006 Summary: (provided by applicant): The role of testosterone as an anabolic agent is widely misunderstood and the mechanisms of its anabolic effects on the muscle are largely unknown. Testosterone replacement increases fat-free mass in HIV-infected men with weight loss, but its efficacy in improving physical function has not been demonstrated. The objective of this competing continuation is to determine if testosterone replacement of HIV-infected men with weight loss will improve physical function, perceptions of physical function and body image. A second objective is to elucidate the mechanisms by which testosterone increases muscle mass; we will determine whether testosterone supplementation increases satellite cell number by promoting G:S phase transition, thus inducing satellite cells to enter the cell cycle or by inhibiting satellite cell apoptosis. We will also determine the effects of testosterone supplementation on muscle protein breakdown and protein synthetic efficiency. HIVinfected men, 18-60 yrs of age, with serum testosterone less than 350 ng/dL, and free of acute illness, will be randomly assigned to receive either placebo or 75- mg testosterone gel daily for 16 weeks. 75-mg testosterone gel, when applied daily, will raise serum testosterone in to the mid-normal range. Energy and protein intake, and exercise stimulus will be standardized. We will assess intramuscular molecular and cellular events and measure breakdown rates of mixed skeletal muscle protein by the combined use of the AV difference method and the three-pool model at baseline and after 2-weeks of treatment. The number of satellite cells and myonuclei will be assessed by electron microscopy, and satellite cell apoptosis by TUNEL method. Phosphorylated retinoblastoma protein and proliferating cell nuclear antigen (PCNA) will be used as markers of satellite cell cycle events. We will measure myostatin, IGF-1, and IGFBP-4 mRNA and protein concentrations by RT-PCR and Western blot analyses, and ubiquitin and proteasome mRNA by northern blots. The following outcomes will be measured at baseline and after 16 weeks: physical function by the stair climbing power, walking speed, and load carry test using threshold-independent methods; muscle performance by measurements of power, endurance, and 1 -repetition maximum strength in the leg press exercise; effort-independent muscle performance by force:EMG relationship; thigh muscle volume by MRI scan; perception of physical function, fatigue/energy, and body image by validated instruments. Total and free testosterone and DHT levels will be measured as markers of androgen bioavailability, and LH, FSH, and SHBG as markers of androgen action. For safety, we will follow hematocrit, AST and ALT, PSA, plasma lipids, apolipoproteins, and lipoprotein particles, digital rectal examinations, and sleep apnea questionnaire. A multi-disciplinary team of investigators, careful subject selection, access to a large patient pool, attention to potential confounding variables such as dietary intake, exercise stimulus, learning effect, and power and effect size, and state-of-the-art methods should maximize the chances of detecting treatment effects and elucidating the mechanism of androgen action. This study should help identify a therapeutic intervention that might improve physical function in HIV-infected men with

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weight loss, and enhance our understanding of the mechanisms by which testosterone stimulates muscle accretion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VIRUS PHOTOINACTIVATION--DIMETHYLMETHYLENE BLUE IN RBC Principal Investigator & Institution: Wagner, Stephen J.; Director; American National Red Cross Washington, Dc 20037 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2005 Summary: Despite careful donor selection and extensive laboratory testing, a small risk of virus transmission by transfusion still exists. Additional efforts in donor selection and infectious disease testing may not substantially reduce this risk. However, the development of virus inactivation methods should provide an additional level of safety. The goal of this research is to develop practical methods to photoinactivate intracellular and extracellular viruses in red cell (RBC) suspensions of transfusable hematocrit under conditions that will neither harm the recipient nor the in vitro/in vivo properties of red cells. More specifically, the photosensitizer 1,9-dimethylmethylene blue (DMMB) and red light will be used to rapidly inactivate (within 10-20 second timeframe) virus in thin films of oxygenated RBC suspensions. Based on preliminary studies, virus inactivation will be enhanced and photoinduced RBC damage will be diminished by the addition of a single substance that acts as a competitive inhibitor to prevent DMMB binding to RBCs. The competitive inhibitor will be safe to transfuse to recipients and shares several structural features with DMMB, yet it will not absorb red light nor produce reactive oxygen species upon red light illumination. The specific aims of the research are to: 1) Develop a simple and reproducible method for oxygenating full units of RBCs in a closed system; 2) Design a flow cell system suitable for rapid photoinactivation of 1-2 mm thin films of 45-60% hematocrit RBC of 1-2 mm thin films of 45-60% hematocrit RBS suspensions with minimal alterations of RBC properties during 42 day 1-6 degrees C storage; 3) Identify an analytical procedure to quantitate levels of DMMB, its photoproducts, and the competitive inhibitor in blood; 4) Develop a device to remove DMMB, photoproducts and the competitive inhibitor from blood that is compatible with 42 day 1-6 degrees C storage; 5) Perform in vitro and in-vivo genotoxicity and acute toxicity testing for DMMB and phototreatment in an animal (baboon) model, and finally, 7) Investigate safety and RBC recovery and lifespan following virucidal phototreatment in a Phase 1 clinical trial conducted during the final year of the study. 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

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.

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unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “hematocrit” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for hematocrit in the PubMed Central database: •

Effects of Hematocrit on Renal Hemodynamics and Sodium Excretion in Hydropenic and Volume-Expanded Dogs. by Schrier RW, Earley LE.; 1970 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=322649

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Erythrocyte sequestration and anemia in severe falciparum malaria. Analysis of acute changes in venous hematocrit using a simple mathematical model. by Davis TM, Krishna S, Looareesuwan S, Supanaranond W, Pukrittayakamee S, Attatamsoonthorn K, White NJ.; 1990 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=296794

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Immune responses to band 3 neoantigens on Plasmodium falciparum-infected erythrocytes in subjects living in an area of intense malaria transmission are associated with low parasite density and high hematocrit value. by Hogh B, Petersen E, Crandall I, Gottschau A, Sherman IW.; 1994 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=303117

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Inverse changes in erythroid cell volume and number regulate the hematocrit in newborn genetically hypertensive rats. by Boylan JW, Van Liew JB, Feig PU.; 1991 Nov 1; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=52818

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Polycystic kidney disease in patients on the renal transplant waiting list: trends in hematocrit and survival. by Abbott KC, Agodoa LY.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=122070

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THE BODY/VENOUS HEMATOCRIT RATIO: ITS CONSTANCY OVER A WIDE HEMATOCRIT RANGE. by Chaplin H Jr, Mollison PL, Vetter H.; 1953 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=438476

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THE HEMATOCRIT OF THE LESSER CIRCULATION IN MAN. by Lilienfield LS, Kovach RD, Marks PA, Hershenson LM, Rodnan GP, Ebaugh FG Jr, Freis ED.; 1956 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=441720

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 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. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text

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

A computer model comparing normovolemic hemodilution, hypervolemic hemodilution, and neither on intraoperative blood loss and final hematocrit. Author(s): Engoren M. Source: Am J Anesthesiol. 1995 September-October; 22(5): 229-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10159678

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A decrease in regional cerebral blood volume and hematocrit in crossed cerebellar diaschisis. Author(s): Yamauchi H, Fukuyama H, Nagahama Y, Okazawa H, Konishi J. Source: Stroke; a Journal of Cerebral Circulation. 1999 July; 30(7): 1429-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10390318

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A hemodynamic analysis for determining critical hematocrit in transfusions for sickle cell patients. Author(s): Zheng ZC. Source: Technology and Health Care : Official Journal of the European Society for Engineering and Medicine. 2001; 9(3): 225-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11381203

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A justification for high resolution hematocrit measurement. Author(s): Kelly ME, Luetkemeier MJ, Pantalos GM. Source: Medicine and Science in Sports and Exercise. 1994 May; 26(5): 547-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8007800

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A relationship between blood pressure control, hematocrit level, and renal function in treated essential hypertension. Author(s): Mandal AK, Markert RJ, Bell RD. Source: Journal of Clinical Pharmacology. 1993 May; 33(5): 427-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8331199

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 semi-empirical model of apparent blood viscosity as a function of vessel diameter and discharge hematocrit. Author(s): Kiani MF, Hudetz AG. Source: Biorheology. 1991; 28(1-2): 65-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2049533

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Accuracy evaluation and hematocrit effect of commercial ionized calcium analyzers using Japanese serum reference material. Author(s): Kuwa K, Tani W, Hayashi K, Umemoto M. Source: Scand J Clin Lab Invest Suppl. 1996; 224: 173-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8865433

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Accuracy of a mixed venous saturation catheter during acutely induced changes in hematocrit in humans. Author(s): van Woerkens EC, Trouwborst A, Tenbrinck R. Source: Critical Care Medicine. 1991 August; 19(8): 1025-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1860326

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Accuracy of in-line venous saturation and hematocrit monitors in pediatric perfusion. Author(s): Yaskulka SM, Burnside J, Bennett D, Olshove V, Langwell J. Source: J Extra Corpor Technol. 1995 September; 27(3): 132-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10172476

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Achieving target hematocrit in dialysis patients: new concepts in iron management. Author(s): Nissenson AR. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1997 December; 30(6): 907-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9398140

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Adequacy of dialysis and differences in hematocrit among dialysis facilities. Author(s): Ifudu O, Uribarri J, Rajwani I, Vlacich V, Reydel K, Delosreyes G, Friedman EA. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2000 December; 36(6): 1166-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11096041

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Adolescent pregnancy: effects of nutrients on hematocrit and birth weight in Orangeburg County. Author(s): Jackson E, Mathur K. Source: J S C Med Assoc. 1991 January; 87(1): 8-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2002665

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Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? Author(s): Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 June; 125(6): 1438-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12830066

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Analysis of flow acceleration during erythrocyte filtration: dependence of hematocrit and cell rigidity. Author(s): Lindmark K, Engstrom KG. Source: Biorheology. 1996 July-October; 33(4-5): 379-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8977662

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Angiotensin-converting enzyme inhibitors reduce hemoglobin concentrations, hematocrit, and serum erythropoietin levels in renal transplant recipients without posttransplant erythrocytosis. Author(s): Montanaro D, Gropuzzo M, Tulissi P, Boscutti G, Risaliti A, Baccarani U, Mioni G. Source: Transplantation Proceedings. 2001 February-March; 33(1-2): 2038-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11267615

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Appropriate discard volumes when drawing arterial blood for hematocrit determination. Author(s): Jordan BS. Source: The Journal of Burn Care & Rehabilitation. 2000 July-August; 21(4): 394. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10935826

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Appropriate discard volumes when drawing arterial blood for hematocrit determination. Author(s): Walker SC. Source: The Journal of Burn Care & Rehabilitation. 2000 July-August; 21(4): 393. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10935825

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Appropriate hematocrit levels of erythropoietin supplementary therapy in end-stage renal failure complicated by coronary artery disease. Author(s): Nagao K, Tsuchihashi K, Ura N, Nakata T, Shimamoto K. Source: The Canadian Journal of Cardiology. 1997 August; 13(8): 747-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9284841

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Arterial blood pressure. Correlation with erythrocyte count, hematocrit, and hemoglobin concentration. Author(s): Gobel BO, Schulte-Gobel A, Weisser B, Glanzer K, Vetter H, Dusing R. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1991 January; 4(1 Pt 1): 14-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2006992

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Assessing patient outcomes with higher hematocrit levels. Author(s): Kurtin PS. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1995 April; 25(4 Suppl 1): S8-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7702072

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Benefits of a lower hematocrit during extracorporeal membrane oxygenation? Author(s): Griffin MP, Minifee PK, Daeschner CW 3rd, Zwischenberger JB. Source: Am J Dis Child. 1992 March; 146(3): 373-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1543190

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Beyond the hematocrit and Po2: a symposium on teaching humanities in academic medical centers. Author(s): Diehl AK, Perkins HS. Source: The American Journal of the Medical Sciences. 2000 May; 319(5): 271-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10830548

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Blockade of angiotensin II AT 1 receptor reduces hematocrit in patients with posttransplant erythrocytosis. Author(s): Tsang WK, Tong KL, Chan HW. Source: Transplantation Proceedings. 1998 November; 30(7): 3072-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9838354

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Blood cyclosporine pharmacokinetics in patients undergoing marrow transplantation. Influence of age, obesity, and hematocrit. Author(s): Yee GC, McGuire TR, Gmur DJ, Lennon TP, Deeg HJ. Source: Transplantation. 1988 September; 46(3): 399-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3047931

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Blood glucose reagent strip tests in the operating room: influence of hematocrit, partial pressure of oxygen, and blood glucose level--a comparison of the BM-test 1-44, BM-Accutest, and Satellite G reagent strip systems. Author(s): Cross MH, Brown DG. Source: Journal of Clinical Monitoring. 1996 January; 12(1): 27-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8732813

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Blood hematocrit changes after coronary angioplasty. Author(s): Dimmitt S. Source: The American Journal of Cardiology. 1990 July 1; 66(1): 124. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2360530

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Blood hematocrit changes during paroxysmal atrial fibrillation. Author(s): Imataka K, Nakaoka H, Kitahara Y, Fujii J, Ishibashi M, Yamaji T. Source: The American Journal of Cardiology. 1987 January 1; 59(1): 172-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3812234

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Blood low shear rate rheometry: influence of fibrinogen level and hematocrit on slip and migrational effects. Author(s): Picart C, Piau JM, Galliard H, Carpentier P. Source: Biorheology. 1998 July-October; 35(4-5): 335-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10474659

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Blood testing in biathlon: observation of hematocrit values during competitive periods 1994-1997. Author(s): Manfredini F, Tschukin A, Moran M, Mongolini C, Buzzoni D, Haberstroh J. Source: International Journal of Sports Medicine. 1999 August; 20(6): 403-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10496121

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Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Author(s): Scott BH, Seifert FC, Glass PS, Grimson R. Source: Anesthesia and Analgesia. 2003 October; 97(4): 958-63, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14500140

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Blood viscosity and optimal hematocrit in narrow tubes. Author(s): Stadler AA, Zilow EP, Linderkamp O. Source: Biorheology. 1990; 27(5): 779-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2271768

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Blood viscosity and optimal hematocrit in preterm and full-term neonates in 50- to 500-micrometer tubes. Author(s): Linderkamp O, Stadler AA, Zilow EP. Source: Pediatric Research. 1992 July; 32(1): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1635852

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Blood viscosity in man following decompression: correlations wiht hematocrit and venous gas emboli. Author(s): Neuman TS, Harris MG, Linaweaver PG Jr. Source: Aviation, Space, and Environmental Medicine. 1976 August; 47(8): 803-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=949295

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Blood viscosity in tube flow: dependence on diameter and hematocrit. Author(s): Pries AR, Neuhaus D, Gaehtgens P. Source: The American Journal of Physiology. 1992 December; 263(6 Pt 2): H1770-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1481902

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Blood volume and hematocrit value in macroglobulinemia and myeloma. Author(s): Kopp WL, MacKinney AA Jr, Wasson G. Source: Archives of Internal Medicine. 1969 April; 123(4): 394-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4976452

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Blood volume determination as a function of hematocrit and mass in three preservative solutions and saline. Author(s): Burstain JM, Brecher ME, Halling VW, Pineda AA. Source: American Journal of Clinical Pathology. 1994 December; 102(6): 812-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7801897

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Blunted effect of ANP on hematocrit and plasma volume in streptozotocin-induced diabetes mellitus in rats. Author(s): Valentin JP, Sechi LA, Humphreys MH. Source: The American Journal of Physiology. 1994 February; 266(2 Pt 2): R584-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8141419

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Cardiopulmonary bypass temperature, hematocrit, and cerebral oxygen delivery in humans. Author(s): Cook DJ, Oliver WC Jr, Orszulak TA, Daly RC, Bryce RD. Source: The Annals of Thoracic Surgery. 1995 December; 60(6): 1671-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8787461

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Cardiovascular effect of normalizing the hematocrit level during erythropoietin therapy in predialysis patients with chronic renal failure. Author(s): Hayashi T, Suzuki A, Shoji T, Togawa M, Okada N, Tsubakihara Y, Imai E, Hori M. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2000 February; 35(2): 250-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10676724

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CD34(+) cell collection efficiency does not correlate with the pre-leukapheresis hematocrit. Author(s): Mehta J, Oyama Y, Winter J, Williams S, Tallman M, Singhal S, Villa M, Shook T, Burt R, Traynor A, Soff G, Masarik S, Ramsey G, Gordon L. Source: Bone Marrow Transplantation. 2001 September; 28(6): 597-601. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11607773

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Cerebral hematocrit decreases with hemodynamic compromise in carotid artery occlusion: a PET study. Author(s): Yamauchi H, Fukuyama H, Nagahama Y, Katsumi Y, Okazawa H. Source: Stroke; a Journal of Cerebral Circulation. 1998 January; 29(1): 98-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9445336

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Cerebrovascular response to decreased hematocrit: effect of cell-free hemoglobin, plasma viscosity, and CO2. Author(s): Rebel A, Ulatowski JA, Kwansa H, Bucci E, Koehler RC. Source: American Journal of Physiology. Heart and Circulatory Physiology. 2003 October; 285(4): H1600-8. Epub 2003 June 19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12816746

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Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy. Author(s): Rehm M, Haller M, Orth V, Kreimeier U, Jacob M, Dressel H, Mayer S, Brechtelsbauer H, Finsterer U. Source: Anesthesiology. 2001 October; 95(4): 849-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11605923

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Chronic treatment with human recombinant erythropoietin increases hematocrit and improves water maze performance in mice. Author(s): Hengemihle JM, Abugo O, Rifkind J, Spangler E, Danon D, Ingram DK. Source: Physiology & Behavior. 1996 January; 59(1): 153-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8848475

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Clinical comparisons of continuous venous oxygen saturation and hematocrit monitors in pediatric surgery. Author(s): Bennett D, Burnside J, Langwell J, Beckley PD. Source: J Extra Corpor Technol. 1993; 25(4): 140-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10172011

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Clinical evaluation of the CDI-100 in-line hematocrit/saturation monitor. Author(s): Walton HG, Boucher D, Linne D. Source: J Extra Corpor Technol. 1999 June; 31(2): 80-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10724647

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Cognitive impairment in children with hemoglobin SS sickle cell disease: relationship to MR imaging findings and hematocrit. Author(s): Steen RG, Miles MA, Helton KJ, Strawn S, Wang W, Xiong X, Mulhern RK. Source: Ajnr. American Journal of Neuroradiology. 2003 March; 24(3): 382-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12637286

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Cognitive impairment in polycythemia vera: partial reversibility upon lowering of the hematocrit. Author(s): Di Pollina L, Mulligan R, Juillerat Van der Linden A, Michel JP, Gold G. Source: European Neurology. 2000; 44(1): 57-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10894997

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Comparison of urea reduction ratio and hematocrit data reported in different data systems: results from the Centers for Medicare & Medicaid Services and the Renal Network Inc. Author(s): Frankenfield DL, Brier ME, Bedinger MR, Milam RA, Eggers PW, Cain JA, Aronoff GR, Frederick PR. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 February; 41(2): 433-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12552507

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Con: a hematocrit of 20% is not adequate for separation from cardiopulmonary bypass. Author(s): Mossad E, Estafanous F. Source: Journal of Cardiothoracic and Vascular Anesthesia. 1996 February; 10(2): 294-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8850414

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Conductometric study of shear-dependent processes in red cell suspensions. II. Transient cross-stream hematocrit distribution. Author(s): Pribush A, Meyerstein D, Meiselman HJ, Meyerstein N. Source: Biorheology. 2004; 41(1): 29-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14967888

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Continuous hematocrit monitoring method in an extracorporeal circulation system and its application for automatic control of blood volume during artificial kidney treatment. Author(s): Ishihara T, Igarashi I, Kitano T, Shinzato T, Maeda K. Source: Artificial Organs. 1993 August; 17(8): 708-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8215952

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Continuous monitoring of plasma, interstitial, and intracellular fluid volumes in dialyzed patients by bioimpedance and hematocrit measurements. Author(s): Jaffrin MY, Fenech M, de Fremont JF, Tolani M. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 2002 MayJune; 48(3): 326-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12059010

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Control of high hematocrit levels in a hemodialysis patient with an angiotensinconverting enzyme inhibitor. Author(s): Yabana M, Kihara M, Toya Y, Tamura K, Takagi N, Kurita K, Onishi M, Umemura S. Source: Nephron. 1999; 83(2): 181-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10516507

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Correction of the platelet adhesion defect in delta-storage pool deficiency at elevated hematocrit--possible role of adenosine diphosphate. Author(s): Weiss HJ, Lages B, Hoffmann T, Turitto VT. Source: Blood. 1996 May 15; 87(10): 4214-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8639780

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Correlation between carotid intima-media thickness and hematocrit and hemoglobin values in renal transplant recipients. Author(s): Brzosko S, Lebkowska U, Malyszko J, Hryszko T, Pawlak K, Mysliwiec M. Source: Clinical Transplantation. 2001 October; 15(5): 349-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11678962

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Cut-off hematocrit value for hemoconcentration in dengue hemorrhagic fever. Author(s): Balasubramanian S, Anandnathan K, Shivbalan S, Datta M, Amalraj E. Source: Journal of Tropical Pediatrics. 2004 April; 50(2): 123-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15088805

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Death, hospitalization, and economic associations among incident hemodialysis patients with hematocrit values of 36 to 39%. Author(s): Collins AJ, Li S, St Peter W, Ebben J, Roberts T, Ma JZ, Manning W. Source: Journal of the American Society of Nephrology : Jasn. 2001 November; 12(11): 2465-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11675424

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Decrease in hematocrit after coronary stent placement and dextran therapy. Author(s): Haught WH, Sokol M, Kerensky RA, Mehta JL. Source: The American Journal of Cardiology. 1995 August 1; 76(4): 314-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7542431

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Deduction of pulmonary microvascular hematocrit from indicator dilution curves. Author(s): Overholser KA, Lomangino NA, Harris TR, Bradley JD, Bosan S. Source: Bulletin of Mathematical Biology. 1994 March; 56(2): 225-47. Erratum In: Bull Math Biol 1995 November; 57(6): 931. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8186753

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Detection of ferricyanide as a probe for the effect of hematocrit in whole blood biosensors. Author(s): Magner E. Source: The Analyst. 2001 June; 126(6): 861-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11445952

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Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. Author(s): Leypoldt JK, Cheung AK, Steuer RR, Harris DH, Conis JM. Source: Journal of the American Society of Nephrology : Jasn. 1995 August; 6(2): 214-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7579087

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Determination of fluid shifts during chronic hemodialysis using bioimpedance spectroscopy and an in-line hematocrit monitor. Author(s): Jabara AE, Mehta RL. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 1995 JulySeptember; 41(3): M682-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8573892

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Determination of hematocrit based on diffusion of an inert molecular probe from agarose gels into whole blood. Author(s): Malin MJ, Mihalik MC, Sclafani L. Source: Analytical Biochemistry. 1983 March; 129(2): 434-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6846840

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Development and evaluation of a simplified method to collect blood samples to determine hemoglobin and hematocrit using chromatographic paper discs. Author(s): Feraudi M, Mejia LA. Source: The American Journal of Clinical Nutrition. 1987 April; 45(4): 790-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3565308

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Diagnostic errors in neonatal polycythemia based on method of hematocrit determination. Author(s): Villalta IA, Pramanik AK, Diaz-Blanco J, Herbst JJ. Source: The Journal of Pediatrics. 1989 September; 115(3): 460-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2769507

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Diaspirin crosslinked hemoglobin enables extreme hemodilution beyond the critical hematocrit. Author(s): Meisner FG, Kemming GI, Habler OP, Kleen MS, Tillmanns JH, Hutter JW, Bottino DA, Thein E, Meier JM, Wojtczyk CJ, Pape A, Messmer K. Source: Critical Care Medicine. 2001 April; 29(4): 829-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11373478

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Differences between young and elderly subjects in seasonal and circadian variations of total plasma proteins and blood volume as reflected by hemoglobin, hematocrit, and erythrocyte counts. Author(s): Touitou Y, Touitou C, Bogdan A, Reinberg A, Auzeby A, Beck H, Guillet P. Source: Clinical Chemistry. 1986 May; 32(5): 801-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3698272

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Discrepancy between the hemoglobin and hematocrit, secondary to in vitro hemolysis. Author(s): O'Connor DM, Gale GB, Chu JY, Collins MA. Source: Am J Pediatr Hematol Oncol. 1986 Fall; 8(3): 262-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3766916

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Discussion on the relationship between normal hematocrit and geographical factors in China. Author(s): Miao G, Yan Y, Chuanmin Z, Naiying L. Source: Clinical Hemorheology and Microcirculation. 1997 November-December; 17(6): 459-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9502530

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Disproportional changes in hematocrit, plasma volume, and proteins during exercise and bed rest. Author(s): Van Beaumont W, Greenleaf JE, Juhos L. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1972 July; 33(1): 55-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5037411

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Distinct increase in hematocrit associated with paroxysm of atrial fibrillation. Author(s): Okuno S, Ashida T, Ebihara A, Sugiyama T, Fujii J. Source: Japanese Heart Journal. 2000 September; 41(5): 617-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11132168

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Distortion of calculated whole-body hematocrit during lower-body immersion in water. Author(s): Knight DR, Santoro T, Bondi KR. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1986 November; 61(5): 1885-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3781996

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Distribution of cyclosporin A metabolites among plasma and cells in whole blood: effect of temperature, hematocrit, and metabolite concentration. Author(s): Lensmeyer GL, Wiebe DA, Carlson IH. Source: Clinical Chemistry. 1989 January; 35(1): 56-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2642763

•

Distribution of hematocrit values after aneurysmal subarachnoid hemorrhage. Author(s): Giller CA, Wills MJ, Giller AM, Samson D. Source: Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging. 1998 July; 8(3): 169-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9664854

•

Do hematocrit and serum fibrinogen influence transcranial Doppler measurements? Author(s): Sohn YH, Kim GW, Kim JS. Source: Journal of Korean Medical Science. 1997 October; 12(5): 405-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9364297

•

Does hepatitis C virus infection increase hematocrit and hemoglobin levels in hemodialyzed patients? Author(s): Sahin I, Arabaci F, Sahin HA, Ilhan M, Ustun Y, Mercan R, Eminov L. Source: Clinical Nephrology. 2003 December; 60(6): 401-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14690257

•

Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia. Author(s): Elizalde JI, Clemente J, Marin JL, Panes J, Aragon B, Mas A, Pique JM, Teres J. Source: Transfusion. 1997 June; 37(6): 573-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9191816

•

Effect of an increase of the hematocrit on middle cerebral artery peak and umbilical vein maximum velocities in anemic fetuses. Author(s): Sikkel E, Vandenbussche FP, Oepkes D, Klumper FJ, Teunissen KA, Meerman RH, Le Cessie S, Kanhai HH. Source: Fetal Diagnosis and Therapy. 2003 November-December; 18(6): 472-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14564123

Studies

51

•

Effect of hematocrit on blood pressure via hyperviscosity. Author(s): Cinar Y, Demir G, Pac M, Cinar AB. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1999 July; 12(7): 739-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10411372

•

Effect of hematocrit on calculation of cerebral blood flow and lambda in xenon CT. Author(s): Harrigan MR, Satti JA, Deveikis JP, Thompson BG. Source: The Keio Journal of Medicine. 2000 February; 49 Suppl 1: A36-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10750333

•

Effect of heparin, platelets, activated platelets, platelet fragments, and hematocrit on activated clotting time. Author(s): Girardi L, Sudi K, Muntean W. Source: Artificial Organs. 2000 July; 24(7): 507-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10916060

•

Effect of maternal anemia at high altitude on infant hematocrit and oxygenation. Author(s): Ramirez-Cardich ME, Saito M, Gilman RH, Escate LE, Strouse JJ, Kabrhel C, Johnson C, Galchen R, Bautista CT. Source: The American Journal of Tropical Medicine and Hygiene. 2004 April; 70(4): 4204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15100457

•

Effect of nonaxisymmetric hematocrit distribution on non-Newtonian blood flow in small tubes. Author(s): Das B, Johnson PC, Popel AS. Source: Biorheology. 1998 January-February; 35(1): 69-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10211130

•

Effect of normalization of hematocrit on brain circulation and metabolism in hemodialysis patients. Author(s): Metry G, Wikstrom B, Valind S, Sandhagen B, Linde T, Beshara S, Langstrom B, Danielson BG. Source: Journal of the American Society of Nephrology : Jasn. 1999 April; 10(4): 854-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10203371

•

Effects of different hematocrit levels on glucose measurements with handheld meters for point-of-care testing. Author(s): Tang Z, Lee JH, Louie RF, Kost GJ. Source: Archives of Pathology & Laboratory Medicine. 2000 August; 124(8): 1135-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10923072

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Hematocrit

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Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Author(s): Painter P, Moore G, Carlson L, Paul S, Myll J, Phillips W, Haskell W. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 February; 39(2): 257-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11840365

•

Effects of hematocrit and blood flow distribution on solute clearance in hollow-fiber hemodialyzers. Author(s): Ronco C, Ghezzi PM, Metry G, Spittle M, Brendolan A, Rodighiero M, Milan M, Zanella M, La Greca G, Levin NW. Source: Nephron. 2001 November; 89(3): 243-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11598384

•

Effects of hematocrit changes on flow-mediated and metabolic vasodilation in humans. Author(s): Giannattasio C, Piperno A, Failla M, Vergani A, Mancia G. Source: Hypertension. 2002 July; 40(1): 74-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12105141

•

Effects of mycophenolate mofetil on hematocrit after renal transplantation. Author(s): Chenhsu RY, Wu YM, Min DI, Zimmerman MB. Source: The Annals of Pharmacotherapy. 2002 September; 36(9): 1479-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12196073

•

Effects of normal hematocrit on ambulatory blood pressure in epoetin-treated hemodialysis patients with cardiac disease. Author(s): Berns JS, Rudnick MR, Cohen RM, Bower JD, Wood BC. Source: Kidney International. 1999 July; 56(1): 253-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10411700

•

Elevation of serum cholesterol at high altitude and its relationship to hematocrit. Author(s): Temte JL. Source: Wilderness Environ Med. 1996 August; 7(3): 216-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11990116

•

Erythropoietin therapy in chronic uremia: the impact of normalization of hematocrit. Author(s): Murphy ST, Parfrey PS. Source: Current Opinion in Nephrology and Hypertension. 1999 September; 8(5): 573-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10541220

Studies

53

•

Estimation of filtration coefficients and circulating plasma volume by continuously monitoring hematocrit during hemodialysis. Author(s): Yashiro M, Hamada Y, Matsushima H, Muso E. Source: Blood Purification. 2002; 20(6): 569-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12566674

•

Etiology of differences in hematocrit between males and females: sequence-based polymorphisms in erythropoietin and its receptor. Author(s): Zeng SM, Yankowitz J, Widness JA, Strauss RG. Source: J Gend Specif Med. 2001; 4(1): 35-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11324238

•

Evaluation of acquired platelet dysfunctions in uremic and cirrhotic patients using the platelet function analyzer (PFA-100 ): influence of hematocrit elevation. Author(s): Escolar G, Cases A, Vinas M, Pino M, Calls J, Cirera I, Ordinas A. Source: Haematologica. 1999 July; 84(7): 614-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10406903

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Evaluation of the micro-erythrocyte sedimentation rate in relation to hemoglobin and hematocrit in newborn infections. Author(s): Giannacopoulou C, Hatzidaki E, Kokori H, Giannacopoulos K, Margari KM, Manoura A, Sbirakis S. Source: Haematologia. 2000; 30(3): 215-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11128115

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Factors contributing to higher hematocrit levels in hemodialysis patients not receiving recombinant human erythropoietin. Author(s): Takeda A, Toda T, Shinohara S, Mogi Y, Matsui N. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 July; 40(1): 104-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12087567

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Factors influencing hematocrit response to testosterone in patients on chronic hemodialysis. Author(s): Duffy BS, Tauber J, Chrysant SG, Zerefos NS, Gandhi V, Case LF, Kaplan E, Lavender AR. Source: Proc Clin Dial Transplant Forum. 1972; 2: 120-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4681297

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Factors that predict low hematocrit levels in the postpartum patient after vaginal delivery. Author(s): Petersen LA, Lindner DS, Kleiber CM, Zimmerman MB, Hinton AT, Yankowitz J. Source: American Journal of Obstetrics and Gynecology. 2002 April; 186(4): 737-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11967500

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Failure of hematocrit to detect iron deficiency in infants. Author(s): Kazal LA Jr. Source: The Journal of Family Practice. 1996 March; 42(3): 237-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8636674

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Falling hematocrit value on cessation of smoking. Author(s): Markman M. Source: Jama : the Journal of the American Medical Association. 1981 April 3; 245(13): 1314. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7206123

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Fetal blood velocities in Rh isoimmunization: relationship to gestational age and to fetal hematocrit. Author(s): Rightmire DA, Nicolaides KH, Rodeck CH, Campbell S. Source: Obstetrics and Gynecology. 1986 August; 68(2): 233-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2942811

•

Finding logic in the hematocrit measurement audit. Author(s): Lundin AP. Source: Nephrol News Issues. 1998 June; 12(6): 9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9697470

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Findings from routine urinalysis and hematocrit on ambulatory oral and maxillofacial surgery patients. Author(s): Gold BD, Wolfersberger WH. Source: J Oral Surg. 1980 September; 38(9): 677-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6931889

•

Fluid volumes determination by impedance spectroscopy and hematocrit monitoring: application to pediatric hemodialysis. Author(s): Fenech M, Maasrani M, Jaffrin MY. Source: Artificial Organs. 2001 February; 25(2): 89-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11251474

Studies

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Four cases of radical hysterectomy with acute normovolemic hemodilution despite low preoperative hematocrit values. Author(s): Rehm M, Orth V, Kreimeier U, Thiel M, Haller M, Brechtelsbauer H, Finsterer U. Source: Anesthesia and Analgesia. 2000 April; 90(4): 852-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10735787

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From low hematocrit physiology to isovolemic hemodilution. Author(s): Oriani G, Sacchi C, Borghi B. Source: Int J Artif Organs. 1995 March; 18(3): 143-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7499017

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Glucose determinations in plasma and serum: potential error related to increased hematocrit. Author(s): Sidebottom RA, Williams PR, Kanarek KS. Source: Clinical Chemistry. 1982 January; 28(1): 190-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7055911

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Hematocrit and left ventricular mass: the Framingham Heart study. Author(s): Amin MG, Tighiouart H, Weiner DE, Stark PC, Griffith JL, MacLeod B, Salem DN, Sarnak MJ. Source: Journal of the American College of Cardiology. 2004 April 7; 43(7): 1276-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15063442

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Hematocrit and risk for hypertension in middle-aged Japanese male office workers. Author(s): Nakanishi N, Yoshida H, Okamoto M, Nakamura K, Uzura S, Suzuki K, Tatara K. Source: Ind Health. 2001 January; 39(1): 17-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11212285

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Hematocrit and stroke in black Africans under tropical climate and meteorological influence. Author(s): Longo-Mbenza B, Phanzu-Mbete LB, M'Buyamba-Kabangu JR, Tonduangu K, Mvunzu M, Muvova D, Lukoki-Luila E, Bayekula M, Odio W, Kintoki V, MbalaMukendi M, Tshiamala P, Kilembi M, Katalay L, Lelo-Tshinkwela M, Ndoma EK, Mpaka M. Source: Annales De Medecine Interne. 1999 April; 150(3): 171-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10445086

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Hematocrit and the risk of coronary heart disease mortality. Author(s): Brown DW, Giles WH, Croft JB. Source: American Heart Journal. 2001 October; 142(4): 657-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11579356

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Hematocrit as a function of age and altitude in China. Author(s): Miao G, Zhiyuan R, Qingsheng Y, Pinghua L, Shuyan Y, Wanfu Y. Source: The Journal of Laboratory and Clinical Medicine. 2001 August; 138(2): 146-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11477382

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Hematocrit as a predictor of significant injury after penetrating trauma. Author(s): Paradis NA, Balter S, Davison CM, Simon G, Rose M. Source: The American Journal of Emergency Medicine. 1997 May; 15(3): 224-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9148973

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Hematocrit correlates well with circulating red blood cell volume in very low birth weight infants. Author(s): Mock DM, Bell EF, Lankford GL, Widness JA. Source: Pediatric Research. 2001 October; 50(4): 525-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11568298

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Hematocrit determination (HCT) as an early marker associated with necrotizing pancreatitis and organ failure. Author(s): Pezzilli R, Morselli-Labate AM. Source: Pancreas. 2001 May; 22(4): 433-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11345147

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Hematocrit is associated with carotid atherosclerosis in men but not in women. Author(s): Irace C, Ciamei M, Crivaro A, Fiaschi E, Madia A, Cortese C, Gnasso A. Source: Coronary Artery Disease. 2003 June; 14(4): 279-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12826926

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Hematocrit level associated mortality in hemodialysis patients, by Ma JZ, Ebben J, Xia H, Collins AJ. J Am Soc Nephrol 10:610-619, 1999. Author(s): Khan S, Pereira BJ. Source: Seminars in Dialysis. 2000 March-April; 13(2): 112-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10795115

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Hematocrit levels and associated Medicare expenditures. Author(s): Collins AJ, Li S, Ebben J, Ma JZ, Manning W. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2000 August; 36(2): 282-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10922306

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Hematocrit levels and hospitalization risks in hemodialysis patients. Author(s): Xia H, Ebben J, Ma JZ, Collins AJ. Source: Journal of the American Society of Nephrology : Jasn. 1999 June; 10(6): 1309-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10361870

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Hematocrit stability following intravenous versus subcutaneous administration of epoetin alfa to dialysis patients: a post hoc analysis. Author(s): Goodkin DA, Gimenez LF, Graber SE, Van Stone JC, Egrie JC, Okamoto DM. Source: Clinical Nephrology. 1999 June; 51(6): 367-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10404697

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Hematocrit, volume expander, temperature, and shear rate effects on blood viscosity. Author(s): Eckmann DM, Bowers S, Stecker M, Cheung AT. Source: Anesthesia and Analgesia. 2000 September; 91(3): 539-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10960372

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Hematocrit-based measurements of vascular access flow rate. Author(s): Bell DA, Zhang S. Source: Contrib Nephrol. 2004; 142: 228-37. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719396

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Hemolysis of 40% hematocrit, Albunex-supplemented human erythrocytes by pulsed ultrasound: frequency, acoustic pressure and pulse length dependence. Author(s): Brayman AA, Strickler PL, Luan H, Barned SL, Raeman CH, Cox C, Miller MW. Source: Ultrasound in Medicine & Biology. 1997; 23(8): 1237-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9372572

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Hemorheological correlates of fitness and unfitness in athletes: moving beyond the apparent "paradox of hematocrit"? Author(s): Gaudard A, Varlet-Marie E, Bressolle F, Mercier J, Brun JF. Source: Clinical Hemorheology and Microcirculation. 2003; 28(3): 161-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12775898

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Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis. Author(s): Shibata J, Hasegawa J, Siemens HJ, Wolber E, Dibbelt L, Li D, Katschinski DM, Fandrey J, Jelkmann W, Gassmann M, Wenger RH, Wagner KF. Source: Blood. 2003 June 1; 101(11): 4416-22. Epub 2003 February 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12576335

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How valid is the determination of hematocrit values to detect blood manipulations? Author(s): Schmidt W, Biermann B, Winchenbach P, Lison S, Boning D. Source: International Journal of Sports Medicine. 2000 February; 21(2): 133-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10727075

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Hyperinsulinemia may boost both hematocrit and iron absorption by up-regulating activity of hypoxia-inducible factor-1alpha. Author(s): McCarty MF. Source: Medical Hypotheses. 2003 November-December; 61(5-6): 567-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14592787

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Impact of disease severity and hematocrit level on reuse-associated mortality. Author(s): Ebben JP, Dalleska F, Ma JZ, Everson SE, Constantini EG, Collins AJ. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2000 February; 35(2): 244-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10676723

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Impact of hematocrit on morbidity and mortality. Author(s): Collins AJ, Ma JZ, Ebben J. Source: Semin Nephrol. 2000 July; 20(4): 345-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10928336

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Impact of hematocrit value after coronary artery surgery on perioperative myocardial infarction rate. Author(s): Klass O, Mehlhorn U, Zilkens K, Kroner A, Hekmat K, Geissler HJ, de Vivie ER. Source: The Thoracic and Cardiovascular Surgeon. 2002 October; 50(5): 259-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12375180

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Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Author(s): Fang WC, Helm RE, Krieger KH, Rosengart TK, DuBois WJ, Sason C, Lesser ML, Isom OW, Gold JP. Source: Circulation. 1997 November 4; 96(9 Suppl): Ii-194-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9386097

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Impact of reservoir hematocrit and processing parameters on the quality of processed blood product. Author(s): Shulman G. Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : Ains. 2002 December; 37(12): 734-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12469286

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Improving the efficacy of preoperative autologous blood donation in patients with low hematocrit: a randomized, double-blind, controlled trial of recombinant human erythropoietin. Author(s): Price TH, Goodnough LT, Vogler WR, Sacher RA, Hellman RM, Johnston MF, Bolgiano DC, Abels RI. Source: The American Journal of Medicine. 1996 August 26; 101(2A): 22S-27S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8928704

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Increase of fetal hematocrit decreases the middle cerebral artery peak systolic velocity in pregnancies complicated by rhesus alloimmunization. Author(s): Mari G, Rahman F, Olofsson P, Ozcan T, Copel JA. Source: The Journal of Maternal-Fetal Medicine. 1997 July-August; 6(4): 206-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9260116

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Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients. Author(s): Djamali A, Becker YT, Simmons WD, Johnson CA, Premasathian N, Becker BN. Source: Transplantation. 2003 September 15; 76(5): 816-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501860

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Increasing the hematocrit has a beneficial effect on quality of life and is safe in selected hemodialysis patients. Spanish Cooperative Renal Patients Quality of Life Study Group of the Spanish Society of Nephrology. Author(s): Moreno F, Sanz-Guajardo D, Lopez-Gomez JM, Jofre R, Valderrabano F. Source: Journal of the American Society of Nephrology : Jasn. 2000 February; 11(2): 33542. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10665941

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Influence of baseline hematocrit and hemodilution on BOLD fMRI activation. Author(s): Levin JM, Frederick Bde B, Ross MH, Fox JF, von Rosenberg HL, Kaufman MJ, Lange N, Mendelson JH, Cohen BM, Renshaw PF. Source: Magnetic Resonance Imaging. 2001 October; 19(8): 1055-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11711229

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Influence of baseline hematocrit on between-subject BOLD signal change using gradient echo and asymmetric spin echo EPI. Author(s): Gustard S, Williams EJ, Hall LD, Pickard JD, Carpenter TA. Source: Magnetic Resonance Imaging. 2003 July; 21(6): 599-607. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915190

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Influence of fibrinogen and hematocrit on the early outcome of angioplasty in patients with PAOD. Author(s): Rudofsky G, Strubel G, Michler E, Kuegler C, Biro F. Source: Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists. 2004 April; 11(2): 125-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15056033

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Influence of hematocrit and platelet count on impedance and reactivity of whole blood for electrical aggregometry. Author(s): Muller MR, Salat A, Pulaki S, Stangl P, Ergun E, Schreiner W, Losert U, Wolner E. Source: Journal of Pharmacological and Toxicological Methods. 1995 September; 34(1): 17-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7496042

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Influence of hematocrit on hemostasis in continuous venovenous hemofiltration during acute renal failure. Author(s): Stefanidis I, Heintz B, Frank D, Mertens PR, Kierdorf HP. Source: Kidney International. Supplement. 1999 November; 72: S51-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10560806

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Interference of hematocrit in the tacrolimus II microparticle enzyme immunoassay. Author(s): Kuzuya T, Ogura Y, Motegi Y, Moriyama N, Nabeshima T. Source: Therapeutic Drug Monitoring. 2002 August; 24(4): 507-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12142635

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Intraoperative hematocrit and cardiopulmonary bypass. Author(s): Shuhaiber JH. Source: The Journal of Thoracic and Cardiovascular Surgery. 2004 April; 127(4): 1226-7; Author Reply 1227-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15052236

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Is a high hematocrit level good for patients with heart failure? Author(s): Sharma R, Kalra PR, Anker SD. Source: Journal of the American College of Cardiology. 2002 May 15; 39(10): 1703-4; Author Reply 1704-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12020504

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Is a high hematocrit value an independent risk factor for adverse outcome after coronary artery bypass grafting? Author(s): Graham A, O'Kane H. Source: The Journal of Thoracic and Cardiovascular Surgery. 1999 October; 118(4): 765-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10504651

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Is routine hemoglobin and hematocrit testing on admission to labor and delivery needed? Author(s): Sherard GB 3rd, Newton ER. Source: Obstetrics and Gynecology. 2001 December; 98(6): 1038-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11755550

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Is the evidence for high hematocrit targets valid? Author(s): Cotter DJ. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 February; 41(2): 520; Author Reply 521. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12552521

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Lack of value of routine postpartum hematocrit determination after vaginal delivery. Author(s): Nicol B, Croughan-Minihane M, Kilpatrick SJ. Source: Obstetrics and Gynecology. 1997 October; 90(4 Pt 1): 514-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9380307

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Lactate measured in diluted and undiluted whole blood and plasma: comparison of methods and effect of hematocrit. Author(s): Toffaletti J, Hammes ME, Gray R, Lineberry B, Abrams B. Source: Clinical Chemistry. 1992 December; 38(12): 2430-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1458580

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Letter: Hematocrit unchanged by hemodilution. Author(s): Beautyman W, Bills T. Source: The New England Journal of Medicine. 1975 July 3; 293(1): 45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1128632

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Letter: Hematocrit unchanged by hemodilution. Author(s): Nerrill JM. Source: The New England Journal of Medicine. 1975 April 3; 292(14): 754. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1113789

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Levels of lead in blood and hematocrit: implications for the evaluation of the newborn and anemic patient. Author(s): Kochen JA, Greener Y. Source: Pediatric Research. 1973 November; 7(11): 937-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4749008

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Long-term effects of radium exposure in female dial workers: hematocrit and blood pressure. Author(s): Polednak AP. Source: Environmental Research. 1977 April; 13(2): 237-49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=862596

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Losartan reduces hematocrit in patients with chronic obstructive pulmonary disease and secondary erythrocytosis. Author(s): Vlahakos DV, Marathias KP, Kosmas EN. Source: Annals of Internal Medicine. 2001 March 6; 134(5): 426-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11242510

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Losartan, an angiotensin II type 1 receptor antagonist, lowers hematocrit in posttransplant erythrocytosis. Author(s): Julian BA, Brantley RR Jr, Barker CV, Stopka T, Gaston RS, Curtis JJ, Lee JY, Prchal JT. Source: Journal of the American Society of Nephrology : Jasn. 1998 June; 9(6): 1104-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9621296

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Lower hematocrit levels in blacks are not due to diet or socioeconomic factors. Author(s): Garn SM. Source: Pediatrics. 1981 April; 67(4): 580. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7254983

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Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Author(s): DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, Forest RJ, Pieroni JW, Warren CS, Bogosian ME, Krumholz CF, Clark C, Clough RA, Weldner PW, Lahey SJ, Leavitt BJ, Marrin CA, Charlesworth DC, Marshall P, O'Connor GT. Source: The Annals of Thoracic Surgery. 2001 March; 71(3): 769-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11269449

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Mapping genes controlling hematocrit in the spontaneously hypertensive rat. Author(s): Pravenec M, Zidek V, Zdobinska M, Kren V, Krenova D, Bottger A, van Zutphen LF, Wang J, St Lezin E. Source: Mammalian Genome : Official Journal of the International Mammalian Genome Society. 1997 June; 8(6): 387-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9166579

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Maternal cigarette smoking and fetal oxygen transport: a study of P50, 2,3diphosphoglycerate, total hemoglobin, hematocrit, and type F hemoglobin in fetal blood. Author(s): Bureau MA, Shapcott D, Berthiaume Y, Monette J, Blouin D, Blanchard P, Begin R. Source: Pediatrics. 1983 July; 72(1): 22-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6191270

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Maternal hematocrit and albumin as predictors of intrauterine growth retardation and preterm delivery. Author(s): Forest JC, Masse J, Moutquin JM. Source: Clinical Biochemistry. 1996 December; 29(6): 563-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8939404

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Maternal hematocrit and premature labor. Author(s): Goodlin RC. Source: American Journal of Obstetrics and Gynecology. 1989 December; 161(6 Pt 1): 1750-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2631724

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Mathematical modeling of carbon monoxide exposures from anesthetic breakdown: effect of subject size, hematocrit, fraction of inspired oxygen, and quantity of carbon monoxide. Author(s): Woehlck HJ, Mei D, Dunning MB 3rd, Ruiz F. Source: Anesthesiology. 2001 March; 94(3): 457-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11374606

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Measurement of regional cerebral plasma pool and hematocrit with copper-62-labeled HSA-DTS. Author(s): Okazawa H, Yonekura Y, Fujibayashi Y, Yamauchi H, Ishizu K, Nishizawa S, Magata Y, Tamaki N, Fukuyama H, Yokoyama A, Konishi J. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 1996 July; 37(7): 1080-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8965173

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Mode of delivery and neonatal hematocrit. Author(s): Lubetzky R, Ben-Shachar S, Mimouni FB, Dollberg S. Source: American Journal of Perinatology. 2000; 17(3): 163-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11012142

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Modeling the frequency dependence (5-120 MHz) of ultrasound backscattering by red cell aggregates in shear flow at a normal hematocrit. Author(s): Fontaine I, Cloutier G. Source: The Journal of the Acoustical Society of America. 2003 May; 113(5): 2893-900. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765406

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Neonatal hematocrit and maternal glycemic control in insulin-dependent diabetes. Author(s): Green DW, Khoury J, Mimouni F. Source: The Journal of Pediatrics. 1992 February; 120(2 Pt 1): 302-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1735833

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Neonatal polycythemia: II. Plasma, blood and red cell volume estimates in relation to hematocrit levels and quality of intrauterine growth. Author(s): Brans YW, Shannon DL, Ramamurthy RS. Source: Pediatrics. 1981 August; 68(2): 175-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7196569

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Nomograms for the prediction of patient's plasma volume in plasma exchange therapy from height, weight, and hematocrit. Author(s): Sprenger KB, Huber K, Kratz W, Henze E. Source: Journal of Clinical Apheresis. 1987; 3(3): 185-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3558344

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Nonequivalence of automated and manual hematocrit and erythrocytic indices. Author(s): Fairbanks VF. Source: American Journal of Clinical Pathology. 1980 January; 73(1): 55-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7352424

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Nonhemorrhagic decrements in hematocrit values after percutaneous renal biopsy. Author(s): Bolton WK. Source: Jama : the Journal of the American Medical Association. 1977 September 19; 238(12): 1266-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=578175

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Noninvasive determination of hemoglobin and hematocrit using a temperaturecontrolled localized reflectance tissue photometer. Author(s): Wu X, Yeh S, Jeng TW, Khalil OS. Source: Analytical Biochemistry. 2000 December 15; 287(2): 284-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11112275

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Noninvasive in vivo measurements of hematocrit. Author(s): Secomski W, Nowicki A, Guidi F, Tortoli P, Lewin PA. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2003 April; 22(4): 375-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12693621

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Noninvasive measurement of hematocrit by electrical admittance plethysmography technique. Author(s): Yamakoshi KI, Shimazu H, Togawa T, Fukuoka M, Ito H. Source: Ieee Transactions on Bio-Medical Engineering. 1980 March; 27(3): 156-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7358418

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Noninvasive transcutaneous access flow measurement before and after hemodialysis: impact of hematocrit and blood pressure. Author(s): Ronco C, Brendolan A, Crepaldi C, D'Intini V, Sergeyeva O, Levin NW. Source: Blood Purification. 2002; 20(4): 376-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12169848

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Normalization of hematocrit in a uremic patient receiving hemodialysis: role of erythropoietin. Author(s): Chandra M, Garcia JF, Miller ME, Waldbaum RS, Bluestone PA, McVicar M. Source: The Journal of Pediatrics. 1983 July; 103(1): 80-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6345743

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Normalization of hematocrit in hemodialysis patients does not affect silent ischemia. Author(s): Conlon PJ, Kovalik E, Schumm D, Minda S, Schwab SJ. Source: Renal Failure. 2000 March; 22(2): 205-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10803764

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Normalization of hematocrit in hemodialysis patients with cardiac disease does not increase blood pressure. Author(s): Conlon PJ, Kovalik E, Schumm D, Minda S, Schwab SJ. Source: Renal Failure. 2000; 22(4): 435-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10901181

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Normalization of hematocrit in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis: the role of erythropoietin. Author(s): Zappacosta AR, Caro J, Erslev A. Source: The American Journal of Medicine. 1982 January; 72(1): 53-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7058823

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Normalization of hematocrit in regular hemodialysis patients: the role of renal cyst formation. Author(s): Ono K, Kikawa K, Okamoto T, Matsuo H. Source: Trans Am Soc Artif Intern Organs. 1985; 31: 639-43. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3837523

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Normalization of hematocrit with recombinant human erythropoietin in chronic hemodialysis patients does not fully improve their exercise tolerance abilities. Author(s): Suzuki M, Tsutsui M, Yokoyama A, Hirasawa Y. Source: Artificial Organs. 1995 December; 19(12): 1258-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8967885

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Normalizing hematocrit in dialysis patients improves brain function. Author(s): Pickett JL, Theberge DC, Brown WS, Schweitzer SU, Nissenson AR. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1999 June; 33(6): 1122-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10352201

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Nutritional status of preschool children: hemoglobin, hematocrit, and plasma iron values. Author(s): Owen GM, Nelsen CE, Garry PJ. Source: The Journal of Pediatrics. 1970 May; 76(5): 761-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5440363

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Optical measurement of hematocrit and other biological constituents in renal therapy. Author(s): Steuer RR, Bell DA, Barrett LL. Source: Adv Ren Replace Ther. 1999 July; 6(3): 217-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10452704

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Optimal hematocrit and blood viscosity in secondary polycythemia as determined from cerebral blood flow. Author(s): Menon D, York EL, Bornstein RA, Jones RL, Sproule BJ. Source: Clinical and Investigative Medicine. Medecine Clinique Et Experimentale. 1981; 4(2): 117-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7285399

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Optimal hematocrit for adult cardiopulmonary bypass. Author(s): Jonas RA. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2001 October; 15(5): 672. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11688018

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Optimal hematocrit for hemodialysis. Author(s): Nissenson AR. Source: Current Opinion in Nephrology and Hypertension. 1997 November; 6(6): 524-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9375264

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Optimal hematocrit for the maximum oxygen delivery to the brain with recombinant human erythropoietin in hemodialysis patients. Author(s): Hirakata H, Kanai H, Fukuda K, Tsuruya K, Ishida I, Kubo M, Hirano T, Hirakata E, Kuwabara Y, Fujishima M. Source: Clinical Nephrology. 2000 May; 53(5): 354-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11305808

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Optimal hematocrit in patients on dialysis therapy. Author(s): Nissenson AR. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1998 December; 32(6 Suppl 4): S142-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9892381

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Optimal hematocrit in patients with intermittent claudication. Exercise-induced muscle tissue oxygen pressure after stepwise hemodilution. Author(s): Hoffkes HG, Saeger-Lorenz K, Ehrly AM. Source: Acta Medica Austriaca. 1991; 18 Suppl 1: 16-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1950385

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Optimal hematocrit value in critically ill postoperative patients. Author(s): Czer LS, Shoemaker WC. Source: Surg Gynecol Obstet. 1978 September; 147(3): 363-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=684587

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Optimal hematologic variables for oxygen transport, including P50, hemoglobin cooperativity, hematocrit, acid-base status, and cardiac function. Author(s): Winslow RM. Source: Biomater Artif Cells Artif Organs. 1988; 16(1-3): 149-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3140916

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Osmolality- and hematocrit-mediated flow behavior of RBC suspensions in 33 micrometer ID tubes. Author(s): McKay CB, Meiselman HJ. Source: Biorheology. 1989; 26(4): 863-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2611376

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Overnight decrease in hematocrit after nasal CPAP treatment in patients with OSA. Author(s): Krieger J, Sforza E, Barthelmebs M, Imbs JL, Kurtz D. Source: Chest. 1990 March; 97(3): 729-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2407456

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Oxygen transport on Mount Everest: the effects of increased hematocrit on maximal O2 transport. Author(s): Cerretelli P. Source: Advances in Experimental Medicine and Biology. 1976; 75: 113-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1015398

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Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy. Author(s): Hogue CW Jr, Goodnough LT, Monk TG. Source: Transfusion. 1998 October; 38(10): 924-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9767742

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Perioperative transfusions associated with colorectal cancer surgery: clinical judgment versus the hematocrit. Author(s): Tartter PI, Quintero S, Barron D. Source: World Journal of Surgery. 1986 June; 10(3): 516-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3727613

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Platelet adhesion to subendothelium--effect of shear rate, hematocrit and platelet count on the dynamic equilibrium between platelets adhering to and detaching from the surface. Author(s): Remuzzi A, Languino LR, Costantini V, Guardabasso V, de Gaetano G, Dejana E. Source: Thrombosis and Haemostasis. 1985 December 17; 54(4): 857-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4089819

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Polycystic kidney disease in patients on the renal transplant waiting list: trends in hematocrit and survival. Author(s): Abbott KC, Agodoa LY. Source: Bmc Nephrology [electronic Resource]. 2002 August 23; 3(1): 7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12194700

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Polycythemia of the preterm and full-term newborn infant: relationship between hematocrit and gestational age, total blood solutes, reticulocyte count, and blood pH. Author(s): Carmi D, Wolach B, Dolfin T, Merlob P. Source: Biology of the Neonate. 1992; 61(3): 173-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1610945

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Poor predictive value of hematocrit and hemodynamic parameters for erythrocyte deficits after extensive elective vascular operations. Author(s): Cordts PR, LaMorte WW, Fisher JB, DelGuercio C, Niehoff J, Pivacek LE, Dennis RC, Siebens H, Georgio A, Valeri CR, et al. Source: Surg Gynecol Obstet. 1992 September; 175(3): 243-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1514159

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Possible role of erythrocyte sedimentation rate, hematocrit and oxygen supply of tissue in clinical investigations. Author(s): Koch HJ. Source: Cardiology. 1995; 86(2): 177-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7605446

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Postnatal alteration in hematocrit and viscosity in normal and polycythemic infants. Author(s): Ramamurthy RS, Berlanga M. Source: The Journal of Pediatrics. 1987 June; 110(6): 929-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3585609

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Practice trends in the management of low hematocrit in the acute rehabilitation setting. Author(s): Diamond PT, Julian DM. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2001 November; 80(11): 816-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805452

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Prediagnostic hematocrit values and subsequent cancer risk. Author(s): Kato I, Nomura A, Stemmermann GN, Chyou PH. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 1991 November-December; 1(1): 51-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1845170

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Predialysis versus postdialysis hematocrit evaluation during erythropoietin therapy. Author(s): Movilli E, Pertica N, Camerini C, Cancarini GC, Brunori G, Scolari F, Maiorca R. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 April; 39(4): 850-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11920353

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Predicting the severity of acute pancreatitis: is it time to concentrate on the hematocrit? Author(s): Baron TH. Source: The American Journal of Gastroenterology. 2001 July; 96(7): 1960-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11467620

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Prediction of hematocrit decline after intravascular fetal transfusion. Author(s): MacGregor SN, Socol ML, Pielet BW, Sholl JS, Silver RK. Source: American Journal of Obstetrics and Gynecology. 1989 December; 161(6 Pt 1): 1491-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2513718

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Predictive value of nutritional markers (albumin, creatinine, cholesterol, and hematocrit) for patients on dialysis for up to 30 years. Author(s): Avram MM, Bonomini LV, Sreedhara R, Mittman N. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1996 December; 28(6): 910-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8957046

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Pretreatment hematocrit as an independent prognostic variable in Hodgkin's disease. Author(s): Jaffe HS, Cadman EC, Farber LR, Bertino JR. Source: Blood. 1986 August; 68(2): 562-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3730617

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Primary hemostasis in hemodilution--1) Hematocrit. Author(s): Dietrich G, Kretschmer V, Orth D, Haupt W. Source: Infusionstherapie. 1990 August; 17(4): 212-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2210863

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Pro: a hematocrit of 20% is adequate to wean a patient from cardiopulmonary bypass. Author(s): Martineau RJ. Source: Journal of Cardiothoracic and Vascular Anesthesia. 1996 February; 10(2): 291-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8850413

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Prospective crossover study of the effect of phlebotomy and intravenous crystalloid on hematocrit. Author(s): Kass LE, Tien IY, Ushkow BS, Snyder HS. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1997 March; 4(3): 198-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9063546

Studies

71

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Prothrombotic effects of environmental stress: changes in platelet function, hematocrit, and total plasma protein. Author(s): Patterson SM, Krantz DS, Gottdiener JS, Hecht G, Vargot S, Goldstein DS. Source: Psychosomatic Medicine. 1995 November-December; 57(6): 592-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8600486

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Pulsed Doppler flow-velocity waveforms in the prediction of fetal hematocrit of the severely isoimmunized pregnancy. Author(s): Copel JA, Grannum PA, Green JJ, Belanger K, Hobbins JC. Source: American Journal of Obstetrics and Gynecology. 1989 August; 161(2): 341-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2504040

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Quality assurance in the intensive care unit--monitoring hematocrit orders. Author(s): Morse EE, Gordon S, Isidro A, Pisciotto P. Source: Ann Clin Lab Sci. 1990 September-October; 20(5): 319-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2256659

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Quality of life and hematocrit level. Author(s): Levin NW. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1992 July; 20(1 Suppl 1): 16-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1626552

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Quantification of the effect of altering hematocrit and temperature on blood viscosity. Author(s): Stammers AH, Vang SN, Mejak BL, Rauch ED. Source: J Extra Corpor Technol. 2003 June; 35(2): 143-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12939024

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Quick measurement of hematocrit and erythrocyte sedimentation-rate by means of a density tracking method. Author(s): Schneditz D, Kenner T, Gallasch E, Rainer F. Source: Blut. 1987 September; 55(3): 153-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3620711

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Rapidly rising pretransplant hematocrit and hematocrit > or = 30% signal independent risks for delayed function and primary nonfunction in primary cadaveric renal transplantation. Author(s): Schmidt R, Kupin W, Dumler F, Venkat KK, Mozes M. Source: Transplantation Proceedings. 1993 February; 25(1 Pt 2): 1064-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8442044

72

Hematocrit

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Re: Lankisch et al.: the role of hematocrit as a prognostic factor in newly diagnosed acute pancreatitis. Author(s): Shuhaiber J. Source: The American Journal of Gastroenterology. 2002 July; 97(7): 1839; Author Reply 1839-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12135048

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Readjustment of hematocrit values after packed red cell transfusion in the neonate. Author(s): Sekhsaria S, Fomufod A. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1991 June; 11(2): 161-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1890477

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Recoveries of phenylalanine from two sets of dried-blood-spot reference materials: prediction from hematocrit, spot volume, and paper matrix. Author(s): Adam BW, Alexander JR, Smith SJ, Chace DH, Loeber JG, Elvers LH, Hannon WH. Source: Clinical Chemistry. 2000 January; 46(1): 126-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10620584

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Reducing symptoms during hemodialysis by continuously monitoring the hematocrit. Author(s): Steuer RR, Leypoldt JK, Cheung AK, Senekjian HO, Conis JM. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1996 April; 27(4): 525-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8678063

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Reference range of hematocrit in the elderly with respect to altitude. Author(s): Miao G. Source: Clinical Hemorheology and Microcirculation. 2003; 29(1): 25-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14561901

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Reference value of presenile human hematocrit and geographical factors. Author(s): Miao G, Qingsheng Y, Zhiyuan R, Hongxian Z, Yanfang Z, Shuyan Y. Source: Journal of Clinical Laboratory Analysis. 2002; 16(1): 26-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11835527

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Relation between blood pressure and hematocrit in anephric patients treated by means of recombinant DNA human erythropoietin. Author(s): Iorio L, Saltarelli G, Nacca RG, Violi F. Source: Nephron. 1996; 72(2): 373-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8684581

Studies

73

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Relation between serum cholesterol and hematocrit. Author(s): Kochar MS, Paka S, Kim MJ. Source: Jama : the Journal of the American Medical Association. 1992 February 26; 267(8): 1071. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1735919

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Relation of hematocrit values to coronary heart disease, arterial hypertension, and respiratory impairment in occupational and population groups of the Athens area. Author(s): Goubali A, Voukiklaris G, Kritsikis S, Viliotou F, Stamatis D. Source: Angiology. 1995 August; 46(8): 719-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7639419

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Relationship between area under the concentration versus time curve of cyclosporin A, creatinine clearance, hematocrit value, and other clinical factors in Japanese renal transplant patients. Author(s): Shibata N, Hoshino N, Minouchi T, Yamaji A, Park K, Tomoyoshi T, Abe H, Kodama M. Source: Int J Clin Pharmacol Ther. 1998 April; 36(4): 202-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9587046

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Relationship between erythrocyte deformability and hematocrit in maternal and cord blood. Author(s): Lurie S. Source: American Journal of Perinatology. 1996 May; 13(4): 255. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8724730

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Relationship between hematocrit and blood pressure: implications for primary hypertension. Author(s): Cirillo M, Capasso G, DeSanto NG. Source: Nephron. 1993; 65(4): 505-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8302401

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Relationship between hematocrit and renal function in men and women. Author(s): Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Source: Kidney International. 2001 February; 59(2): 725-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11168955

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Relationship between hematocrit, primary hemostasis, and cardiovascular disease in athletes. Author(s): Lippi G, Manzato F, Franchini M, Guidi G. Source: American Heart Journal. 2002 November; 144(5): E14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12422165

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Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study. Author(s): Diamond PT, Gale SD, Evans BA. Source: Archives of Physical Medicine and Rehabilitation. 2003 July; 84(7): 964-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12881817

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Relationships between plasma atrial natriuretic peptide concentrations and hemodynamics and hematocrit in patients with cirrhosis. Author(s): Moreau R, Hadengue A, Pussard E, Soubrane O, Sogni P, Gaudin C, Lebrec D. Source: Hepatology (Baltimore, Md.). 1991 December; 14(6): 1035-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1835708

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Role of hematocrit in the recruitment of pulmonary diffusing capacity: comparison of human and dog. Author(s): Wu EY, Ramanathan M, Hsia CC. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1996 March; 80(3): 101420. Erratum In: J Appl Physiol 1996 June; 80(6): 1849. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8964719

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Roles of hematocrit and fibrinogen in red cell aggregation determined by ultrasonic scattering properties. Author(s): Kitamura H, Sigel B, Machi J, Feleppa EJ, Sokil-Melgar J, Kalisz A, Justin J. Source: Ultrasound in Medicine & Biology. 1995; 21(6): 827-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8571470

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Routine hematocrit after elective gynecologic surgery. Author(s): Kohli N, Mallipeddi PK, Neff JM, Sze EH, Roat TW. Source: Obstetrics and Gynecology. 2000 June; 95(6 Pt 1): 847-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10831979

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Safe hemoglobin or hematocrit levels in surgical patients. Author(s): Lundsgaard-Hansen P. Source: World Journal of Surgery. 1996 November-December; 20(9): 1182-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8864079

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Screening and evaluation of blood donors with upper-limit hematocrit levels. Author(s): Zanella A, Silvani C, Banfi P, Bellone A, Fumagalli G, Sirchia G. Source: Transfusion. 1987 November-December; 27(6): 485-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3686658

Studies

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Selective cerebral hematocrit decrease in the centrum semiovale after carotid artery occlusion: a PET study. Author(s): Yamauchi H, Fukuyama H, Nagahama Y, Katsumi Y, Hayashi T, Okazawa H, Yonekura Y. Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 1999 January; 19(1): 10914. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9886361

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Sequence-based polymorphisms in members of the apoptosis Bcl-2 gene family and their association with hematocrit level. Author(s): Zeng SM, Yankowitz J, Widness JA, Strauss RG. Source: J Gend Specif Med. 2003; 6(4): 36-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14714449

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Serum ferritin, hematocrit and mean corpuscular volume in hemodialysis. Author(s): Goldwasser P, Koutelos T, Abraham S, Avram MM. Source: Nephron. 1994; 67(1): 30-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8052364

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Sex-related and age-related differences in platelet function in vitro: influence of hematocrit. Author(s): Kasjanovova D, Adameckova D, Gratzlova J, Hegyi L. Source: Mechanisms of Ageing and Development. 1993 October 1; 71(1-2): 103-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8309275

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Shear rate and hematocrit dependence of fluorescence from retinal vessels in fluorescein angiography. Author(s): van den Biesen PR, Jongsma FH, Tangelder GJ, Slaaf DW. Source: Annals of Biomedical Engineering. 1994 September-October; 22(5): 456-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7825748

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Short-term effects of intramuscular and transdermal testosterone on bone turnover, prostate symptoms, cholesterol, and hematocrit in men over age 70 with low testosterone levels. Author(s): Kenny AM, Prestwood KM, Raisz LG. Source: Endocrine Research. 2000 May; 26(2): 153-68. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10921445

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Should hemoglobin-hematocrit be routinely measured in children undergoing minor surgery? Author(s): Mayhew JF, Kaplan RM. Source: Anesthesiology. 1990 June; 72(6): 1100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2350030

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Should the hematocrit (hemoglobin) be normalized in Pre-ESRD or dialysis patients? Yes! Author(s): Besarab A, Aslam M. Source: Blood Purification. 2001; 19(2): 168-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11150804

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Should the hematocrit be normalized in dialysis and in pre-ESRD patients? Author(s): Macdougall IC. Source: Blood Purification. 2001; 19(2): 157-67. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11150803

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Significance of low hematocrit levels in asymptomatic young adults: results of 15 years follow-up. Author(s): Froom P, Benbassat J, Kiwelowicz A, Erel J, Davidson B, Ribak J. Source: Aviation, Space, and Environmental Medicine. 1999 October; 70(10): 983-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10519476

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Significance of the initial spun hematocrit in trauma patients. Author(s): Snyder HS. Source: The American Journal of Emergency Medicine. 1998 March; 16(2): 150-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9517690

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Significant decrease in hemoglobin and hematocrit levels in a virologically controlled HIV-infected patient. Pure red cell aplasia (PRCA) caused by human parvovirus B19. Author(s): Naval-Srinivas RM, Church LW. Source: Aids Read. 2003 April; 13(4): 189. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12741369

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Simultaneous determination of hematocrit, aggregate size and sedimentation velocity by He-Ne laser scattering. Author(s): Muralidharan E. Source: Biorheology. 1994 September-October; 31(5): 587-99. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7833459

Studies

77

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Sonolysis of Albunex-supplemented, 40% hematocrit human erythrocytes by pulsed 1-MHz ultrasound: pulse number, pulse duration and exposure vessel rotation dependence. Author(s): Brayman AA, Miller MW. Source: Ultrasound in Medicine & Biology. 1999 February; 25(2): 307-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10320320

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Spleen emptying and venous hematocrit in humans during exercise. Author(s): Laub M, Hvid-Jacobsen K, Hovind P, Kanstrup IL, Christensen NJ, Nielsen SL. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1993 March; 74(3): 1024-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8387068

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Subcutaneous erythropoietin results in lower dose and equivalent hematocrit levels among adult hemodialysis patients: Results from the 1998 End-Stage Renal Disease Core Indicators Project. Author(s): McClellan WM, Frankenfield DL, Wish JB, Rocco MV, Johnson CA, Owen WF Jr; End-Stage Renal Disease Core Indicators Work Group. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2001 May; 37(5): E36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11325701

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Subtle brain abnormalities in children with sickle cell disease: relationship to blood hematocrit. Author(s): Rivera JP. Source: Annals of Neurology. 2000 February; 47(2): 279-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10665509

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Subtle brain abnormalities in children with sickle cell disease: relationship to blood hematocrit. Author(s): Steen RG, Xiong X, Mulhern RK, Langston JW, Wang WC. Source: Annals of Neurology. 1999 March; 45(3): 279-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10072041

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The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Author(s): Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. Source: The Annals of Thoracic Surgery. 2003 September; 76(3): 784-91; Discussion 792. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963200

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The clinical efficacy of higher hematocrit levels in children with chronic renal insufficiency and those undergoing dialysis. Author(s): Yorgin PD, Belson A, Al-Uzri AY, Alexander SR. Source: Semin Nephrol. 2001 September; 21(5): 451-62. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11559886

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The effect of hematocrit on cerebral blood flow velocity in neonates and infants undergoing deep hypothermic cardiopulmonary bypass. Author(s): Gruber EM, Jonas RA, Newburger JW, Zurakowski D, Hansen DD, Laussen PC. Source: Anesthesia and Analgesia. 1999 August; 89(2): 322-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10439741

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The effect of hematocrit on the efficiency of hemodialysis in cases of chronic renal failure. Author(s): Nand N, Arya S, Mahajan SK, Sharma M, Aggarwal HK, Kumar P. Source: Indian Journal of Medical Sciences. 1996 February; 50(2): 29-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8979630

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The effect of parathyroidectomy on hematocrit and erythropoietin dose in patients on hemodialysis. Author(s): Rault R, Magnone M. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 1996 September-October; 42(5): M901-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8945016

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The hematocrit-corrected erythrocyte sedimentation rate can be useful in diagnosing inflammation in hemodialysis patients. Author(s): Borawski J, Mysliwiec M. Source: Nephron. 2001 December; 89(4): 381-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11721153

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The influence of maternal hematocrit on placental development from the first to the second trimesters of pregnancy. Author(s): Michailidis GD, Morris RW, Mamopoulos A, Papageorgiou P, Economides DL. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 October; 20(4): 351-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12383316

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The minimum discard volume: accurate analysis of peripheral hematocrit. Author(s): Yucha CB, DeAngelo E. Source: Journal of Intravenous Nursing : the Official Publication of the Intravenous Nurses Society. 1996 May-June; 19(3): 141-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8788832

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The paradox of hematocrit in exercise physiology: which is the "normal" range from an hemorheologist's viewpoint? Author(s): Brun JF, Bouchahda C, Chaze D, Benhaddad AA, Micallef JP, Mercier J. Source: Clinical Hemorheology and Microcirculation. 2000; 22(4): 287-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11081466

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The relationship between hematocrit and bleeding time in very low birth weight infants during the first week of life. Author(s): Sola MC, del Vecchio A, Edwards TJ, Suttner D, Hutson AD, Christensen RD. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2001 September; 21(6): 368-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11593370

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The volume of blood shed during the bleeding time correlates with the peripheral venous hematocrit. Author(s): Crowley JP, Metzger JB, Valeri CR. Source: American Journal of Clinical Pathology. 1997 November; 108(5): 579-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9353098

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Transient blood/plasma density and hematocrit effects after passive (sitting) thermoneutral water immersion in men. Author(s): Hinghofer-Szalkay H, Konig EM, Gunga HC. Source: Physiologist. 1993 February; 36(1 Suppl): S116-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11538506

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Treatment with recombinant human erythropoietin induces a moderate rise in hematocrit and thrombin antithrombin in healthy subjects. Author(s): Clyne N, Berglund B, Egberg N. Source: Thrombosis Research. 1995 July 1; 79(1): 125-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7495099

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Ultrasonic backscatter from flowing whole blood. I: Dependence on shear rate and hematocrit. Author(s): Yuan YW, Shung KK. Source: The Journal of the Acoustical Society of America. 1988 July; 84(1): 52-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3411055

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Ultrasonic energy backscattered from blood. An experimental determination of the variation of sound energy with hematocrit. Author(s): Borders SE, Fronek A, Kemper WS, Franklin D. Source: Annals of Biomedical Engineering. 1978 June; 6(2): 83-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=152591

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Ultrasonic measurement of sound velocity in whole blood. A comparison between an ultrasonic method and the conventional packed-cell-volume test for hematocrit determination. Author(s): Bakke T, Gytre T, Haagensen A, Giezendanner L. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1975 September; 35(5): 473-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1188300

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Underestimation of plasma volume changes in humans by hematocrit/hemoglobin method. Author(s): Johansen LB, Videbaek R, Hammerum M, Norsk P. Source: The American Journal of Physiology. 1998 January; 274(1 Pt 2): R126-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9458908

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Urinary trypsinogen activation peptide is more accurate than hematocrit in determining severity in patients with acute pancreatitis: a prospective study. Author(s): Khan Z, Vlodov J, Horovitz J, Jose RM, Iswara K, Smotkin J, Brown A, Tenner S. Source: The American Journal of Gastroenterology. 2002 August; 97(8): 1973-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12190163

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Use of fetal scalp hematocrit in the diagnosis of severe hemorrhage from vasa previa. Author(s): Silva PD, Stoskopf CG, Keegan KA, Murata Y. Source: American Journal of Obstetrics and Gynecology. 1985 October 1; 153(3): 307-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4050896

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Use of flow cytometry to extend and improve in vivo determinations of microvessel hematocrit and cell flux. Author(s): Sweeney TE, Sarelius IH. Source: Microvascular Research. 1986 March; 31(2): 184-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3702768

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Use of hematocrit changes as an indicator of blood loss in adult trauma patients who receive intravenous fluids. Author(s): Oman KS. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1995 October; 21(5): 395-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7500564

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Use of hematocrit values in evaluation of red cell survival with chromium-51. Author(s): Milam JD, Samuels MS, Hidalgo JU, Burke RA. Source: American Journal of Clinical Pathology. 1966 January; 45(1): 56-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5904205

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Use of theophylline to control hematocrit in respiratory polycythemia. Author(s): Souweine B, Serre AF, Fialip J, Jimenez C, Philippe P. Source: The Annals of Pharmacotherapy. 1993 July-August; 27(7-8): 978. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8364287

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Variable responses of whole blood to heparin: hematocrit as an important factor. Author(s): Perkash A. Source: American Journal of Clinical Pathology. 1979 July; 72(1): 132. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=453105

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Variation in blood lead and hematocrit levels during pregnancy in a socioeconomically disadvantaged population. Author(s): Schell LM, Czerwinski S, Stark AD, Parsons PJ, Gomez M, Samelson R. Source: Archives of Environmental Health. 2000 March-April; 55(2): 134-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10821515

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Variations in hematocrit induced by hemodialysis. Author(s): Di Iorio B, Bellizzi V. Source: Blood Purification. 2001; 19(1): 68-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11114580

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Variations in white blood count, thromboxane B2 levels and hematocrit in chronic venous hypertension. Author(s): Guimaraes PC, Puech-Leao P, Netto BM, Wolosker N, Aun R, Yamamoto LU. Source: Rev Paul Med. 1998 May-June; 116(3): 1721-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9876450

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Velocity profiles of human blood at normal and reduced hematocrit in glass tubes up to 130 diameter. Author(s): Gaehtgens P, Meiselman HJ, Wayland H. Source: Microvascular Research. 1970 January; 2(1): 13-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5523911

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Venous and capillary blood hematocrit at rest and following submaximal exercise. Author(s): Fahey TD, Rolph R. Source: European Journal of Applied Physiology and Occupational Physiology. 1975 April 4; 34(2): 109-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1193086

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Venous and capillary hematocrit in newborn infants and placental transfusion. Author(s): Oh W, Lind J. Source: Acta Paediatr Scand. 1966 January; 55(1): 38-48. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5919472

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Viscosity of mixtures of sickle and normal red cells at varying hematocrit levels. Implications for transfusion. Author(s): Schmalzer EA, Lee JO, Brown AK, Usami S, Chien S. Source: Transfusion. 1987 May-June; 27(3): 228-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3590284

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Weekly subcutaneous erythropoietin maintains hematocrit in chronic hemodialysis patients. Author(s): Parker KP, Sands JM. Source: Journal of the American Society of Nephrology : Jasn. 1993 April; 3(10): 1717-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8318688

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What are the best temperature, flow, and hematocrit levels for pediatric cardiopulmonary bypass? Author(s): Corno AF. Source: The Journal of Thoracic and Cardiovascular Surgery. 2002 October; 124(4): 856-7; Author Reply 857. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12324753

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Whole body hematocrit: large vessel hematocrit ratio in hypertension. The effects of hypotensive drugs. Author(s): Hansen J, Ronnov-Jessen V. Source: Acta Med Scand. 1968 January-February; 183(1-2): 17-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5317775

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Whole-blood glucose testing at alternate sites: glucose values and hematocrit of capillary blood drawn from fingertip and forearm. Author(s): Lock JP, Szuts EZ, Malomo KJ, Anagnostopoulos A. Source: Diabetes Care. 2002 February; 25(2): 337-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11815506

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Whole-blood viscosity, hematocrit and plasma protein in normal subjects at different ages. Author(s): Ditzel J, Kampmann J. Source: Acta Physiologica Scandinavica. 1971 February; 81(2): 264-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4101667

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Why is erythropoietin made in the kidney? The kidney functions as a 'critmeter' to regulate the hematocrit. Author(s): Donnelly S. Source: Advances in Experimental Medicine and Biology. 2003; 543: 73-87. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14713115

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

Finding Nutrition Studies on Hematocrit 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 “hematocrit” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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

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

Alterations in skeletal muscle microvascular hematocrit with short-term reduced renal mass hypertension. Author(s): Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. Source: Frisbee, J C Lombard, J H Microvasc-Res. 2000 May; 59(3): 390-3 0026-2862

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nutrition

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

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

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

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to hematocrit 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 “hematocrit” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to hematocrit: •

“Antimalarial” medicinal plants and their impact on cell populations in various organs of mice. Author(s): Agomo PU, Idigo JC, Afolabi BM. Source: Afr J Med Med Sci. 1992 December; 21(2): 39-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1308080

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Comparison of conductivity measured hematocrit to microhematocrit. Author(s): Gotch F, Torres L, Evans M, Keen M, Metzner K, Westphal D, Polaschegg H. Source: Asaio Trans. 1991 July-September; 37(3): M138-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1751082

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Effect of circulating epinephrine on platelet function and hematocrit. Author(s): Kjeldsen SE, Weder AB, Egan B, Neubig R, Zweifler AJ, Julius S.

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Source: Hypertension. 1995 May; 25(5): 1096-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7737722 •

Increased red cell osmotic fragility and hematocrit after hyperbaric O2 exposure are related to acidosis. Author(s): Braisted JC, Harabin AL. Source: The Journal of Laboratory and Clinical Medicine. 1994 July; 124(1): 105-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8035092

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The effect of five-year zinc supplementation on serum zinc, serum cholesterol and hematocrit in persons randomly assigned to treatment group in the age-related eye disease study: AREDS Report No. 7. Author(s): Age-Related Eye Disease Study Research Group. Source: The Journal of Nutrition. 2002 April; 132(4): 697-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11925463

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The effect of N-acetylcysteine supplementation upon viral load, CD4, CD8, total lymphocyte count and hematocrit in individuals undergoing antiretroviral treatment. Author(s): Spada C, Treitinger A, Reis M, Masokawa IY, Verdi JC, Luiz MC, Silveira MV, Michelon CM, Avila-Junior S, Gil DO, Ostrowskyl S. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2002 May; 40(5): 452-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12113286

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The influence of l-carnitine supplementation on hematocrit and hemoglobin levels in patients with end stage renal failure on CAPD. Author(s): Sotirakopoulos N, Athanasiou G, Tsitsios T, Mavromatidis K. Source: Renal Failure. 2002 July; 24(4): 505-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12212830

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Vitamin B(6) therapy does not improve hematocrit in hemodialysis patients supplemented with iron and erythropoietin. Author(s): Weissgarten J, Modai D, Oz D, Chen Levy Z, Cohn M, Marcus O, Dishi V, Galperin E, Averbukh Z. Source: Nephron. 2001 April; 87(4): 328-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11287776

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to hematocrit; 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 Iron-Deficiency Anemia Source: Healthnotes, Inc.; www.healthnotes.com Sickle Cell Anemia Source: Healthnotes, Inc.; www.healthnotes.com

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Herbs and Supplements Panax Alternative names: Ginseng; Panax ginseng 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. PATENTS ON HEMATOCRIT 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 “hematocrit” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hematocrit, we have not necessarily excluded nonmedical patents in this bibliography.

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

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

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example of the type of information that you can expect to obtain from a patent search on hematocrit: •

Air gap for controlling sample absorption and hematocrit dependence Inventor(s): Coe; Matthew A. (La Mesa, CA), Nelson; Eric M. (San Clemente, CA) Assignee(s): Diabetes Diagnostics, Inc. (San Diego, CA) Patent Number: 6,656,741 Date filed: March 3, 1999 Abstract: A method and apparatus for controlling the absorption of a liquid sample through an absorbent layer (2) and reducing the effect of hematocrit by applying the sample on one side of the layer (2a) and providing an air gap (4c) on the opposite side, so that absorption is controlled by preventing the release of air from the air gap. Excerpt(s): The present invention relates to analyzing liquid samples and more specifically to controlling the absorption of a liquid sample by an absorbent layer, thereby reducing the effect of hematocrit. Test strips are widely available for conveniently analyzing liquid samples. Typically, a test strip has one or more layers of absorbent material containing chemical reagents. When the liquid sample is applied to the absorbent layers, the reagents react with the components of interest in the test sample. The resulting reaction can then be measured by a variety of means to yield a measurement of the components in the sample. For example, it is useful for certain diabetes patients to monitor the concentration of glucose in their blood. A glucose test strip can have an absorbent layer containing reagents that react with glucose present in the blood sample. When a patient applies a blood sample to the absorbent layer, the reagents then react with the glucose in the sample. If the reaction results in a detectable color change--turning the absorbent layer from colorless to dark blue, for example--the reaction can then be measured, and the amount of color produced related to the concentration of glucose in the blood sample. Web site: http://www.delphion.com/details?pn=US06656741__

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Assembly for analyzing blood samples Inventor(s): Brinster; Wayne L. (Kinnelon, NJ), Levine; Robert A. (Guilford, CT), Wardlaw; Stephen C. (Lyme, CT) Assignee(s): Becton Dickinson and Company (Franklin Lakes, NJ) Patent Number: 6,365,104 Date filed: June 25, 1999 Abstract: An improved system can be used to examine a centrifuged sample of anticoagulated whole blood for evidence of blood borne rare events such as: circulating cancer cells; malarial parasites; other hemato-parasites; bacteria; and the like; and can also be used in the measurement of hematocrit and hemoglobin, as well as white cell and platelet count values in the centrifuged blood sample. The system includes a transparent blood sample tube and an insert that is placed in the tube. The insert floats on the packed erythrocyte layer in the centrifuged blood sample, and expands all of the layers above the packed erythrocyte layer. The insert also forces any blood borne rare events to the periphery of the blood sample in the tube where such events can be detected through the tube wall. The bottom end of the tube is closed by a closure which

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includes an outer sheath and an inner plug that projects up into the tube bore to a degree necessary to elevate at least the upper portion of the packed erythrocyte layer into which the insert has settled sufficiently so as to be detectable above the cap, and preferably examinable microscopically after the blood sample has been centrifuged. The outer sheath of the tube closure includes an outer annular surface which is provided with sensible indicia. The indicia are operable to enable an instrument or a person examining the sample to rotate the tube, and to determine the circumferential location in the tube of any suspicious objects noted in the blood sample. Excerpt(s): This invention relates to the analysis of centrifuged anticoagulated blood samples which are contained in a centrifuge tube having a blood constituent-elongating insert therein. More particularly, this invention relates to a centrifuge tube assembly which is useful for measuring various blood parameters such as hematocrit, and which is also designed to examine the blood sample for evidence of rare events such as: bloodborne cancer cells; malarial parasites; other hemato-parasites; bacteria; or the like. The blood sample can also be analyzed in the tube for hematocrit and hemoglobin values as well as white cell and platelet counts. U.S. Pat. No. 4,027,660 granted to Stephen C. Wardlaw et al describes a method and paraphernalia for use in measuring differential white cell and platelet counts in a centrifuged sample of anticoagulated whole blood. The procedure described in this patent suggests that a scale be used to measure the length of physically expanded white cell and platelet layers, and that a table be used to convert the measured layer lengths to definitive blood cell and platelet layer counts. U.S. Pat. Nos. 4,156,570 and 4,558,947 granted to Stephen C. Wardlaw disclose instruments which are used to measure cell and platelet counts in centrifugal blood samples contained in the aforesaid tube-insert paraphernalia, which instruments include microprocessor controllers that are programmed to automatically convert measured erythrocyte and platelet layer band lengths into cell and platelet counts. U.S. Pat. No. 4,259,012 granted to Stephen C. Wardlaw, and U.S. Pat. No. 5,132,087 granted to Kristen L. Manion et al describe devices for measuring white cell, platelet and hematocrit counts, which devices do not require conversion tables or microprocessor controllers. U.S. Pat. No. 4,209,226 granted to Stephen C. Wardlaw et al describes an optical viewing instrument which includes a capillary tube and a holder which includes a slot for containing the capillary tube. U.S. Pat. No. 4,190,328 granted to Robert A. Levine et al describes a process for the detection of blood-borne parasites wherein a centrifuge tube with an insert are used to trap blood-borne parasites between the tube and the insert so that the parasites will be visible under magnification through the tube. The aforesaid group of patents all relate to inventions which utilize a tube and insert combination to either measure blood sample parameters quantitatively; or detect the presence or absence of blood-borne parasites, such as malarial parasites, microfilaria, or the like. In the latter case, the blood samples in the tubes are examined immersed in oil and under magnification, typically with an epi-illuminating UV or fluorescence microscope such as described in U.S. Pat. No. 5,198,927, granted Mar. 30, 1993 to R. R. Rathbone et al; and U.S. Pat. No. 5,349,468, granted Sep. 20, 1994 to R. R. Rathbone et al. When the centrifuged blood sample is being analyzed for parasites, or for blood borne rare events, there is currently no way to positively ascertain the location of the evidence of rare events in the centrifuge tube. The reason for this fact is that analysis of the blood sample in the tubes requires that the tubes be rotated so that the blood layers trapped between the tube wall and the insert can be thoroughly examined throughout the entire three hundred sixty degree circumference of the tube. Web site: http://www.delphion.com/details?pn=US06365104__

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Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit Inventor(s): Cairone; Robert (Crystal Lake, IL), Foley; John T (Wheeling, IL), Patno; Timothy J (Evanston, IL), Pierce; Jennifer A (Arlington Heights, IL) Assignee(s): Baxter International Inc. (Deerfield, IL) Patent Number: 6,730,054 Date filed: February 20, 2001 Abstract: Blood processing systems and methods convey blood drawn from a donor through a blood processing circuit to separate the blood into at least one targeted blood component for collection. The systems and methods derive an estimated effect of the procedure upon the donor. The estimated effect can be expressed in terms of a net blood fluid volume loss, or as a hematocrit of the donor after completion of the desired blood collection procedure. The systems and methods present the estimated effect to an operator for viewing, reading, or offloading. Excerpt(s): The invention relates to centrifugal blood processing systems and apparatus. Certain therapies transfuse large volumes of blood components. For example, some patients undergoing chemotherapy require the transfusion of large numbers of platelets on a routine basis. Manual blood bag systems simply are not an efficient way to collect these large numbers of platelets from individual donors. On line blood separation systems are today used to collect large numbers of platelets to meet this demand. On line systems perform the separation steps necessary to separate concentration of platelets from whole blood in a sequential process with the donor present. On line systems establish a flow of whole blood from the donor, separate out the desired platelets from the flow, and return the remaining red blood cells and plasma to the donor, all in a sequential flow loop. Web site: http://www.delphion.com/details?pn=US06730054__

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Blood filter unit Inventor(s): Fujiwara; Kiyotaka (Saitama, JP), Higo; Akemi (Saitama, JP), Kitajima; Masao (Saitama, JP), Sugaya; Fumio (Kanagawa, JP), Tezuka; Shigeru (Saitama, JP), Yazawa; Kenichiro (Saitama, JP) Assignee(s): Fuji Photo Film Co., Ltd. (Kanagawa, JP) Patent Number: 6,170,671 Date filed: April 12, 1999 Abstract: The blood filter unit of the invention is composed of a blood filtering material made of glass fiber filter and microporous membrane and a holder having a blood inlet and a filtrate outlet. The holder accommodates the blood filtering material so that the microporous membrane is located on the filtrate outlet side, provides a space between the blood filtering material and the filtrate outlet, and provides a means for preventing adhesion of the blood filtering material on the filtrate outlet side. By using the blood filter unit, a necessary volume of plasma or serum for analysis can be separated surely, irrespective of hematocrit value of the blood. Excerpt(s): This invention relates to a blood filter unite used for the preparation of plasma or serum sample from whole blood. Type or concentration of blood components, such as metabolites, proteins, lipids, electrolytes, enzymes, antigens, and antibodies, is

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measured, in general, using a plasma or serum sample obtained by centrifuging whole blood. However, centrifuging takes labor and time. Particularly, centrifuging is unsuitable for an urgent case of measuring a small number of samples promptly and in site inspection, because of requiring a centrifuge and electricity. Thereupon, it has been investigated to separate serum from whole blood by filtration. Several filtration methods using glass fiber filter have been known wherein whole blood is charged into the glass fiber in a column from one side of the column, and pressurized or sucked to obtain plasma or serum from the other side (Japanese Patent KOKOKU Nos. 44-14673, 5-52463, Japanese Patent KOKAI Nos. 2-208565, 4-208856). Web site: http://www.delphion.com/details?pn=US06170671__ •

Capillary hematocrit separation structure and method Inventor(s): Bhullar; Raghbir S. (Indianapolis, IN), Shelton; Jeffrey N. (Fishers, IN), Wilsey; Christopher D. (Carmel, IN) Assignee(s): Roche Diagnostics Corporation (Indianapolis, IN) Patent Number: 6,319,719 Date filed: October 28, 1999 Abstract: A capillary hematocrit separation structure is included within a housing having a fluid inlet port, a reaction region, and a capillary pathway connecting the inlet port and the reaction region. The capillary pathway is dimensioned so that the driving force for the movement of liquid through the capillary pathway arises from capillary pressure. A plurality of obstructions are fixed in the capillary pathway, each obstruction having a concave portion facing toward the vented reaction region on the down stream side of the obstructions as viewed with reference to a liquid flowing from the inlet port to the reaction region. The capillary pathway in a hematocrit separation structure for a single drop sample size includes about 10.sup.5 obstructions, each obstruction including a concave portion having a volume of between about 10.sup.-4 to 10.sup.-5.mu.l for selectively receiving hematocrit. Excerpt(s): The present invention is directed to physical structures and methods for separating hematocrit out of small volume whole blood samples leaving merely the plasma or plasma containing a substantially reduced partial volume of hematocrit. The present invention is particularly directed to such structures having no moving parts which subsequent to separation of the plasma would facilitate contacting the reduced hematocrit content plasma with a dry reagent to permit an accurate detection of an analyte. Many diagnostic tests are carried out in the clinical field utilizing a blood sample. It is desirable, when possible, to use a very small volumes of blood, often no more than a drop or two. Capillary structures are often employed when handling such small volumes of blood or other fluids. The presence of the hematocrit in the blood sample often interferes with accurate testing and so the removal of, or reduction in concentration of, the hematocrit in the sample, leaving a reduced hematocrit content plasma for testing, is often desirable or even necessary. The removal of the hematocrit is often done using a filter. An example of such a filter device employing capillary structures is described in Hillman, et al., U.S. Pat. Nos. 4,753,776 and 5,135,719. Other devices employing capillary structures to handle whole blood samples are disclosed in McDonald, et al., U.S. Pat. No. 5,039,617; Hillman, et al., U.S. Pat. No. 4,963,498; and Columbus, U.S. Pat. No. 4,271,119. While such filter devices generally perform satisfactorily, many filter materials tend to absorb a significant portion of the plasma from the blood sample thus leaving only a small volume of the reduced plasma for

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analytical testing. As the total volume of the sample is diminished, the proportion of the plasma fraction that is absorbed by the filter tends to increase leaving even smaller volumes for testing. It is therefore desirable to construct alternative means for removing hematocrit from whole blood that would be usable on very small sample volumes. Web site: http://www.delphion.com/details?pn=US06319719__ •

Disposable extracorporeal conduit for blood constituent monitoring Inventor(s): Miller; David R. (Morgan, VT), Steuer; Robert R. (Pleasant View, VT) Assignee(s): In-Line Diagnostics Corporation (Riverdale, UT) Patent Number: 6,090,061 Date filed: October 22, 1997 Abstract: A cuvette having a pedestal for transmitting light through a relatively thin layer of blood. While the pedestal enables the use of a small path length it also permits the use of a high volume and/or high flow rate conduit. The pedestal further enables methods of determining various blood parameters in which the path length, d, is fixed; i.e., there are little or no pulsatile variations. Hence, the flow-through cuvette accommodates a large range of blood flow rates without any reduction in accuracy of the hematocrit measurement. The pedestal, because of its elliptical shape, does not damage or hemolyze the individual red blood cells as they pass through. A quantitative method for determining changes in blood volume in view of the path length is provided along with a method for measuring a patient's cardiac output and oxygen consumption rate. Cardiac output is obtained by injecting a saline arterial bolus and a saline venous bolus into a patient and measuring the change in hematocrit caused by each bolus. The oxygen consumption rate is then determined using the cardiac output and measuring the degree of oxygen saturation. Finally, an improved cuvette and corresponding method of measuring microemboli is provided. The cuvette contains multiple minilenses that focus narrow beams of light through the blood. These narrow beams of light are individually monitored by detectors. Excerpt(s): The present invention is directed to an improved extracorporeal conduit and methods and systems for deriving desired biologic constituent concentration values present in a flowing fluid. Medical professionals routinely desire to know the hematocrit, oxygen saturation, and oxygen consumption rate of a patient. Especially in critically ill patients or in cardiovascular surgery, the oxygen consumption rate, hematocrit value and microemboli content become very significant parameters. The prior art contains disclosures of flow-through cuvettes that may be used in a blood conduit for the spectrophotometric analysis of blood. For example, U.S. Pat. No. 5,456,253 discloses a disposable conduit/cuvette for analyzing blood. Web site: http://www.delphion.com/details?pn=US06090061__

Patents 99

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Disposable test strips with integrated reagent/blood separation layer Inventor(s): Alvarez-Icaza; Manuel (Inverness, GB), Davies; Oliver W. H. (Inverness, GB), Hall; Geoff (Inverness, GB), McAleer; Jerome F. (Wantage, GB), Plotkin; Elliot V. (Inverness, GB), Scott; David (Witney Oxon, GB) Assignee(s): Inverness Medical Technology, Inc. (Waltham, MA) Patent Number: 6,241,862 Date filed: January 12, 1999 Abstract: An improved disposable glucose test strip for use in a test meter of the type which receives a disposable test strip and a sample of blood from a patient and performs an electrochemical analysis is made using a non-conductive integrated reagent/blood separation layer containing a filler, an enzyme effective to oxidize glucose, e.g., glucose oxidase, and a mediator effective to transfer electrons from the enzyme. The integrated layer formulation is printed over a conductive carbon element to form a working electrode. The filler, for example a silica filler, is selected to have a balance of hydrophobicity and hydrophilicity such that one drying it forms a two-dimensional network on the surface of the conductive element. The response of this test strip is essentially temperature independent over relevant temperature ranges and is substantially insensitive to the hematocrit of the patient. Excerpt(s): This application relates to disposable test strips for use in electrochemical determinations of blood analytes such as glucose, and to methods and compositions for use in making such strips. Glucose monitoring is a fact of everyday life for diabetic individuals, and the accuracy of such monitoring can literally mean the difference between life and death. To accommodate a normal life style to the need for frequent monitoring of glucose levels, a number of glucose meters are now available which permit the individual to test the glucose level in a small amount of blood. Many of these meters detect glucose in a blood sample electrochemically, by detecting the oxidation of blood glucose using an enzyme such as glucose oxidase provided as part of a disposable, single-use electrode system. Examples of devices of this type are disclosed in European Patent No. 0 127 958, and U.S. Pat. Nos. 5,141,868, 5,286,362, 5,288,636, and 5,437,999 which are incorporated herein by reference. Web site: http://www.delphion.com/details?pn=US06241862__

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Method and device for the noninvasive determination of hemoglobin and hematocrit Inventor(s): Hanna; Charles F. (Libertyville, IL), Jeng; Tzyy-Wen (Vernon Hills, IL), Kantor; Stanislaw (Buffalo Grove, IL), Khalil; Omar S. (Libertyville, IL), Wu; Xiaomao (Gurnee, IL), Yeh; Shu-jen (Grayslake, IL) Assignee(s): Abbott Laboratoies (Abbott Park, IL) Patent Number: 6,662,031 Date filed: May 8, 2000 Abstract: A method for the determination of hemoglobin and hematocrit by means of an apparatus that is capable of controlling the temperature of a defined subcutaneous volume of human skin. The method involves a calculation of hemoglobin concentration and hematocrit value that takes into consideration the values of optical parameters of the sample at various pre-set temperatures. The apparatus and method employ steady state optical measurements of samples, such as, for example, human tissue, by means of

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a reflectance tissue photometer and localized control of the temperature of the sample. According to the method of this invention, an optical signal from a defined subcutaneous volume of human skin is measured as the temperature of this volume is controlled. The method and apparatus of this invention allow determination of hemoglobin concentration and hematocrit value non-invasively in a population of subjects having different skin colors by means of steady state reflectance measurements. The method of this invention for determination of hemoglobin concentration and hematocrit value is useful for monitoring patients, testing at the point of care, and screening for anemia. In contrast to other attempts in the prior art that rely on signals of cardiac pulses, the method of this invention has the advantage for the determination of analytes in weak cardiac pulse situations, such as, for example, in elderly patients. Excerpt(s): This invention relates to devices and methods for the noninvasive determination of concentrations of hemoglobin and hematocrit in a human subject in vivo, particularly for the noninvasive determination of concentrations of hemoglobin and hematocrit in a human subject in vivo, where the temperature of a defined subcutaneous volume of a body part of the subject is controlled and varied between preset boundaries. Non-invasive (hereinafter "NI") monitoring of analytes in the human body by optical devices and methods is an important tool in clinical diagnostics. NI monitoring techniques, which do not require obtaining a sample from the human body or inserting any instrumentation into the human body, have several advantages, including, but not limited to, ease of performing tests, reduction of pain and discomfort to the patient, and decreased exposure to potential biohazards. The most established non-invasive optical technique is pulse oximetry. Oxygenation of blood in tissue and cerebral oxygen saturation can be measured, and the measurement can be used for clinical applications. See Jobsis, "Non-invasive, Infrared Monitoring of Cerebral and Myocardial Oxygen Sufficiency and Circulatory Parameters", Science, 198, 1264-67 (1977), and Shiga, et al., "Study of an Algorithm Based on Model Experiments and Diffusion Theory for a Portable Tissue Oximeter", J. Biomed. Optics; 2(2), 154-161 (1997). Web site: http://www.delphion.com/details?pn=US06662031__ •

Method of in-vivo determination of hemodialysis parameters and a device for carrying out the method Inventor(s): Goldau; Rainer (Rimpur, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,217,539 Date filed: November 26, 1997 Abstract: To be able to optimize the hemodialysis treatment process, in-vivo determination of important parameters, such as the exchange efficiency of the dialyzer, represented by the dialysance or clearance, is desirable. Mathematical quantification of the blood purification processes on the basis of measurement technology is especially important. Important measured quantities and operands for the determination of the desired parameter are usually the dialysate flow and the blood flow (Qd, Qb), the inlet and outlet concentrations (cdi, cdo) of the dialysis fluid and the electrolyte transfer rate derived from it as well as the formulation of the mass balance in the dialyzer.This invention provides that at least one of the two flow rates (Qb, Qd) is set at a minimum of two different values in the measurement interval, and corresponding measured quantities are derived, from which the parameter to be determined is obtained together with the above-mentioned conventional measured quantities and operands as well as on

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the basis of equations between the dialyzer characteristics that describe the mass exchange and a conditional equation. At a known effective blood flow (Qb), this may be, for example, the blood concentration at the inlet (cbi), from which the dialysance can then be determined. When the cbi value is known, the effective blood flow and thus the hematocrit can be determined. Excerpt(s): The invention relates to a method of in-vivo determination of hemodialysis parameters, and to a device for carrying out the method. Hemodialysis has been used successfully for many years for treatment of patients with renal failure and has proven successful throughout the world. Human kidneys have several functions, e.g., eliminating water, removing metabolic waste products (urea, creatinine) and helping to adjust the concentrations of various substances such as blood electrolytes (sodium, bicarbonate, etc.) at certain levels. Web site: http://www.delphion.com/details?pn=US06217539__ •

Noninvasive blood analyzer Inventor(s): Asano; Kaoru (Kobe, JP), Ishihara; Ken (Takarazuka, JP), Kouchi; Yasuhiro (Kobe, JP), Kusuzawa; Hideo (Kobe, JP) Assignee(s): Sysmex Corporation and Ken Ishihara (Hyogo, JP) Patent Number: 6,061,583 Date filed: June 11, 1998 Abstract: A noninvasive blood analyzer is provided which comprises: a light source for illuminating a part of tissues of a living body including a blood vessel; an image pickup section for picking up an image of the illuminated blood vessel and tissues; and an analyzing section for analyzing the picked image; the analyzing section including an extracting section for extracting image density distribution across the blood vessel in the image as an image density profile, a quantifying section for quantifying configurational characteristics of the image density profile, a computing section for computing the concentration of a blood constituent on the basis of the quantified characteristics, and an outputting section for outputting a computation result. The blood analyzer can measure the concentration of blood hemoglobin and the hematocrit in real time with an improved repeatability without blood sampling. Excerpt(s): The present invention relates to a noninvasive blood analyzer. The analyzer of the present invention is capable of transcutaneously monitoring an amount of a blood constituent such as hemoglobin concentration or hematcrit in real time with an improved repeatability without sampling blood from a living body. The hematology test of blood in a peripheral blood vessel is one of the most important and frequently performed tests in the clinical examination. Particularly, test items essential for the diagnosis on the case of anemia are hemoglobin concentration and hematocrit. The hematology test currently performed requires blood sampling from patients. However, the frequent blood sampling imposes a burden on patients and creates a risk of infection due to accidental sticking with an injection needle. In view of the foregoing, there have been proposed apparatuses for transcutaneous (noninvasive) measurement on the aforesaid test items. For example, Japanese Examined Patent Publication No. HEI- 371135 discloses a hemoglobin concentration measurement apparatus for measuring blood hemoglobin on the basis of a change in the light intensity due to pulsation of light of a plurality of wavelengths projected onto a living body. Similarly, U.S. Pat. No.

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5,372,136 discloses a system and method for determining hematocrit in blood by utilizing pulsation and the like. Web site: http://www.delphion.com/details?pn=US06061583__ •

Non-invasive optical measurement of blood hematocrit Inventor(s): Micheels; Ronald H. (Concord, MA), Soller; Babs R. (Northboro, MA) Assignee(s): Polestar Technologies, Inc. (Needham Heights, MA), University of Massachusetts (Boston, MA) Patent Number: 6,304,767 Date filed: December 1, 1999 Abstract: The invention provides an optical method and apparatus for non-invasively determining blood hematocrit. The method includes the step of first irradiating blood with optical radiation. Radiation reflected or transmitted from the blood is then collected to determine an optical spectrum. Hematocrit is then determined by comparing this spectrum to a mathmatical model relating optical properties to blood Hematocrit. Excerpt(s): This invention relates to measurement of blood hematocrit (Hct). Hematocrit is the volume percent of red blood cells in a blood sample and is one of the most commonly performed blood tests. The standard method for measuring hematocrit involves collecting a blood sample in a capillary tube and centrifuging the tube to separate out the red blood cells from the plasma. By measuring the height of a resulting layer of red blood cells in the capillary and referencing it to the total blood volume, the volume percent of red blood cells can be quantified. Hematocrit measurements on blood samples are now often made with more automated techniques such as conductivity measurements. Hematocrit can also be measured non-invasively. Two approaches have been reported for such non-invasive monitoring of hematocrit, an optical approach and an impedance method. Impedance methods are found to be inaccurate when protein and electrolyte levels are abnormal, such as when blood is replaced with crystalloid solutions, as would happen during resuscitation of trauma victims. All of the reported optical techniques are variations on oximetric methods where hematocrit is measured using only the concentrations of oxygenated and deoxygenated hemoglobin. The concentrations of oxygenated and deoxygenated hemoglobin are directly measured by absorption or reflection using 2 to 4 wavelengths of light in the near-infrared region of the hemoglobin spectrum. Web site: http://www.delphion.com/details?pn=US06304767__

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Optical and ultrasound probe for monitoring blood volume changes Inventor(s): Lee; Jen-Shih (2017 Echo Ridge Rd., Charlottesville, VA 22911), Lee; LianPin (2017 Echo Ridge Rd., Charlottesville, VA 22911) Assignee(s): none reported Patent Number: 6,740,036 Date filed: October 18, 2002 Abstract: An apparatus and method to assess the compressibility, density, and hematocrit of blood including an optical ultrasound probe clipped onto tubing in which

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blood is flowing. The probe includes a combination of ultrasound transducers, a light emitting diode, and photodiodes. An indicator medium is injected into the bloodstream of the subject over one or more time points. Ultrasound waves are emitted by a transducer and received by another transducer, and a novel signal-processing unit and a computer with a novel computation scheme process the ultrasound signals to assess the phase shift of ultrasound as it transmitted across the blood stream. Based on the linear relationship between compressibility and density, changes in blood density are calculated from changes in phase shift. The optical part of the probe assesses the hematocrit of blood. Two fluid media are used to calibrate the probe on the relationship between phase shift and density in the factory. Before clinical assessment, an on-line saline injection procedure and the resulting change in density is employed to calibrate the optical density of the optical probe in terms of hematocrit and to establish the interrelation between density and hematocrit on fluid dilution of the circulating blood. One clinical protocol to monitor blood volume and microvascular pooling employs saline infusion to determine the blood volume hourly and the density and hematocrit measurements to determine the change in blood volume and the volume pooled to the microcirculation. Another clinical protocol assesses the time course of hematocrit and density over hemodialysis treatment for the prediction of hypovolemia and microvascular pooling. This cardiovascular monitoring is useful for evaluating how complications are developed during hemodialysis or the adequacy of any post-trauma fluid replacement or therapy to alleviate the complications. Excerpt(s): This invention relates to systems and methods for micro-invasive, continuous monitoring of a patient's changes in blood density and hematocrit in order to determine the blood volume and microvascular pooling of the patient over time to better profile the patient's response to hemodialysis, trauma, or bum injury and to achieve more effective diagnosis and treatment. An apparatus and method are described to monitor the time of sound transmission in the blood stream of a patient, to use a linear relationship between compressibility and density for accurate and sensitive assessment of blood density changes, and to employ optical density for assessment of hematocrit changes due to dilution by saline, dialysate or therapeutic changes. Through appropriate clinical protocols, the density and hematocrit changes are used individually or in combined form to determine the plasma protein concentration, blood volume, change in blood volume, and microvascular pooling of the patient over time. Hypotension and hypovolemia are common circulatory problems that occur during shock (Chien et al, American Journal of Physiology, 210:1411-1418), traumatic injury, dialysis (Amerling et al in Clinical Dialysis 3.sup.rd Edition, Appleton and Lang editors, 1995) and surgical interventions. A variety of disorders and injuries are related to the occurrence of hypotension (Daugirdas, Kidney International 39:233-246). Fluid loss related to burn injury or hemorrhage due to trauma is examples of situations where compensation for such loss is necessary. Infusing isotonic saline, plasma or other physiological solutions into the circulation until arterial pressure is elevated to normal is usually employed as the treatment. Although blood volume reduction correlates with reduction in arterial pressure under laboratory simulations of injury and anesthesia, actual occurrences of traumatic blood loss often show only slightly reduced arterial pressures due to the body's neural compensation mechanisms. Once these mechanisms reach their limits, arterial pressure can drop rapidly. The management of this subnormal arterial pressure is critical to survival; immediate restoration of arterial pressure after traumatic injury can cause more problems than allowing the pressure to remain subnormal. Rapid restoration of arterial pressure results in higher oxygen demand and the increase in blood flow may dislodge clots to cause stroke. Web site: http://www.delphion.com/details?pn=US06740036__

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Optical measurement of blood hematocrit incorporating a self-calibration algorithm Inventor(s): Alderete; Jason E. (Hopkins, MN), Fowler; William V. (Minneapolis, MN), Lee; Wylie I. (Laguna Hills, CA) Assignee(s): Optical Sensors, Inc. (Eden Prairie, MN) Patent Number: 6,064,474 Date filed: February 6, 1998 Abstract: An optical method for obtaining hematocrit values of blood uses the light transmittance properties of blood as a means of acquiring information about the blood sample. An algorithm is used to calculate the hematocrit value based on the absorbance spectra obtained at wavelengths of approximately 500 nm and 800 nm. These absorbance wavelengths are selected for their insensitivity to the oxygen saturation level of hemoglobin. Additionally, the algorithm has demonstrated insensitivity to plasma and other blood constituent scattering effects. Excerpt(s): The invention relates to the determination of blood hematocrit via optical means. More particularly, the invention relates to a technique for the optical measurement of blood hematocrit that incorporates a self-calibration algorithm. Blood hematocrit refers to the packed red blood cell volume of a whole blood sample. Plasma constitutes the remaining portion of the whole blood. Hematocrit can be measured directly in one of several ways, for example by spinning down the red blood cells (RBCs) in a capillary tube. Following centrifugation, the volume of the RBCs is measured. With regard to the determination of hematocrit via optical means, it is well known that the transmission of light through red blood cells is complicated by scattering components from plasma. The scattering capabilities of plasma vary from person to person, thereby complicating the determination of hematocrit. Web site: http://www.delphion.com/details?pn=US06064474__

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System and method for in-vivo hematocrit measurement using impedance and pressure plethysmography Inventor(s): Billings; Robert Gail (Salt Lake City, UT), Clark; Justin S. (Salt Lake City, UT), Kaminsky; Allan L. (Holladay, UT), Neese; Jon (Holladay, UT), Yang; Ke-shieng (Sandy, UT) Assignee(s): Microcor, Inc. (Salt Lake City, UT) Patent Number: 6,128,518 Date filed: July 23, 1998 Abstract: The hematocrit of blood (i.e., the percentage of whole blood volume occupied by red blood cells) perfusing a finger is determined by stimulating the finger with two current frequencies, one relatively high (e.g., 10 MHZ) and the other relatively low (e.g., 100 KHz). Voltages induced in the finger in response to the two current frequencies are then captured and separated into baseline and pulsatile components. The hematocrit is determined as a function of the ratio of the high frequency pulsatile component to the low frequency pulsatile component, multiplied by the ratio of the square of the low frequency baseline component to the square of the high frequency baseline component. The signal-to-noise ratio of the captured voltages can be enhanced by the application of external pressure to the finger, such as by applying a pressure cuff to the finger.

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Excerpt(s): This invention relates in general to devices and methods for in-vivo measurement of blood hematocrit and, more specifically, to devices and methods for such measurement that use impedance and pressure plethysmography. The "hematocrit" of blood, which is defined as the percentage of whole blood volume occupied by erythrocytes (i.e., red blood cells), is an important measure of patient wellbeing in cases of trauma, blood loss by disease, iron depletion in pregnancy, dietary iron deficiency, and a number of more specific medical conditions. Hematocrit has traditionally been measured by centrifuging a column of blood, which has been extracted from the patient, in a glass tube, until the erythrocytes are compacted by centrifugal force to one end of the tube. The hematocrit is determined by measuring the length of the tube containing dark red material and dividing by the total length of the liquid column in the tube. These length observations are usually made visually, but are also made, in some cases, by automated optical means of various designs. Besides centrifugal hematocrit determinations, hematocrit is also derived and reported by various automated blood analyzers which count erythrocytes optically in unpacked blood. This erythrocyte count correlates with packed cell hematocrit and the derived hematocrit is reported. Web site: http://www.delphion.com/details?pn=US06128518__ •

System and method for noninvasive hemodynamic measurements in hemodialysis shunts Inventor(s): Miller; David R. (Morgan, UT), Steuer; Robert R. (Pleasant View, UT) Assignee(s): In-Line Diagnostics Corporation (Riverdale, UT) Patent Number: 6,117,099 Date filed: December 3, 1997 Abstract: Access recirculation in a shunt is determined quantitatively by a method in which a standard solution, such as a saline, is injected into a patient's bloodstream upstream of the shunt. At a point in the access line, a photometric measurement is conducted of the change in hematocrit (.DELTA.H) with respect to time. Electronic circuitry receives signals from the detector and compares the integrated area of.DELTA.H with respect to time of the standard solution initially flowing through the access and of the recirculated solution and provides display of access recirculation. In another aspect, access recirculation and access blood flow are quantitatively determined without injecting a solution into the bloodstream. In this aspect the extent of access recirculation and/or access blood flow is determined quantitatively by a method in which the dialyzer blood flow rate or the ultrafiltration rate (UFR) is changed and the corresponding change in concentration of a blood constituent is measured. In this technique, the concentration of a blood constituent is measured as a function of dialyzer blood flow rate or UFR and electronic circuitry converts these measurements into quantitative determinations of access recirculation and/or access blood flow that can be displayed. Excerpt(s): This invention relates to systems and methods for noninvasively measuring hemodynamic access, access recirculation and blood flow measurements during hemodialysis. More particularly, the present invention relates to noninvasive spectrophotometric systems and methods for quantitatively measuring the shunt (access) recirculation, the access blood flow rate, the dialysis machine blood flow rate and the volumes of priming fluids required by the hemodialysis tubing lines. Modern medical practice utilizes a number of procedures and indicators to assess a patient's

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condition especially in the dialysis setting. Hemodialysis is a process wherein an artificial kidney is required to function in the place of the patient's normal kidney in order to remove certain biologic waste products. When the human kidney no longer functions correctly removing waste products such as urea, potassium, and even excess water, blood must be removed from the patient via blood tubing lines and filtered through an artificial kidney or dialyzer. In this process blood is passed through the dialyzer, cleansed, then returned to the normal circulatory system of the patient. Access to the patient's circulatory system is achieved through the use of a surgically implanted shunt or fistula. This "access site" is typically located in the arm, leg, or neck of the patient. Typically needles are placed into this "access" in such a way as to facilitate the easy removal of blood on the "arterial" or upstream side of the dialyzer and typically return the purified blood downstream of the first needle placement on the "venous" side. Unfortunately, in many cases the fistula, or shunt, will clot or "stenos" over time. This results in decreased blood flow through the access which ultimately necessitates either angioplasty or a surgical replacement of the shunt. As the shunt ceases or "clots off" part of the purified dialyzed blood is forced to flow back into the arterial withdrawal site and, hence, recirculates only to be dialyzed again; this is termed "access recirculation". As this recirculation of purified blood continues, the rest of the patient's circulating blood is not adequately cleansed and, hence, an inadequate delivery of the dialysis dosage is provided to the patient. 3) The dialyzer blood flow rate itself. Web site: http://www.delphion.com/details?pn=US06117099__ •

System for noninvasive hematocrit monitoring Inventor(s): Harris; David H. (Ogden, UT), Steuer; Robert R. (Pleasant View, UT) Assignee(s): Hema Metrics, Inc. (Kaysville, UT) Patent Number: 6,681,128 Date filed: June 13, 2001 Abstract: A system determines heamtocrit transcutaneously and noninvasively. Disclosed are a finger clip assembly and an earlobe clip assembly, each including at least a pair of emitters and a photodiode in appropriate alignment to enable operation in either a transmissive mode or a reflectance mode. At least two, and preferably three, predetermined wavelengths of light are assed onto or through body tissues such as the finger, earlobe, or scalp, etc. and the extinction of each wavelength is detected. Mathematical manipulation of the detected values compensates for the effects of body tissue and fluid and determines the hematocrit value. If a fourth wavelength of light is used which is extinguished substantially differently by oxyhemoglobin and reduced hemoglobin and which is not substantially extinguished by plasmas, then the blood oxygen saturation value, independent of hematocrit, maybe determined. It is also disclosed how to detect and analyze multiple wavelengths using a logarithmic DC analysis technique. Then a pulse wave is not required. So this method may be utilized in states of low blood pressure or low blood flow. Excerpt(s): This invention relates to systems and methods for noninvasively measuring one or more biologic constituent values. More particularly, the present invention relates to noninvasive spectrophotometric systems and methods for quantitatively and continuously monitoring the hematocrit and other blood parameters of a subject. Modern medical practice utilizes a number of procedures and indicators to assess a patient's condition. One of these indicators is the patient's hematocrit. Hematocrit (often abbreviated as Hct) is the volume, expressed as a percentage, of the patient's blood

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which is occupied by red corpuscles (commonly referred to as red blood cells). Human blood consists principally of liquid plasma (which is comprised of over 90% water with more than 100 other constituents such as proteins, lipids, salts, etc.) and three different corpuscles. The three corpuscles found in blood are red corpuscles, white corpuscles, and platelets. Web site: http://www.delphion.com/details?pn=US06681128__ •

Systems and methods for separating high hematocrit red blood cell concentrations Inventor(s): Deniega; Jose C. (Lake Forest, CA), Duff; Daniel H. (Irvine, CA) Assignee(s): Baxter International Inc. (Deerfield, IL) Patent Number: 6,080,322 Date filed: May 5, 1998 Abstract: Blood separation systems and methods utilize a membrane separation device comprising a gap between a microporous membrane and a surface facing the microporous membrane, one of the microporous membrane and the surface being rotatable relative to the other to cause separation of whole blood in the gap into plasma and concentrated red blood cells. The systems and methods include an inlet pump element coupled to the membrane separation device to convey whole blood having a known beginning hematocrit value into the gap for separation. The systems and methods also include a drive element coupled to the membrane separation device to cause rotation of the rotatable one of the microporous membrane and the facing surface. The systems and methods command the inlet pump element and the drive element as a function of the known beginning hematocrit value. This command technique obtains concentrated red blood cells having a high end hematocrit value that remains substantially constant despite variances in the known beginning hematocrit value, and, in particular, when the known beginning hematocrit value is low. Excerpt(s): The invention generally relates to blood collection and processing systems and methods. In a more particular sense, the invention relates to systems and methods for collecting concentrated red blood cells for transfusion or long term storage. Today, most whole blood collected from donors is not itself stored and used for transfusion. Instead, the whole blood is separated into its clinically proven components (typically red blood cells, platelets, and plasma), which are themselves individually stored and used to treat a multiplicity of specific conditions and diseased states. For example, the red blood cell component is used to treat anemia; the concentrated platelet component is used to control thrombocytopenic bleeding; and the platelet-poor plasma component is used as a volume expander or as a source of Clotting Factor VIII for the treatment of hemophilia. Systems composed of multiple, interconnected plastic bags have met widespread use and acceptance in manually collecting these blood components for storage. A typical manual collection procedure collects 450 ml of whole blood from a donor in a primary bag. The donor departs, and the primary bag is centrifuged to separate the whole blood into plasma and red blood cells. For a typical donor, the manual collection procedure yields about 250 ml of concentrated red blood cells and about 200 ml of plasma, which are each expressed from the primary bag into individual storage bags. A majority of the platelets reside either with the plasma or with the red blood cells, depending upon the amount of centrifugal force exerted. Leukocytes typically reside primarily with the red blood cells. These leukocytes can be removed by filtration either before or after storage and prior to transfusion.

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Web site: http://www.delphion.com/details?pn=US06080322__

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

Anemia Inventor(s): Binley, Katie (Mary); (Oxford, GB), Kingsman, Susan Mary; (Oxford, GB), Naylor, Stuart; (Oxford, GB) Correspondence: Frommer Lawrence & Haug; 745 Fifth Avenue- 10th FL.; New York; NY; 10151; US Patent Application Number: 20030143202 Date filed: February 1, 2002 Abstract: Disclosed is a vector containing a nucleic acid sequence encoding erythropoietin (Epo) in operable linkage with an HRE expression control sequence, as well as uses thereof; for instance, in preparing a medicament, as well as in methods for treating anemia in a patient in need thereof. The method can involve administering to the patient a vector comprising a nucleic acid sequence encoding erythropoietin (Epo) in operable linkage with an HRE expression control sequence, wherein expression of Epo is physiologically regulated such that hematocrit levels of the patient are corrected and maintained. Excerpt(s): This application claims priority from British Application No.______, filed Jan. 31, 2002 (UK Attorney Docket No. P013473GB). Reference is made to: U.S. Pat. No. 6,265,390 (Methods For Expressing Nucleic Acid Sequences Using Nucleic Acid Constructs Comprising Hypoxia Response Elements), filed Feb. 22, 1999, U.S. Pat. No. 5,942,434 (Nucleic Acid Constructs Comprising Hypoxia Response Elements), filed Dec. 12, 1996, PCT/GB95/00322, filed Feb. 15, 1995 and published Aug. 17, 1995 as WO 95/21927 (Targeting Gene Therapy), GB application serial no. 9402857, filed Feb. 15, 1994, and WO 00/17371, filed Sep. 22, 1999; nationally processed in the U.S. as U.S. Ser. No. 09/787,562. Each of the foregoing applications and patents and articles, and each document cited or referenced in each of the foregoing applications and patents and articles, including during the prosecution of each of the foregoing applications and patents ("application and article cited documents"), and any manufacturer's instructions or catalogues for any products cited or mentioned in each of the foregoing applications and patents and articles and in any of the application and article cited documents, are hereby incorporated herein by reference. Furthermore, all documents cited in this text, and all documents cited or referenced in documents cited in this text, and any manufacturer's instructions or catalogues for any products cited or mentioned in this text or in any document hereby incorporated into this text, are hereby incorporated herein by reference. Documents incorporated by reference into this text or any teachings therein may be used in the practice of this invention. Documents incorporated by reference into this text are not admitted to be prior art. Furthermore, authors or inventors on documents incorporated by reference into this text are not to be considered

9

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

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to be "another" or "others" as to the present inventive entity and vice versa, especially where one or more authors or inventors on documents incorporated by reference into this text are an inventor or inventors named in the present inventive entity. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for analytical determinations Inventor(s): Anthony Ott, Brian; (New Brighton, MN), Blomberg, Scott Everett; (Plymouth, MN), Sin, Kee Van; (Lino Lakes, MN) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20040021469 Date filed: July 31, 2002 Abstract: An apparatus and method for measuring conductance are provided. The method and apparatus are particularly well adapted for use with a removable or replaceable cartridge in a blood analysis system. The apparatus generally involves providing a system having a first, unfiltered, conductance measurement cell and a second, filtered, conductance measurement cell. The preferred method involves relating values measured in the two cells for a whole blood sample and for a known calibrant together, to obtain a value, for example hematocrit, for the unknown whole blood sample. Excerpt(s): The present disclosure relates generally to medical diagnostic techniques and equipment. It particularly concerns techniques and equipment for blood analyses. The technology particularly concerns conductance measurements, for example for making hematocrit determinations. Hematocrit (Hct) is the volume percentage of erythrocytes in whole blood. Although the term was originally applied to the apparatus or procedure used to evaluate this percentage, it is now generally used to designate the result of the determination. More specifically, hematocrit is defined by the ratio of the volume of packed red blood cells to the volume of whole blood. It has traditionally been determined by centrifugation. According to the centrifugation method, a sample of blood is drawn into a capillary tube which is then spun at a high rate in a centrifuge until the solid portion of the blood cells become packed together in one end of the tube. The ratio of volumes is measured by simply measuring the length of: (1) the packed blood cells; and (2) the overall length of the blood sample in the tube, and dividing length (1) by length (2). In this process, length (or volume) is cancelled out and the result is typically reported as a percentage, commonly referred to as the percent packed cell volume or % PCV. This measurement has proven useful for diagnosing and evaluating a number of conditions and diseases, for example anemias. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Apparatus for hematocrit determination and method for its use Inventor(s): Corey, Scott; (Hydes, MD), Lipford, Keith; (Severna Park, MD), Murphy, Brian; (Erial, NJ), Reed, Samuel; (North Garden, VA), Sakers, John; (Baltimore, MD) Correspondence: Law Offices OF Royal W. Graig P.C.; 10 North Calvert Street; Suite 153; Baltimore; MD; 21202; US Patent Application Number: 20040054283 Date filed: August 28, 2002 Abstract: The present invention provides an apparatus and method for measuring the properties of blood using ultrasound. The present invention is particularly suitable for measuring HCT, HGB, MCV, RBC, MCHC, MCH or TPC of blood. Excerpt(s): The present invention relates to a method and apparatus for measuring one or more of the hematocrit, hemoglobin concentration, mean corpuscular volume, red blood cell count, mean cellular hemoglobin, mean cellular hemoglobin concentration, and total protein concentration of a blood sample. Physicians routinely test blood parameters as part of the diagnostic process. The complete blood count (CBC) is the most common of these tests. Physicians use the results to assess the quantity and the condition of the blood's cellular components. Three of the elements of the complete blood count are used to describe the size and number of red blood cells in the sample: the hematocrit, the mean corpuscular volume, and the red blood cell count. Furthermore, four more blood properties describe the oxygen-carrying capacity of the red blood cells: the hemoglobin concentration, total protein concentration, the mean cellular hemoglobin, and the mean cellular hemoglobin concentration. Hematocrit (HCT) is one of the most important blood parameters to be calculated by the CBC. HCT is defined as the portion of the total volume of blood occupied by red blood cells. This volume fraction may be expressed as a decimal (e.g., liter/liter) or as a percentage (e.g., liter/liter.times.100%). HCT measurements typically provide the same information to the physician as the hemoglobin concentration (HGB) or total protein concentration (TPC)--the oxygen carrying capacity of the blood - because under normal physiological conditions almost all of the total protein in the blood is hemoglobin and it is contained in the red blood cells. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Biosensor having improved hematocrit and oxygen biases Inventor(s): Karinka, Shridhara Alva; (Lowell, MA), Scott, W. James; (Bedford, MA) Correspondence: Steven F. Weinstock; Abbott Laboratories; 100 Abbott Park Road; DEPT. 377/ap6a; Abbott Park; IL; 60064-6008; US Patent Application Number: 20040079653 Date filed: October 23, 2002 Abstract: A biosensor that utilizes a mediator, i.e., an isomer of phenanthroline quinone, 1,10-phenanthroline-5,6-dione, and a metal ion, such as manganese, with an enzyme dependent upon NAD(P).sup.+, such as, for example, glucose dehydrogenase, for improving the hematocrit bias and oxygen bias of biosensors. The electrodes of the biosensors employing this mediator and a metal ion provide an accurate clinical response over a hematocrit range that ranges from about 20% to about 70% and over an oxygen tension range that ranges from about 1 kPa to about 20 kPa.

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Excerpt(s): This invention relates to biosensors, and, more particularly, to biosensors for determining the concentration of an analyte in a biological sample. All biosensors for determining the concentration of analytes in a sample of blood suffer from hematocrit sensitivity to some degree. The biosensor response decreases as the hematocrit of the sample increases. There is no single reason for this decrease in the signal, though some of the reasons include diminished diffusion of the analyte in the sample and increased solution resistance. One of the methods proposed for the elimination of hematocrit sensitivity is to filter the red cells from the sample. The membrane technology to filter red cells increases both the assay time and measurement imprecision. Oxygen sensitivity has presented a challenge. Biosensors employing the enzyme glucose dehydrogenase are not expected to be oxygen sensitive. However, the oxidation-reduction reactions of the mediator (or coenzyme) could involve free radical intermediates. When these intermediates have long lifetimes, molecular oxygen can quench them, thereby rendering the chemistry sensitive to oxygen tension. U.S. Pat. Nos. 5,708,247 and 5,951,836 describe a disposable glucose test strip for use in a test meter of the type that receives a disposable test strip and a sample of blood from a patient and performs an electrochemical analysis. The working formulation comprises a filler, an enzyme effective to oxidize glucose, e.g., glucose oxidase, and a mediator effective to transfer electrons from the enzyme. The working formulation is printed over a conductive base layer to form a working electrode. The filler, for example, a silica filler, is selected to have a balance of hydrophobicity and hydrophilicity such that on drying it forms a twodimensional network on the surface of the conductive base layer. The response of this test strip is claimed to be temperature independent over relevant temperature ranges and is substantially insensitive to the hematocrit of the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Blood processing systems and methods Inventor(s): Brown, Richard I.; (Northbrook, IL) Correspondence: Baxter Healthcare Corporation; Bradford R.L. Price; Fenwal Division Rlp-30; Route 120 And Wilson Road; Round Lake; IL; 60073; US Patent Application Number: 20030102272 Date filed: January 7, 2003 Abstract: Systems and methods centrifugally separate whole blood into red blood cells, plasma, and a platelet concentrate. The systems and methods rotate a first rotating separation zone about a rotational axis, to separate whole blood into red blood cells and plasma constituent carrying platelets. Red blood cells separated are directed in a first circumferential flow direction toward a terminal wall, where blood flow is halted. Surface hematocrit is successively increased in the first circumferential flow direction by separating the plasma constituent from the red blood cells. Separated red blood cells are directed from the first rotating separation zone through a path where the surface hematocrit is the most. Plasma constituent separated is directed in a second circumferential flow direction opposite to the first circumferential flow direction toward a different region in the first rotating separation zone, where the surface hematocrit is the least. The systems and methods separate the plasma constituent into platelet concentrate and plasma in a second rotating separation zone. Excerpt(s): This application is a divisional of co-pending U.S. patent application Ser. No. 09/661,331, filed Sep. 12, 2000, entitled "Compact Enhanced Yield Blood Processing Systems," which claims the benefit of priority of U.S patent application Ser. No.

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08/856,096, filed May 19, 1997 (now U.S. Pat. No. 6,228,017), which claims the benefit of priority of U.S. patent application Ser. No. 08/146,403 filed Nov. 1, 1993 (now U.S. Pat. No. 5,656,163), which claims the benefit of priority of U.S. patent application Ser. No. 07/964,771, filed Oct. 22, 1992 (now abandoned). The invention relates to centrifugal processing systems and apparatus. Today blood collection organizations routinely separate whole blood by centrifugation into its various therapeutic components, such as red blood cells, platelets, and plasma. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Blood processing systems and methods using apparent hematocrit as a process of control parameter Inventor(s): Brown, Richard I.; (Northbrook, IL) Correspondence: Ryan Kromholz & Manion, S.C.; Post Office Box 26618; Milwaukee; WI; 53226; US Patent Application Number: 20010006810 Date filed: February 23, 2001 Abstract: Blood processing systems and methods separate whole blood into red blood cells and a plasma constituent within a rotating centrifugal separation device. The systems and methods convey whole blood into the separation device through an inlet path including a pump operable at a prescribed rate. The systems and methods remove plasma constituent from the separation device through an outlet path including a pump operable at a prescribed rate. The systems and methods derive a value H.sub.b representing an apparent hematocrit of whole blood entering the separation device, where: 1 H b = H rbc ( Q b - Q p ) Q band where H.sub.rbc is a value relating to hematocrit of red blood cells in the separation device. The systems and methods generate outputs and control commands based, at least in part, upon H.sub.b. Excerpt(s): The invention generally relates to blood processing systems and methods. Today people routinely separate whole blood by centrifugation into its various therapeutic components, such as red blood cells, platelets, and plasma. Certain therapies transfuse large volumes of blood components. For example, some patients undergoing chemotherapy require the transfusion of large numbers of platelets on a routine basis. Manual blood bag systems simply are not an efficient way to collect these large numbers of platelets from individual donors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Blood purification device Inventor(s): Mori, Yoshihiro; (Shizuoka, JP), Ohishi, Takayuki; (Shizuoka, JP) Correspondence: Darby & Darby P.C.; P. O. Box 5257; New York; NY; 10150-5257; US Patent Application Number: 20040129616 Date filed: November 14, 2003 Abstract: A blood purification device that does not require measurement of a patient's blood concentration performed ahead of time and that allows treatment time to be reduced, thus reducing the burden on the patient, and allows monitoring of problems in the internal elements. The present invention includes: blood purification device main

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units including a blood pump disposed in an arterial blood circuit, a blood purification device purifying blood, and an ultrafiltration pump for draining water from blood; first measuring means and second measuring means measuring hematocrit values and disposed at the arterial blood circuit and the venous blood circuit respectively; calculating means calculating a ratio for measured hematocrit values and a ratio for a theoretical hematocrit values determined from a predetermined equation and evaluating means evaluating whether the values determined by calculating means are roughly similar. Excerpt(s): The present invention relates to a blood purification device which purifies blood from a patient in extracorporeal blood circulation. In dialysis treatment, a blood circuit consisting mainly of flexible tubing is used to place the blood of a patient in extracorporeal blood circulation. This blood circuit arrangement includes an arterial blood circuit having an arterial needle at one end to collect blood from the patient and a venous blood circuit having venous needle at one end to return the blood to the patient. A dialyzer can be incorporated between the arterial blood circuit and the venous blood circuit. A roller blood pump is placed in the arterial blood circuit. By driving the pump, the blood of the patient is collected through the arterial needle and flows extracorporeally through the arterial blood circuit, the dialyzer, and the venous blood circuit. There are multiple hollow fibers inside the dialyzer. The blood flows through each hollow fiber. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

CONTINUOUS OPTOACOUSTIC MONITORING CONCENTRATION AND HEMATOCRIT

OF

HEMOGLOBIN

Inventor(s): Esenaliev, Rinat; (Galveston, TX), Motamedi, Massoud; (Houston, TX), Prough, Donald; (Galveston, TX) Correspondence: Robert W Strozier, P.L.L.C; PO Box 429; Bellaire; TX; 77402-0429; US Patent Application Number: 20040054268 Date filed: March 1, 2001 Abstract: An optoacoustic apparatus is disclosed which includes a radiation source of pulsed radiation and a probe having a front face to be placed in contact with a tissue site of an animal body. The probe further includes an optical fiber terminating at the surface of the front face of the probe and connected at their other end to a pulsed laser. The front face of the probe also has mounted therein or thereon a piezoelectric transducer for detecting an acoustic response to the radiation pulses connected to a processing unit which converts the transducer signal into a measure of hemoglobin concentration and/or hematocrit of blood. Excerpt(s): This application claims provisional priority to U.S. Provisional Patent Application Serial No. 60/186,193 filed Mar. 1, 2000, incorporated herein by reference. The present invention relates to an apparatus for non-invasive, real-time, accurate, continuous monitoring of hemoglobin concentration and hematocrit and a method for continuously or discretely monitoring hemoglobin concentration and hematocrit. More particularly, the present invention relates to an optoacoustic apparatus including a nanosecond pulsed laser, a fiber-optic delivery system and a probe including a sensitive acoustic transducer and hardware and software for converting a received acoustic signal into a measurement of hemoglobin concentration and hematocrit and to methods for

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monitoring hemoglobin concentration and hematocrit using the apparatus and methods for making the apparatus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device for determination of an analyte in a body fluid using small sample sizes Inventor(s): Douglas, Joel S.; (Los Altos Hills, CA) Correspondence: T. Gene Dillahunty; Burns, Doane, Swecker & Mathis, L.L.P.; P.O. Box 1404; Alexandria; VA; 22313-1404; US Patent Application Number: 20010001034 Date filed: January 5, 2001 Abstract: Devices and methods for utilizing dry chemistry dye indicator systems for body fluid analysis such as glucose level in whole blood are provided by incorporating an indicator in a bibulous matrix contained inside a hollow fiber capillary tube adapted to wick the fluid sample into the tube to wet the matrix and indicator system. The devices also enable visual or meter reading of the indicator by positioning the hollow fiber capillary tube in a housing having an optical opening adapted for receiving light form a source and directing the light to the capillary tube and for directing the light reflected therefrom to a detector. An advantage for the individual user is the small fluid, e.g., blood, sample required, which enables the user to avoid using finger tip sticks for samples. Another aspect of the device provides a determination of and correction for hematocrit level in whole blood in combination with indicator indication of analyte concentration. The devices provided are low cost due to efficient manufacturing. Excerpt(s): 1. The present invention relates to a test device and determination of a chemical or biochemical component (analyte) in an aqueous body fluid, such as whole blood or interstitial fluid. In particular the present invention relates to a dry reagent test device from which an analyte presence and/or concentration is determined by use of an instrument and a disposable capillary reagent carrier and acquisition device. A common use of such test devices is for determination of glucose level in blood by diabetics. 2. Numerous devices have been developed to test for presence and quantity of analytes in aqueous samples, such as whole blood or urine. The patent and technical literature of the last thirty years is replete with inventions which utilize a reagent strip containing a dry chemistry reagent system, that is, a system in which the wet chemistries are imbibed into an absorbent or bibulous medium, dried, and later reconstituted by fluid from the test sample. The reagent strips contain an indicator which changes color, depending on the presence or concentration of a particular analyte in a biological fluid applied to the strip. These strips may be read visually by reference to a color standard or calorimetrically by instrument calibrated or programmed to detect a certain color. Although some of these strips use reduction chemistries, more commonly they involve an oxidizable dye or dye couple. Some of the strips include an enzyme, such as glucose oxidase, which is capable of oxidizing glucose to gluconic acid and hydrogen peroxide. They also contain an oxidizable dye and a substance having peroxidative activity, which is capable of selectively catalyzing oxidation of the oxidizable dye in the presence of hydrogen peroxide. (See, for example, U.S. Pat. No. 4,935,346, to Phillips et al.) Examples of these devices, in addition to those used to test blood glucose, include tests for cholesterol, triglycerides, calcium or albumin in whole blood, and for protein, ketones, albumin or glucose in urine. 3. Dry chemistry reagent strips incorporating enzymebased compositions are used daily by millions of diabetics to determine blood glucose concentrations. The NIH sponsored study, the Diabetes Complications and Control

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Trial, demonstrated conclusively that careful control of blood glucose levels can significantly reduce the incidence of serious complications of diabetes such as vision loss and kidney malfunction. Most diabetics must test themselves periodically in order to make appropriate adjustments to their diet or medication. It is thus especially important for diabetics to have rapid, inexpensive, and accurate reagent strips for glucose determination. The embodiment of dry chemistry reagent systems in test strips enable simple yet effective analytical protocols. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Disposable electrode for whole blood hemoglobin (HGB) and hematocrit (HCT) measurement, and preparation and application thereof Inventor(s): Lin, Yueh-Hui; (Yun Lin Hsien, TW), Shen, Thomas Y.S.; (Hsinchu, TW) Correspondence: Rothwell, Figg, Ernst & Kurz, P.C.; 555 13th Street , N.W.; Washington; DC; 20004; US Patent Application Number: 20020048532 Date filed: January 30, 2001 Abstract: The subject invention relates to a disposable hemoglobin and hematocrit detecting electrode strip, the preparation and the use thereof. The concentration of hemoglobin and hematocrit in a liquid sample can be determined by electrochemically analyzing the liquid sample under a low operation voltage of below 400 mV. When the electrode strip is applied to detect the concentration of hemoglobin and hematocrit in human body, the whole blood is directly used as the sample. The hemoglobin and hematocrit detecting electrode strip is modified by a water-soluble redox electron mediator. The electrode strip simplifies the analysis of hemoglobin and hematocrit, is conveniently portable and can be easily manufactured in mass-production. Excerpt(s): The subject invention relates to an electrode strip which can easily determine the concentration of hemoglobin and hematocrit in a liquid sample, and to the preparation and the applications thereof. More specifically, the invention relates to a disposable hemoglobin and hematocrit electrode strip based on the theory of electrochemistry modified by a water-soluble redox electron mediator, which is disposable, and suitable for household use, screening for blood banks. In addition, said electrode strip can precisely detect the concentration of hemoglobin and hematocrit without any interference caused by other components in a liquid. Hemoglobin is also called hematochrome, which is 90% of erythrocyte and is composed of four globins and four ferrohemes. The main function of hemoglobin is to transport oxygen and carbon dioxide. The decrease of the concentration of hemoglobin shows anemia; and the increase shows polycythemia. Many methods can be used to determine the concentration of hemoglobin, including: (1) chemical method; (2) gas determination method; (3) specific density method; and (4) colorimetric method. The drawback of the former three methods are respectively: (1) being troublesome and time-consuming, (2) requiring specific equipment and (3) providing poor preciseness. Therefore, those methods are not useful in routine tests. Normally, routine test is performed by colorimetric method. In general, the colorimetric method includes acid hematin method and cyanmet-hemoglobin method. The acid hematin method: Sahli's method is normally used, which utilizes Sahli's tube to suck up 0.2 ml of HCl (0.1N) to mix with 0.1 ml of blood for hemolysis and reaction for 15 minutes. Water is dropwise added to the solution until the color of the solution and the color standards are consistent while the color of the solution is colorimetered with the color standards of the Sahli-Hellige

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hemoglobinometer. Because the color is subjectively judged by the operator in this method, the CV % is larger (about 5% to 10%). The cyanmet-hemoglobin method: the Drabkin's solution is used to dissolve the erytirocyte, and the component of the Drabkin's solution, K.sub.3Fe(CN).sub.6, can oxidize the ferrous moiety of hemoglobin into ferric moiety to form ferriheme (met-Hb; MHb). Ferriheme may combine with potassium cyanide (KCN) to form stable ferriheme cyanide, then ferriheme cyanide is colorimetered at 540 nm with a photoelectric colorimeter. This method is rapid and precise, and is publicly recognized as a standard method. Except that sulfhemoglobin does not show reaction, all types of hemoglobin can be detected. In this method, there is a hypertoxic pollution problem caused by potassium cyanide. Hematocrit (Hct) is referred to the percentage of globin volume, which is used for determining the proportion of erythrocyte contained in a certain amount of blood. Hematocrit is a good index for the judgment of anemia, which can correct the detection of erythrocyte and hemoglobin and determine the RBC indices. The method for determination of hematocrit includes centrifugation method and automatic globin counting method. The centrifugation method comprises precipitating the whole blood under certain centrifugation force by use of Wintrobe's tube or capillary tube (75*1 mm) to obtain three layers, i.e., a blood plasma layer, a gray-yellow layer and an erythrocyte layer, respectively. The volume percentage of the erythrocyte accumulated is determined and converted to hematocrit. The former method utilizing the Wintrobe's tube is the standard method for determination of hematocrit, but a large amount of blood is required. On the other hand, the latter method utilizing the capillary tube must be performed in combination with the use of a centrifugal machine and a hematocrit proportion ruler and need a high operation technique, although a little amount of blood is required. The automatic globin counting method is based on that the impulse is varied with the globin particles passing through the electric field in an electrolyte solution, and thus the cell number and cell size can be determined thereby. The other way of the automatic globin counting method is based on the cell number converted from the light of flash generated by the light beam when the particles of globin pass through tiny channels. Because the automatic globin counting method requires an impulse or a light of flash analyzer and a large amount of an electrolyte solution, and the analyzer need to be maintained and corrected, this method cannot be conveniently utilized. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Electrochemical methods and devices for use in the determination of hematocrit corrected analyte concentrations Inventor(s): Kermani, Mahyar Z.; (Pleasanton, CA), Ohara, Timothy; (Danville, CA) Correspondence: Bozicevic, Field & Francis Llp; 200 Middlefield RD; Suite 200; Menlo Park; CA; 94025; US Patent Application Number: 20020125145 Date filed: May 10, 2002 Abstract: Methods and devices for determining the concentration of an analyte in a physiological sample are provided. In the subject methods, the physiological sample is introduced into an electrochemical cell having a working and reference electrode. A first electric potential is applied to the cell and the resultant cell current over a period of time is measured to determine a first time-current transient. A second electric potential of opposite polarity is then applied and a second a time-current transient is determined.

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The preliminary concentration of the analyte is then calculated from the first and/or second time-current transient. This preliminary analyte concentration less a background value is then multiplied by a hematocrit correction factor to obtain the analyte concentration in the sample, where the hematocrit correction factor is a function of the preliminary analyte concentration and the variable.gamma. of the electrochemical cell. The subject methods and devices are suited for use in the determination of a wide variety of analytes in a wide variety of samples, and are particularly suited for the determination of analytes in whole blood or derivatives thereof, where an analyte of particular interest is glucose. Excerpt(s): The field of this invention is analyte determination, particularly electrochemical analyte determination and more particularly the electrochemical determination of blood analytes. Analyte detection in physiological fluids, e.g. blood or blood derived products, is of ever increasing importance to today's society. Analyte detection assays find use in a variety of applications, including clinical laboratory testing, home testing, etc., where the results of such testing play a prominent role in diagnosis and management in a variety of disease conditions. Analytes of interest include glucose for diabetes management, cholesterol, and the like. In response to this growing importance of analyte detection, a variety of analyte detection protocols and devices for both clinical and home use have been developed. One type of method that is employed for analyte detection is an electrochemical method. In such methods, an aqueous liquid sample is placed into a reaction zone in an electrochemical cell comprising two electrodes, i.e. a reference and working electrode, where the electrodes have an impedance which renders them suitable for amperometric measurement. The component to be analyzed is allowed to react directly with an electrode, or directly or indirectly with a redox reagent to form an oxidisable (or reducible) substance in an amount corresponding to the concentration of the component to be analyzed, i.e. analyte. The quantity of the oxidisable (or reducible) substance present is then estimated electrochemically and related to the amount of analyte present in the initial sample. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Extracorporeal blood processing methods and apparatus Inventor(s): Bainbridge, Marlene; (Lakewood, CO), Keller, Muriel; (Thornton, CO) Correspondence: Gambro, Inc; Patent Department; 10810 W Collins Ave; Lakewood; CO; 80215; US Patent Application Number: 20010000185 Date filed: December 4, 2000 Abstract: Improved extracorporeal blood processing methods and apparatus are disclosed. In one aspect of the invention, an extracorporeal method for the collection of platelets and red blood cells, and if desired plasma, is provided, wherein the collection of platelets and red blood cells may occur in differing time periods utilizing the same blood processing vessel. The flow of blood to the blood processing vessel and return of uncollected blood components may be provided via a single needle, wherein blood is removed and returned to a donor/patient during alternating blood removal and blood return submodes. Prior to red blood cell collection, a set-up phase may be carried out during which a predetermined hematocrit and AC ratio is established. Excerpt(s): 1. The present invention generally relates to the field of extracorporeal blood processing and, more particularly, to methods and apparatus which may be

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incorporated into an apheresis system (e.g., blood component collection, therapeutic). 2. One type of extracorporeal blood processing is an apheresis procedure in which blood is removed from a donor or donor/patient, directed to a blood component separation device (e.g., centrifuge), and separated into various blood component types (e.g., red blood cells, white blood cells, platelets, plasma) for collection or therapeutic purposes. One or more of these blood component types are collected (e.g., for therapeutic purposes), while the remainder are returned to the donor or donor/patient. 3. A number of factors affect the commercial viability of an apheresis system. One factor relates to the operator of the system, specifically the time and/or expertise required of an individual to prepare and operate the apheresis system. For instance, reducing the time required by the operator to load and unload the disposables, as well as the complexity of these actions, can increase productivity and/or reduce the potential for operator error. Moreover, reducing the dependency of the system on the operator may lead to reductions in operator errors and/or to reductions in the credentials desired/required for the operators of these systems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Extracorporeal blood processing methods and apparatus Inventor(s): Bainbridge, Marlene; (Lakewood, CO), Butzke, Scott D.; (Littleton, CO), Gordon, Timothy M.; (Littleton, CO), Keller, Muriel; (Thornton, CO), McAteer, Michael J.; (Lakewood, CO) Correspondence: Gambro, Inc; Patent Department; 10810 W Collins Ave; Lakewood; CO; 80215; US Patent Application Number: 20020033370 Date filed: March 9, 2001 Abstract: Methods and apparatus particularly involving the separation of blood into blood components and the collection of such components are disclosed. In one aspect, an extracorporeal method for the collection of plasma and red blood cells is provided, wherein the collection of plasma and red blood cells may occur simultaneously or subsequently utilizing the same dual stage blood processing vessel. The flow of blood to the blood processing vessel and return of uncollected blood components may be provided via a single needle, wherein blood is removed from and returned to a donor/patient during alternating blood removal and blood return submodes. Platelet separation and collection options are also described. In either case, prior to red blood cell collection, a set-up phase may be carried out to set a predetermined hematocrit and AC ratio. Replacement fluid delivery may optionally also be provided either substantially continuously during any collection phase(s) and/or in a bolus mode. Excerpt(s): This patent application claims the benefit of U.S. Provisional Patent Application No. 60/188,133; filed Mar. 09, 2000. The present invention generally relates to the field of extracorporeal blood processing and, more particularly, to methods and apparatus which may be incorporated into an apheresis system useful for blood component collection, or for therapeutic purposes. One type of extracorporeal blood processing is an apheresis procedure in which blood is removed from a donor or patient (hereafter, donor/patient), directed to a blood component separation device (e.g., centrifuge), and separated into various blood component types (e.g., red blood cells, white blood cells, platelets, plasma) for collection and/or therapeutic purposes. One or more of these blood component types are collected (e.g., for therapeutic transfusion purposes), while the remainder are preferably returned to the donor or donor/patient.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Hematocrit sampling system Inventor(s): Hunley, Steven Kenneth; (Loveland, CO), Koenig, Rainer Harald; (Denver, CO) Correspondence: Terry L. Wiles, ESQ.; Popovich & Wiles, PA; Suite 1902, Ids Center; 80 South 8th Street; Minneapolis; MN; 55402; US Patent Application Number: 20030195452 Date filed: April 8, 2003 Abstract: Accurate measurement of hematocrit during blood recovery or plasma sequestration processes by means of algorithms to account for the presence of air or other non-blood substances in salvaged or separated blood is described. A method of automatic start-up of the hematocrit measurement circuit and a method of determining the minimum volume of blood required to obtain an accurate measurement of the hematocrit also is described. Excerpt(s): The present invention relates to extracorporeal blood processing. More particularly, this invention relates to a method and apparatus for the automated sampling of the hematocrit of blood. The collection and reinfusion of a patient's own blood, referred to as autologous blood, offers a number of recognized benefits. For example, the use of autologous blood reduces concerns relating to the possibility of disease transmission via donor blood transfusions, referred to as homologous blood, as well as concerns regarding febrile/allergic reactions. Additionally, autologous blood recovery ensures the rapid availability of blood and reduces or eliminates the need for compatibility testing on such blood since the procedure is most typically completed in an operating room. Further, the use of autologous blood provides red blood cells which are generally superior in quality to banked blood and reduces any quantity of homologous blood otherwise needed. The use of autologous blood is also desirous to many patients for psychological and/or religious reasons. Intraoperative procedures where autologous blood salvage is currently employed include cardiac and vascular surgery. Specialties which employ autologous blood salvage include orthopedics, plastic and reconstructive surgery, neurosurgery, solid organ transplants, general surgery, gynecology and trauma. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for determining blood parameters and vital signs of a patient Inventor(s): Hanna, Charles F.; (Libertyville, IL), Hohs, Ronald R.; (Kenosha, WI), Kantor, Stanislaw; (Buffalo Grove, IL), Khalil, Omar S.; (Libertyville, IL), Koziarz, James J.; (Highland Park, IL), Leiden, Jeffrey M.; (Glencoe, IL), Shain, Eric Brian; (Glencoe, IL), Wu, Xiaomao; (Gurnee, IL), Yeh, Shu-jen; (Grayslake, IL) Correspondence: Steven F. Weinstock; Abbott Laboratories; 100 Abbott Park Road; DEPT. 377/ap6a; Abbott Park; IL; 60064-6008; US Patent Application Number: 20030212316 Date filed: May 10, 2002

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Abstract: A method of monitoring a patient that comprises a non-invasive measurement of the hematocrit value or the concentration of hemoglobin coupled with the measurement of one or more vital signs. These vital signs include, but are not limited to, cardiac pulse rate, blood pressure, and arterial blood oxygenation. The invention also provides an apparatus for monitoring changes in the hematocrit value of a patient, in combination with one or more of the patient's vital signs. Excerpt(s): This invention relates to an apparatus and a method for monitoring the condition of a patient, more particularly, for monitoring the condition of a patient by monitoring the change in a blood parameter, such as the concentration of hemoglobin or the hematocrit value, combined with changes in the patient's vital signs, such as cardiac pulse rate, oxygen saturation, and blood pressure. Measuring the vital signs of a patient is a standard practice in the care of a patient. Vital signs include cardiac pulse rate, temperature, breathing frequency, and blood pressure. Vital signs are usually measured at the physician's office, before the patient is admitted to a hospital, and routinely during hospital care. Additionally, these vital signs are continuously, or at least frequently, monitored during and after a surgical operation. In addition to cardiac pulse rate, temperature, and blood pressure, another parameter, arterial blood oxygen saturation, is monitored during and after a surgical procedure. A decrease in cardiac pulse rate, blood pressure, or blood oxygen saturation is indicative of a deterioration of the condition of the patient. The cardiac pulse rate is an important vital sign for determining the health status of a patient and for monitoring the patient's status during intensive care and postoperative recovery. A decrease in cardiac pulse rate indicates a decrease in the frequency at which the heart contracts and expands, and thus indicates a decrease in cardiac sufficiency. An irregular cardiac pulse rate is an indication of heart murmur and asynchronous cardiac performance. Monitors that incorporate blood oxygen saturation measurements and cardiac pulse rate are commercially available. A single sensor is used to determine both parameters. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for determining erythrocyte sedimentation rate and hematocrit Inventor(s): Bennett, Michael; (Cambridge, MA), Tanasijevic, Milenko J.; (Chestnut Hill, MA), Winkelman, James W.; (Brookline, MA) Correspondence: Samuels, Gauthier, & Stevens Llp; Suite 3300; 225 Franklin Street; Boston; MA; 02110; US Patent Application Number: 20030113930 Date filed: January 13, 2003 Abstract: A method and apparatus is disclosed for determining the erythrocyte sedimentation rate and hematocrit simultaneously with the centrifugation of whole blood. A centrifuge separates the whole blood into its erythrocytes and its fluid portion. A video camera measures the levels of whole blood, erythrocytes and the fluid portion of the blood-and records the time of the formation of an interface between the erythrocytes and fluid portion. A monitor displays the results of the recording. Also disclosed are the method steps performed. Excerpt(s): Daily there are hundreds of thousands of samples of blood drawn in hospitals, medical clinics and doctors' offices for analytical purposes. Some of this blood is analyzed directly as whole blood without being processed. Some is analyzed after separation of the cellular components of the blood (e.g., leukocytes and erythrocytes)

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from the fluid portion of the blood (plasma or serum). For example, whole blood can be used for hematological analysis to measure the total concentration of red blood cells and white blood cells in the whole blood, or to prepare blood smears for microscopic analysis of the different types of cells that are present in the blood. Microscopic analysis can be used to diagnose a number of different diseases that might be present, such as certain types of leukemias or anemias. Very commonly, the patient will have a complete blood count (CBC) performed on a whole blood sample. A CBC typically includes a red blood cell (RBC) count, a white blood cell (WBC) count, a differential white blood cell count to identify the types of white blood cells present, a platelet count and the determination of blood parameters such as total hemoglobin and hematocrit. Alternatively, whole blood can be processed to separate the cellular components from the fluid portion to obtain serum or plasma. Initially, blood is drawn from a patient into a small glass tube. If the tube contains an anticoagulant, the blood does not coagulate (i.e., form a clot) and the cells remain "suspended" in the plasma. If the tube does not contain an anticoagulant, the blood coagulates. The formation of a clot removes certain protein components from the plasma, with serum remaining as the fluid portion of the blood. Processing whole blood to separate cells from plasma/serum is typically accomplished by centrifugation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for improving the accuracy of noninvasive hematocrit measurements Inventor(s): Schmitt, Joseph M.; (Andover, MA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20020165439 Date filed: March 16, 2001 Abstract: A device and a method to provide a more reliable and accurate measurement of hematocrit (Hct) by noninvasive means. The changes in the intensities of light of multiple wavelengths transmitted through or reflected light from the tissue location are recorded immediately before and after occluding the flow of venous blood from the tissue location with an occlusion device positioned near the tissue location. As the venous return stops and the incoming arterial blood expands the blood vessels, the light intensities measured within a particular band of near-infrared wavelengths decrease in proportion to the volume of hemoglobin in the tissue location; those intensities measured within a separate band of wavelengths in which water absorbs respond to the difference between the water fractions within the blood and the displaced tissue volume. A mathematical algorithm applied to the time-varying intensities yields a quantitative estimate of the absolute concentration of hemoglobin in the blood. To compensate for the effect of the unknown fraction of water in the extravascular tissue on the Hct measurement, the tissue water fraction is determined before the occlusion cycle begins by measuring the diffuse transmittance or reflectance spectra of the tissue at selected wavelengths. Excerpt(s): This invention relates to systems and methods for spectrophotometric measurement of biochemical compounds in the skin for non-invasive medical diagnosis and monitoring. Specifically, the present invention relates to the determination of the hematocrit or the absolute concentration of hemoglobin in the blood by multiplewavelength optical plethysmography. The total concentration of hemoglobin in blood

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(Hb.sub.T) or the hematocrit (Hct), defined as the fraction or percentage of red cells in whole blood, are primary variables used by physicians to assess the health of a patient. The hematocrit is the fraction of the total blood volume occupied by the red blood cells, and hemoglobin is the principal active constituent of red blood cells. Approximately 34% of the red cell volume is occupied by hemoglobin. A value of Hb.sub.T less than 10 g/dl or Hct <0.30 indicates an anemic state which can impair the normal functions of the body. Severe anemia can lead to death when the quantity of hemoglobin becomes insufficient to supply oxygen to the brain and other vital organs. Patients with kidney disease, pregnant women, and young children in developing countries are especially susceptible to chronic anemia. Acute anemia resulting from loss of blood, infection, or autoimmune disorders can be life-threatening and requires close monitoring. The conventional means employed to measure Hct in clinical medicine is to puncture the skin, draw blood from a vein or capillary into a small-diameter tube, and measure the solid (packed-cell) fraction that remains after centrifugation of the blood. Measurement of Hb.sub.T in accordance with standard practice also requires drawing a blood sample, which is then subjected to a chemical or mechanical process to lyse the red cells and release the liquid hemoglobin. After transferring the hemoglobin to a cuvette, its concentration is measured either by direct spectrophotometry or by colorimetry following the addition of a chemical reagent. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for measuring the hemoglobin concentration and/or hematocrit in whole blood using diffuse light Inventor(s): Fletcher, Gary; (Wallingford, PA), Groner, Warren; (Great Neck, NY), Perkins, Amy; (Philadelphia, PA), Wang, Hsing-Wen; (Philadelphia, PA) Correspondence: Caesar, Rivise, Bernstein,; Cohen & Pokotilow, LTD.; 12th Floor, Seven Penn Center; 1635 Market Street; Philadelphia; PA; 19103-2212; US Patent Application Number: 20040058311 Date filed: August 4, 2003 Abstract: A system, method and computer program product is provided for obtaining linear optical measurements (e.g., optical density) of hemoglobin concentration or hematrocrit in whole blood using diffuse illumination. The present invention uses a diffuse illumination source to measure spectral signatures. The light source is projected such that the optical measurement does not need to be corrected for scattering effects. The detected light in the present invention can be collimated light or light collected over a small solid angle and imaged onto a detector for accurate microvessel hematocrit measurements. Excerpt(s): The present invention relates generally to reflected spectral imaging. More particularly, the present invention relates to correcting reflected spectral images for scattering effects to improve analysis of visualizable components within a fluid flowing in a tubular system. The development of techniques for microvessel hematocrit (Hct) determination using optical density (OD) measurement has posed a challenging problem since 1960s. The Lambert-Beer law of light absorption holds for hemoglobin in solution but not for whole blood due to light scattering from individual red blood cells. Further, the complex optical properties of whole blood lead to a nonlinear relationship between optical density and either the hemoglobin concentration or tube Hct. These phenomena have been studied and reported by several researchers. For example, wavescattering phenomena is described in V. Twersky, "Multiple scattering of waves and

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optical phenomena," J. Opt. Soc. Amer. 52, 145-171, 1962; V. Twersky, "Absorption and multiple scattering by biological suspensions," J. Opt. Soc. Am. 60, 1084-1093, 1970; and V. Twersky, "Interface effects in multiple scattering by large, low-refracting, absorbing particles," J. Opt. Soc. Am. 60, 908-914, 1970. In these references, Twersky proposes a wave-scattering theory that agrees reasonably well with experimental data. This subject is also addressed in R. J. Jendrucko and J. S. Lee, "The measurement of hematocrit of blood flowing in glass capillaries by microphotometry," Microvasc. Res. 6, 316-331, 1973; H. H. Lipowsky, S. Usami, S. Chien, and R. N. Pittman, "Hematocrit determination in small bore tubes from optical density measurements under white light illumination," Microvasc. Res. 20, 51-70, 1980; J. M. Steinke and A. P. Shepherd, "Role of light scattering in spectrophotometric measurements of arteriovenous oxygen difference," IEEE Trans. Biomed. Eng. BME 33, 729-734, 1986; and J. M. Steinke and A. P. Shepherd, "Role of light scattering in whole blood oximetry," IEEE Trans. Biomed. Eng. BME 33, 294-301, 1986. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for non-invasive blood constituent monitoring Inventor(s): Miller, David R.; (Morgan, UT), Steuer, Robert R.; (Pleasant View, UT) Correspondence: Jacobson Holman Pllc; 400 Seventh Street N.W.; Suite 600; Washington; DC; 20004; US Patent Application Number: 20010039376 Date filed: January 30, 2001 Abstract: A system for determining a biologic constituent including hematocrit transcutaneously, noninvasively and continuously. A finger clip assembly includes including at least a pair of emitters and a photodiode in appropriate alignment to enable operation in either a transmissive mode or a reflectance mode. At least one predetermined wavelength of light is passed onto or through body tissues such as a finger, earlobe, or scalp, etc. and attenuation of light at that wavelength is detected. Likewise, the change in blood flow is determined by various techniques including optical, pressure, piezo and strain gage methods. Mathematical manipulation of the detected values compensates for the effects of body tissue and fluid and determines the hematocrit value. If an additional wavelength of light is used which attenuates light substantially differently by oxyhemoglobin and reduced hemoglobin, then the blood oxygen saturation value, independent of hematocrit may be determined. Further, if an additional wavelength of light is used which greatly attenuates light due to bilirubin (440 nm) or glucose (1060 nm), then the bilirubin or glucose value may also be determined. Also how to determine the hematocrit with a two step DC analysis technique is provided. Then a pulse wave is not required, so this method may be utilized in states of low blood pressure or low blood flow. Excerpt(s): The present invention is related to U.S. Pat. Nos. 5,372,136 and 5,499,627 the text and drawings of which are incorporated herein by reference as if reproduced in full. The present invention relates to improvements in the systems and methods for noninvasively measuring one or more biologic constituent concentration values. More particularly, the present invention relates to non-invasive spectrophotometric systems and methods for quantitatively and continuously monitoring the hematocrit and other blood parameters. Modern medical practice utilizes a number of procedures and indicators to assess a patient's condition. One of these indicators is the patient's hematocrit. Hematocrit (often abbreviated as HCT) is the volume expressed as a percentage of the patient's blood which is occupied by red corpuscles, commonly

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referred to as red blood cells. The present invention is presented in the context of hematocrit. However, it is to be understood that the teachings of the present invention apply to any desired biologic constituent parameter. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for separation of particles in a microfluidic device Inventor(s): Blankenstein, Gert; (Dortmund, DE), Peters, Ralf-Peter; (Dortmund, DE), Profitt, James A.; (Goshen, IN), Pugia, Michael J.; (Granger, IN), Schulman, Lloyd; (Osceola, IN) Correspondence: Jenkens & Gilchrist, P.C.; 225 West Washington; Suite 2600; Chicago; IL; 60606; US Patent Application Number: 20040121449 Date filed: December 19, 2002 Abstract: A microfluidic device provides separation of particles in a liquid sample, particularly, separation of a sample of whole blood into its components for further analysis. Separation into red blood cells and plasma occurs within a few seconds after the blood sample has been transferred into a separation chamber with the application of centrifugal force of less than one up to about five times gravity. With the application of greater force measurement of hematocrit is possible. Excerpt(s): This invention relates generally to the field of microfluidic devices, such as are used for analysis of various biological and chemical compositions. Generally, the invention relates to separation of particulate matter from liquid samples. In a preferred embodiment, the invention relates to a method and apparatus for separating samples of blood for analysis of its components. To determine the presence (or absence) of, or the amount of an analyte, such as glucose, albumin, or bacteria in bodily or other fluids, a reagent device is generally used to assist a technician performing the analysis. Such reagent devices contain one or more reagent areas at which the technician can apply the sample fluid and then compare the result to a standard. For example, a reagent strip is dipped into the sample fluid and the strip changes color, the intensity or type of color being compared with a standard reference color chart. Preparation of such devices is difficult when the sample has a complex composition, as many bodily fluids do. The component to be identified or measured may have to be converted to a suitable form before it can be detected by a reagent to provide a characteristic color. Other components in the sample fluid may interfere with the desired reaction and they must be separated from the sample or their effect neutralized. Sometimes, the reagent components are incompatible with each other. In other cases, the sample must be pretreated to concentrate the component of interest. These and other problems make it difficult to provide in a single device the reagent components which are needed for a particular assay. The art contains many examples of devices intended to overcome such problems and to provide the ability to analyze a fluid sample for a particular component or components. A different approach is to carry out a sequence of steps which prepare and analyze a sample, but without requiring a technician to do so. One way of doing this is by preparing a device which does the desired processes automatically, but by keeping the reagents isolated, is able to avoid the problems just discussed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for the automatic control of a blood centrifuge Inventor(s): Belloni, Massimo; (Isola Della Scala Vr, IT), Comai, Guido; (Budrio Bo, IT), Panzani, Ivo; (Mirandola, IT), Zanella, Andrea; (Mirandola, IT) Correspondence: Terry L. Wiles, ESQ.; Popovich & Wiles, PA; Suite 1902, Ids Center; 80 South 8th Street; Minneapolis; MN; 55402; US Patent Application Number: 20010027157 Date filed: June 4, 2001 Abstract: A method and an apparatus for the automatic control of a blood centrifuge, including a controller that processes four input values and two output parameters. The four input values include the hematocrit value of the input blood, the volume of the red cells present in the centrifuge, the filling level of the centrifuge, and, selectively, the hematocrit value for collected blood at the end of the filling step and the time required for the filling step. The two output parameters include the flow rate of the blood into the centrifuge and either the time required for the filling step (when the hematocrit value is provided as input) or the predicted hematocrit value (when the time for the filling step is provided as input). Excerpt(s): This is a continuation of application Ser. No. 09/366,989, filed Aug. 4, 1999, the contents of which are hereby incorporated herein by reference. The present invention relates to a method and an apparatus for the automatic control of a blood centrifuge. The hematocrit value is the percentage of the volume of the blood that is occupied by red blood cells. During some medical procedures, such as, for example, autotransfusion during or after surgery, there is a need to increase the blood's hematocrit value. Increasing the blood's hematocrit value is currently performed in blood centrifuges where blood is introduced by a peristaltic pump. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and device for measurement of hematocrit Inventor(s): Grzeda, Barbara R.; (Schaumburg, IL), Maggiore, Jack A.; (Lombard, IL) Correspondence: Olson & Hierl, LTD.; 36th Floor; 20 North Wacker Drive; Chicago; IL; 60606; US Patent Application Number: 20040023399 Date filed: April 17, 2003 Abstract: Hematocrit in a blood sample is visualized by separating blood plasma from red blood cells in the blood sample on an absorbent substrate provided with a blood plasma soluble dye. Methods and devices to achieve the visualization are described. Excerpt(s): This application claims priority of U.S. Provisional Application No. 60/373,303, filed on Apr. 17, 2002. This invention relates to a method and apparatus for measuring blood parameters such as hematocrit in a whole blood sample. More particularly the invention relates to a hematocrit measuring device that contains a blood plasma separating membrane and its use. Hemoglobin determination is one of the most frequently performed tests in hospitals. Anemia, or a decrease in hemoglobin concentration, is a sign of an underlying disease process. Mild anemic states often cause no symptoms because of the body's ability to compensate for the deficiency in hemoglobin, at least on a short term basis. With increasing severity of anemia, however,

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the resulting increased cardiac stress may cause tachycardia, shortness of breath, and headaches. In its most severe form, anemia may lead to coma and death. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for treating cancer and increasing hematocrit levels Inventor(s): Kuo, Calvin; (Palo Alto, CA), Mulligan, Richard; (Cambridge, MA) Correspondence: David S Resnick; Nixon Peabody; 101 Federal Street; Boston; MA; 02110; US Patent Application Number: 20040132675 Date filed: February 10, 2004 Abstract: The present invention provides a method for inhibiting undesired angiogenesis including tumor-associated angiogenesis. The invention further provides a method for increasing the number of red blood cells or hematocrit in the circulation in subjects in need thereof. The invention also provides a method for simultaneously treating low hematocrit and undesired angiogenesis. Additionally, the present inventio provides a method for determining efficacy or endpoint of treatment with one or more VEGF-inhibitors. Excerpt(s): The present invention relates to methods for treatment of cancer and low hematocrit levels. Specifically, the invention relates to methods of treating large preexisting tumors. Additionally the invention relates to methods of treating low hematocrit levels. The invention further relates to methods of determining the efficacy of VEGF-inhibitor related treatments. Angiogenesis, the growth of new blood vessels from existing endothelium is tightly controlled by opposing effects of positive and negative regulators. At least three families of receptor tyrosine kinases have been implicated in positive angiogenic regulation, the VEGF receptors (Flk1, Flt1), the TIE receptors (TIE1, TIE2), and the ephB4/ephrin B2 system [Ferrara et al., Nat Med 5:13591364, 1999; Gale et al., Genes Dev 13:1055-66, 1999]. On the other hand, putative negative angiogenic regulators, such as angiostatin and endostatin, have recently been identified [O'Reilly et al., Cell 88:277-85, 1997; O'Reilly et al., Cell 79:315-28, 1994]. Under certain pathological conditions, including proliferative retinopathies, rheumatoid arthritis, psoriasis and cancer, positive regulators prevail and angiogenesis contributes to disease progression [reviewed in Folkman, Nat Med 1:27-31, 1995]. For example, the quantity of blood vessels in tumor tissue is a strong negative prognostic indicator in breast and prostate cancer, brain tumors and melanoma [Weidner et al., J Natl Cancer Inst 84:18751887, 1992; Weidner et al., Am J Pathol 143:401-409, 1993; Li et al., Lancet 344:82-86, 1994; Foss et al., Cancer Res 56:2900-2903, 1996]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of enhancing the efficacy of anti-tumor agents Inventor(s): Piver, M. Steven; (Buffalo, NY), Silver, David F.; (Buffalo, NY) Correspondence: Ranjana Kadle; Hodgson, Russ Andrews,; Woods & Goodyear, Llp; One M&t Plaza, Suite 2000; Buffalo; NY; 14203-2391; US Patent Application Number: 20010000730 Date filed: December 19, 2000

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Abstract: A method for enhancing the effect of anti-tumor agents on solid tumors is provided. The method comprises administering to an individual an anti-tumor agent and a hematocrit elevator. The hematocrit elevator may be administered before or concurrently with the anti-tumor agent. Excerpt(s): 1. This application is a continuation of U.S. patent application Ser. No. 09/300,124 filed on Apr. 27, 1999, the disclosure of which is incorporated herein by reference. 2. This invention relates to the field of treatment of cancer. More particularly, this invention, relates to increasing the efficacy of chemotherapeutic agents for the treatment of solid tumors by improving the hematocrit during chemotherapy. 5. Although, platinum compounds are useful against malignancies, the development of tumor resistance during the course of treatment limits their usefulness. Many of the specific antitumor mechanisms of platinum are not fully understood. Without detailed mechanistic information of platinum cytotoxicity, it has been difficult to overcome the problem of tumor resistance to cisplatin and therefore to enhance the efficacy of platinum and other anti-tumor agents. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods for treating or preventing ischemic injury Inventor(s): Stamler, Jonathan S.; (Chapel Hill, NC) Correspondence: Mintz, Levin, Cohn, Ferris,; Glovsky And Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20040009908 Date filed: July 10, 2002 Abstract: A therapeutic or prophylactic treatment method of myocardial ischemia, such as due to myocardial infarction, by administering erythropoietin, alone or in combination with other drugs, to a patient suffering from or at risk of cardiac injury, such as myocardial ischemia. The erythropoietin is administered in a concentration such that the subject's hematocrit level or production of red blood cells is not significantly affected. Excerpt(s): The present invention generally relates to methods, preparations and pharmaceutical compositions for treating or preventing ischemic injury in mammalian subjects. More specifically, the present invention uses erythropoietins to treat myocardial ischemia or ischemia-reperfusion injury in patients in need thereof. Ischemia occurs when the flow of blood to a region of the body is decreased or eliminated, such as during a myocardial infarction, causing damage to the tissue distal to the blockage. In the United States, approximately 1.5 million myocardial infarctions (MIs) occur each year, and mortality with acute infarction is approximately 30 percent (Pasternak, R. and Braunwald, E., Acute Myocardial Infarction, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 13th Ed., McGraw Hill Inc., p.p. 1066-77 (1994)). Myocardial infarction occurs generally with an abrupt decrease in coronary blood flow that follows a thrombotic occlusion of a coronary artery. The occluded artery often has been narrowed previously by atherosclerosis, and the risk of recurrent nonfatal myocardial infarction persists in many patients. Ultimately, the extent of myocardial damage caused by the coronary occlusion depends upon the "territory" supplied by the affected vessel, the degree of occlusion of the vessel, the amount of blood supplied by collateral vessels to the affected tissue, and the demand for oxygen of the myocardium whose blood supply has suddenly been limited (Pasternak, R. and Braunwald, E. Acute Myocardial

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Infarction, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 13th Ed., McGraw Hill Inc., p.p. 1066-77 (1994)). In some cases, the flow of blood to a region of the body is temporarily halted and then re-established (reperfusion), resulting in ischemiareperfusion injury. Ischemia-reperfusion injury can occur during certain surgical procedures, such as repair of aortic aneurysms and organ transplantation. Clinically, ischemia-reperfusion injury is manifested by such complications as pulmonary dysfunction, including adult respiratory distress syndrome, renal dysfunction, consumptive coagulopathies including thrombocytopenia, fibrin deposition into the microvasculature and disseminated intravascular coagulopathy, transient and permanent spinal cord injury, cardiac arrhythmias and acute ischemic events, hepatic dysfunction including acute hepatocellular damage and necrosis, gastrointestinal dysfunction including hemorrhage and/or infarction and multisystem organ dysfunction (MSOD) or acute systemic inflammatory distress syndromes (SIRS). The injury may occur in the parts of the body to which the blood supply was interrupted, or it can occur in parts fully supplied with blood during the period of ischemia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods of determining glucose concentration in whole blood samples Inventor(s): Genshaw, Marvin A.; (Elkhart, IN), Melle, Bryan S.; (Elkhart, IN), Vreeke, Mark S.; (Houston, TX) Correspondence: Jerome L. Jeffers, ESQ.; Bayer Healthcare Llc; P. O. Box 40; Elkhart; IN; 46515-0040; US Patent Application Number: 20040079652 Date filed: August 22, 2003 Abstract: The glucose concentration in a whole blood sample may be determined by providing an electrochemical sensor adapted to measure glucose and hematocrit concentrations. The hematocrit concentration of the whole blood sample is measured using the electrochemical sensor via electrochemical impedance spectroscopy. The initial glucose concentration of the whole blood sample is measured using the electrochemical sensor. The unbiased glucose concentration in the whole blood sample is calculated using the initial glucose concentration measurement and the hematocrit concentration. Excerpt(s): The present invention relates generally to methods of determining glucose concentration in whole blood samples and, more specifically, methods of determining glucose concentration in whole blood samples using hematocrit concentration. Individuals have attempted to determine glucose concentration in whole blood samples for a number of years. The determination of glucose concentration in whole blood samples is important in a variety of applications. For example, determining and monitoring glucose concentration are important for diabetics in reducing risks and improving quality of life. The results of such tests can be used to determine what, if any, insulin or other medication needs are to be administered. Glucose concentration in whole blood samples can be difficult to determine because of the biasing associated with the whole blood hematocrit concentration. The hematocrit concentration is the concentration of red blood cells in the whole blood sample. Variations in the hematocrit concentration of whole blood samples result in bias to the glucose concentration measurements. The bias to the glucose concentrations can be significant such as, for example, a 1% bias per 1% change in the hematocrit concentration. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Microfluidic blood sample separations Inventor(s): Leonard, Leslie Anne; (Portola Valley, CA) Correspondence: Agilent Technologies, INC.; Legal Department, Dl429; Intellectual Property Administration; P.O. Box 7599; Loveland; CO; 80537-0599; US Patent Application Number: 20040019300 Date filed: July 26, 2002 Abstract: A microfluidic system isolates blood cells of a minute volume of a blood sample by using a passive-settlement approach or an active-flow approach, rather than an approach that requires centrifugation. In the passive-settlement approach, the microfluidic system yields a hematocrit measurement by detecting the volume of red blood cells that settle under the influence of gravitational force. According to the activeflow approach, blood cells are isolated at one or more porous regions having pores dimensioned which preferentially pass constituents of the blood sample. Excerpt(s): The invention relates generally to isolating blood cells of a blood sample and more particularly to determining measurements for a small volume of blood. In clinical chemistry, the identification of the composition of a person's blood is used as an important diagnostic tool. Blood is primarily serum, but includes three major types of cells. Serum comprises approximately sixty percent to seventy percent of a human blood sample, while approximately thirty to forty percent of the sample is cellular. Plasma within the sample is more than ninety percent water, with the remainder consisting of proteins, lipids, salts and the like. The three major blood cell types are red blood cells (RBCs), white blood cells (WBCs) and platelets. The category "hematology" encompasses a wide variety of different measurements, including hemoglobin, hematocrit, total RBC count, total WBC count, total platelet count, differential WBC count, platelet function and calculated RBC indices. Additionally, newer tests are becoming standard additions to this list, including RBC morphology, reticulocyte counts, and neutrophil maturation. Routinely, a large quantity of blood is drawn from a vein in the arm of a person when clinical lab tests are requested. Typically, more than ten milliliters (mis) are drawn. This sample volume is significantly more than is needed for one test, but it is common to run multiple clinical tests. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Systems and methods for sensing red blood cell hematocrit Inventor(s): Joie, Michel L. F.; (Ernage, BE), Muller, Matthew R.; (Lindenhurst, IL), Vandlik, Mark R.; (Mundelein, IL) Correspondence: Baxter Healthcare Corporation; Bradford R.L. Price, Fenwal Division Rlp-30; Route 120 And Wilson Road; Round Lake; IL; 60072; US Patent Application Number: 20020011449 Date filed: July 10, 2001 Abstract: Red blood cell sensing systems and methods rely upon straightforward measurement geometries. the systems and methods comprise an incident light source, an optical sensor, and a blood collection tube. The systems and methods hold the blood collection tube a predetermined radial distance from the incident light source where a linear relationship exists between sensed reflected light measured by the optical sensor

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and red blood cell hematocrit in a range of at least 10 to 90. The systems and methods make possible accurate red blood sensing without use of special optical cuvettes, mirrors, or focusing lenses. The systems and methods also make possible the use of standard transparent plastic tubing, without reliance upon special optical cuvettes. Excerpt(s): This invention relates to systems and methods for processing and collecting blood, blood constituents, or other suspensions of cellular material. Today people routinely separate whole blood, usually by centrifugation, into its various therapeutic components, such as red blood cells, platelets, and plasma. Conventional blood processing methods use durable centrifuge equipment in association with single use, sterile processing systems, typically made of plastic. The operator loads the disposable systems upon the centrifuge before processing and removes them afterwards. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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

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CHAPTER 5. BOOKS ON HEMATOCRIT Overview This chapter provides bibliographic book references relating to hematocrit. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on hematocrit 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 “hematocrit” (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 hematocrit: •

Clinical Practice Guidelines for the Treatment of Anemia of Chronic Renal Failure Source: New York, NY: National Kidney Foundation. 1997. 174 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax (212) 689-9261. PRICE: $13.00. ISBN: 0962972177. Summary: In March 1995, the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) was established, with the objective of improving patient outcomes and survival by providing recommendations for optimal clinical practices in four areas: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and the treatment of anemia of chronic renal failure (CRF). This document presents 28 clinical practice guidelines for anemia. They are categorized in seven sections: anemia workup, target hematocrit and hemoglobin, iron support, administration of Epoetin (erythropoietin), inadequate epoetin response, the role of red blood cell transfusions, and possible adverse effects related to epoetin therapy. Each guideline is accompanied

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by a rationale, enabling dialysis caregivers to make informed decisions about the proper care plan for each individual patient. This document also includes a list of acronyms and abbreviations, a description of the guideline development methodology, endnotes, references, biographical sketches of the NKF-DOQI anemia work group members, and a complete listing of the articles reviewed by the anemia work group. 1 figure. 9 tables. 349 references. (AA-M). •

Guidelines for the Nutritional Intervention of the Adult Dialysis Patient Source: Marina del Rey, CA: R and D Laboratories, Inc. 1990. 88 p. Contact: Available from R and D Laboratories, Inc. 4640 Admiralty Way, Suite 710, Marina del Rey, CA 90292. (800) 338-9066. PRICE: Contact directly for current price. Summary: This handbook is designed to assist the renal dietitian through the complex steps of evaluating the nutrition status of a dialysis patient. The guidelines are arranged by individual diagnoses or problems, and are based primarily on laboratory chemistries, presented as a quick reference. Expected patient outcome criteria are listed for each problem, along with a list of appropriate dietary interventions. A patient education documentation sheet suitable for use in the medical record is provided for each of the problems. Topics include hyperlipidemia, body weight changes, hyper-and hypocalcemia, hyperphosphatemia, elevated BUN, depressed serum albumin, hyperkalemia, fluid overload, and low hematocrit. 18 references.

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

Management of Quality in Dialysis Care Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 307-311. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Continuous Quality Improvement (CQI) is a method to address concerns raised by increased competition in the managed care environment, including demands that providers be responsive to quality and cost issues. This chapter on the management of quality in dialysis care is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter describe CQI and its use in the dialysis care setting. CQI involves collecting data about the current situation, identifying ways to improve the

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performance, introducing new and better approaches and methods to achieve desired outcomes, and then evaluating the interventions. The core indicators used in the dialysis setting are adequacy of dialysis, desirable hematocrit value, optimal nutritional status, and control of blood pressure. All personnel contribute to CQI by being vigilant in recognizing care practices in need of improvement. The authors also outline the role that the ESRD (end stage renal disease) Networks play in quality management and discuss the quality improvement initiative of the National Kidney Foundation (NKF). •

Anemia Correction and Cardiac Function: Coronary Artery Disease and LeftVentricular Hypertrophy Source: in Koch, K.M. and Stein, G., eds. Pathogenetic and Therapeutic Aspects of Chronic Renal Failure. New York, NY: Marcel Dekker, Inc. 1997. p. 225-232. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. PRICE: $115.00. ISBN: 0824798945. Summary: This chapter on anemia correction and cardiac function is from a book based on an international workshop, Chronic Renal Failure: Pathogenetic and Therapeutic Aspects, held in Berlin in May 1996. The author explores the role of renal anemia and the effects of erythropoietin (EPO)-induced recompensation of anemia in dialysis patients with left-ventricular hypertrophy (LVH) and coronary artery disease (CAD). Both of these diseases are characterized by a reduced coronary reserve and episodes of myocardial ischemia. The author examines the indirect evidence available from morphological (echocardiographic) studies and functional studies. The adverse effect of chronic ischemic disease in dialysis patients is mediated by heart failure, which is a strong predictor of earlier death. Recompensation (correction) of renal anemia by EPO to a target hematocrit of 35 percent initiates a slow and moderate echocardiographic regression of LVH, primarily by normalizing diastolic dimensions, and increases crucial coronary reserve in CAD. Induction of arterial hypertension by EPO (a side effect of the drug) may counteract those effects and should by avoided by appropriate antihypertensive agents. 1 figure. 20 references.

•

Surgery Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. p. 545-552. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $37.95. ISBN: 0316173835. Summary: This chapter on surgery is from a handbook that outlines all aspects of dialysis therapy, emphasizing the management of dialysis patients. The authors stress that any operation, ranging from creation of a vascular or peritoneal access (the most common procedures) to open heart surgery, can be performed in dialysis patients without a marked increase in the perioperative morbidity or mortality rate. Topics include preoperative preparation, including fluid status, extent of uremia, electrolyte disorders, acid-base status, hematocrit level, and coagulation profile; intraoperative considerations, notably protection of the vascular access, anesthesia, fluid and electrolyte management, and intraoperative hemodialysis or hemofiltration; and postoperative concerns, including hyperkalemia, hypertension, hypotension, fever, the pulmonary system, and nutrition. The authors present information in outline form, for easy reference. 1 table. 15 references.

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Endoscopic Therapy for Severe Gastrointestinal Bleeding Source: in Schrier, R.W., et al., eds. Advances in Internal Medicine. Vol 40. St. Louis, MO: Mosby-Year Book, Inc. 1995. p. 243-271. Contact: Available from Mosby Year-Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. Fax (800) 535-9935. E-mail: [email protected]. PRICE: $72.95. ISBN: 0815183135. ISSN: 00652822. Summary: This chapter, from a yearbook of advances in internal medicine, covers endoscopic therapy for severe gastrointestinal (GI) bleeding. This is defined as documented GI bleeding (i.e., hematemesis, melano, hematochezia, or blood in nasogastric lavage), with orthostatic hypotension, a decrease in hematocrit by 6 to 8 percent, or transfusion of 2 or more units of packed red blood cells (RBCs). Acute care for these patients is provided by a team of physicians including gastroenterologists, surgeons, and critical care specialists. Optimal patient outcome depends on successful medical resuscitation, precise diagnosis of the bleeding site, knowledge of the natural history of different bleeding lesions, and appropriate use of therapeutic endoscopy and surgery. The authors of this chapter outline the recent advances in endoscopic hemostasis of severe upper and lower GI bleeding and compare their role with medical, interventional radiologic, and surgical therapy. Causes of GI bleeding discussed include peptic ulcer, variceal bleeding, erosive esophagitis, Mallory-Weiss tears, Dieulafoy's lesion, upper GI angiomas, upper GI malignancy, aortoenteric fistulas, colonic angiomas, colonic diverticular hemorrhage, colonic tumors, colonic ischemia, and inflammatory bowel disease (IBD). 5 figures. 9 tables. 78 references.

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

News Services and Press Releases One of the simplest ways of tracking press releases on hematocrit 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 “hematocrit” (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 hematocrit. 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 “hematocrit” (or synonyms). The following was recently listed in this archive for hematocrit: •

Raised hematocrit a diagnostic marker for dengue hemorrhagic fever Source: Reuters Medical News Date: May 25, 2001

•

FDA clears Careside's hemoglobin and hematocrit blood tests Source: Reuters Industry Breifing Date: August 30, 2000

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•

InMedica licenses hematocrit technology to Wantagh Source: Reuters Industry Breifing Date: June 21, 2000

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Normalizing hematocrit not recommended in dialysis patients with cardiovascular disease Source: Reuters Medical News Date: August 27, 1998

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Routine Postpartum Hematocrit Determination Unnecessary In Stable Patients Source: Reuters Medical News Date: October 30, 1997

•

Raised Hematocrit Level Linked To Insulin Resistance Source: Reuters Medical News Date: May 16, 1996 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 “hematocrit” (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 “hematocrit” (or synonyms). If you know the name of a company that is relevant to

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hematocrit, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hematocrit” (or synonyms).

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

Anemia-Related Fatigue: Feeling Tired Isn't Always Normal Source: PKR Progress. 15(3): 10. Fall-Winter 2000. Contact: Available from PKD (Polycystic Kidney Disease) Foundation. 9221 Ward Parkway, Suite 400 Kansas City, MO 64114.(800) PKD-CURE. Fax (816) 931-8655. Email:[email protected]. Website: www.pkdcure.org. Summary: This article from a newsletter for patients with polycystic kidney disease (PKD) explores the problem of anemia related fatigue in patients with kidney diseases. The author notes that since basic treatments are available for PKD, health care providers and researchers are now turning their attention to quality of life medical issues such as anemia. Anemia develops in virtually all patients with renal failure during the course of their disease. Health care providers now know that by intervening earlier in the disease process (in patients with chronic kidney disease who are not yet on dialysis), patients can realize a number of benefits and enhance their overall well being. The kidneys produce about 90 percent of the body's supply of the hormone erythropoietin (EPO); EPO is a major catalyst in the production of red blood cells in the bone marrow, so a reduction in EPO due to kidney disease usually results in fewer red blood cells and insufficient oxygen reaching the body tissues. The author explains the two primary diagnostic tests used to check for anemia, hematocrit (HCT) and hemoglobin. Anemia related fatigue is often described as a total lack of energy or debilitating exhaustion that can last days, weeks, or months. Fatigue can also have mental and emotional effects. The author cautions that because of its gradual onset and insidious nature, fatigue is often overlooked, underrecognized, and undertreated. Readers are encouraged to work with their physicians to address any problems or symptoms of fatigue.

•

SSI Perspective: Overcoming Barriers to Employment Source: Renal Rehabilitation Report. 5(5): 4-5. September-October 1997.

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Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. Summary: This article, from a special issue on vocational rehabilitation and employment for dialysis patients, discusses overcoming barriers to employment. Many dialysis patients fear the potential loss of financial benefits they receive, either through Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). The article provides a case study that illustrates how the SSI system works and how patients can best work within the SSI framework. The case study emphasizes the importance of working closely with the Social Security Administration (SSA) to learn about all the possibilities that are available for people with end-stage renal disease. The article then provides an interview that discusses common questions about SSI. The interview is with Wayne Nix, educational consultant for the National Kidney Foundation of Michigan and director of the OUTREACH: Renal Rehabilitation and Empowerment Program. Topics covered include SSI work incentives, Medicaid coverage, handling overpayment problems, the appeal process, where to get assistance with problems involving the SSI, vocational counseling, training and education issues, the role of part time work, and the indicators that are essential to health and rehabilitation (adequate dialysis, good hematocrit readings, acceptable serum albumin levels, properly controlled blood pressure, and a regular exercise program). •

What Blood Tests Tell Us Source: Harvard Women's Health Watch. 7(3): 6. November 1999. Contact: Available from Harvard Women's Health Watch. P.O. Box 420068, Palm Coast, FL 32142-0068. (800) 829-5921 or (904) 445-4662. Summary: This brief newsletter article describes the standard blood tests that may be done to diagnose disease or monitor risk factors. The author uses the metaphor of the bloodstream as a river that brings oxygen and other vital nutrients to the body's cells and carries waste away from them. This 'river' also transports the cellular and molecular forces that fight disease, and ferries hormones from the glands to the tissues. By sampling this stream, doctors can identify elevated risk in people who are healthy and pick up clues to the sources of symptoms in those who are sick. The few cubic centimeters of blood contain millions of cells and molecules, each of which can vary in number according to the person's state of health. The lab report resulting from a blood test usually consists of two sections: hematology, which provides information about blood cells, and chemistry, which furnishes data about plasma. The bulk of the article consists of a chart that explains the results of a typical blood test. The chart lists the lab values typically studied, the range of results considered normal, and the significance of values outside the normal range. Lab values included are WBC (white blood cells), HCT (hematocrit), PLT (platelets), CHOL (total cholesterol), HDL ('good' cholesterol), LDL ('bad' cholesterol), TRIG (triglycerides), BUN (blood urea nitrogen), CREAT (creatinine), GLU (glucose), and TSH (thyroid stimulating hormone). 1 table.

Academic Periodicals covering Hematocrit Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to hematocrit. In addition to these sources, you can search for articles covering hematocrit that have been published by

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

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

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

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

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

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

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

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

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

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

10

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

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

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

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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

11

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

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

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

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hematocrit” (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 38438 220 39 132 433 39262

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

13

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

14

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

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

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

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

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

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

•

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

18 Adapted 19

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

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

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

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Anemia http://www.nlm.nih.gov/medlineplus/anemia.html Hemochromatosis http://www.nlm.nih.gov/medlineplus/hemochromatosis.html Laboratory Tests http://www.nlm.nih.gov/medlineplus/laboratorytests.html Liver Diseases http://www.nlm.nih.gov/medlineplus/liverdiseases.html Preventing Disease and Staying Healthy http://www.nlm.nih.gov/medlineplus/preventingdiseaseandstayinghealthy.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 hematocrit. 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: •

Anemia in Kidney Disease and Dialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2001. 4 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov/health/kidney/nkudic.htm PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-146. Summary: Anemia (low levels of red blood cells) is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin (EPO) which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often do not make enough EPO. Other common causes of anemia include loss of blood from hemodialysis and low levels of iron and folic acid. This fact sheet describes anemia in kidney disease and dialysis. The presence of anemia is determined by a complete blood count (CBC), which includes a determination of hematocrit (Hct) level, which is the percentage of the blood that consists of red blood cells. Anemia can begin with chronic renal insufficiency, and

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tends to worsen as kidney disease progresses. Treatment includes EPO injections, and iron supplements; a few people may also need vitamin B12 and folic acid supplements to keep anemia under control and let patients feel better, live longer, and have more energy. The fact sheet concludes with a description of current research projects in this area, a brief list of resource organizations for more information, and a brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) and its contact information. 2 figures. 1 table. •

Problems with Your Kidneys? Feeling Tired? You Could be Anemic? Source: Bridgewater, NJ: Ortho Biotech Inc. 2003. 16 p. Contact: Available from Ortho Biotech Inc. P.O. Box 6914, 430 Rt. 22 East, Bridgewater, NJ 08807-0914. (800) 325-7504. Fax (908) 526-9230. Website: www.orthobiotech.org. PRICE: Full-text available online at no charge. Summary: Anemia is a condition in which the body does not have enough red blood cells, resulting in reduced levels of oxygen in the blood and lack of energy. This brochure describes the symptoms of anemia and the use of erythropoietin (epoetin alfa) to treat it. The brochure describes PROCRIT (Epoetin alfa), a drug similar to the body's natural supply of erythropoietin, a protein made in healthy kidneys that helps produce red blood cells. The brochure discusses anemia associated with kidney disease; the diagnostic tests that are used to monitor hemoglobin and hematocrit levels; and common causes of kidney problems, including diabetes, and high blood pressure (hypertension). The brochure concludes with a glossary of related terms. The brochure is illustrated with colorful graphics and photographs. 4 figures. 1 table.

•

Measures of Health: A Transplant Patient's Guide to Vital Signs and Lab Tests Source: Nutley, NJ: Kidney Transplant Patient Partnering Program, Roche Laboratories. 1997. 22 p. Contact: Available from Kidney Transplant Patient Partnering Program. P.O. Box 16514, Kansas City, MO 64133. (800) 893-1995. Price: Single copy free. Summary: This booklet explains the importance of kidney transplant patients checking their vital signs each day and having lab tests done regularly. The booklet describes the different vital signs and lab tests and how they work. The booklet first explains the differences between signs and symptoms and which ones indicate that the body is not functioning properly. The booklet stresses that many things can influence vital signs and lab results, including age, sex, body weight, height, general health, diet, medications (including anti-rejection drugs), and the time of day the tests are done. The vital signs that need to be checked and recorded each day are blood pressure, pulse, temperature, and weight. The latter half of the booklet consists of a glossary of lab tests in which a description of each test is given. Tests covered include bicarbonate, blood urea nitrogen (BUN), calcium, cholesterol, creatinine, glucose (blood sugar), hematocrit, hemoglobin, magnesium, phosphorus, platelets, potassium, proteinuria (protein in the urine), sodium, triglycerides, uric acid, urine culture, and white blood count. Also provided in the glossary is an explanation of what an 'increased' or 'decreased' reading might mean. Finally, there is a space in the description of each test where readers can write in their own 'normal' range.

•

Getting the Most from Your Treatment: What You Need to Know about Hemodialysis Source: New York, NY: National Kidney Foundation. 1998. 31 p.

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Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This booklet summarizes the use of hemodialysis to treat kidney diseases. The booklet tells readers why it is important to get the right amount of hemodialysis, how to care for the hemodialysis access, the complication of anemia and how it is treated, why diet restrictions must be followed carefully, how to help prevent bone disease and heart problems, how to cope with kidney disease and its treatment, how to get involved in one's own treatment plan and additional resources that are available. The brochure outlines the roles of each of the various health care team members who may be involved in the care of a person on hemodialysis. One section encourages readers to educate themselves about their disease and its treatment and to be very involved in their own health care. The brochure concludes with a section that summarizes the 13 laboratory tests commonly used to monitor patients with kidney disease: Kt per V and URR, nPNA, albumin (BCG test), hematocrit, hemoglobin, TSAT and serum ferritin, parathyroid hormone (PTH), calcium, phosphorus, potassium, target weight, average daily weight gain, and blood pressure. The brochure is written in nontechnical language and illustrated with simple line drawings. The brochure is one in a series of materials from an educational program of the National Kidney Foundation Dialysis Outcomes Quality Initiative. •

Importance of Having Enough Iron: A Guide for Dialysis Patients and Their Families Source: Tampa, FL: American Association of Kidney Patients (AAKP). 1995. 9 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-2257 or (813) 223-7099. Fax (803) 223-0001. PRICE: Single copy free. Summary: This brochure explains how erythropoietin (EPO) works with iron to help correct dialysis-associated anemia. Written for patients on dialysis, the booklet also explains why patients may be given iron supplements in addition to EPO. Topics include the physical effects of chronic renal failure (CRF); the impact of anemia; how anemia is measured; the importance of having enough iron; the side effects of iron therapy; how hematocrit and iron levels are measured; how to improve the absorption of oral iron supplements; managing sick days; the impact of surgery on iron levels; and reimbursement issues for EPO and iron supplementation. The booklet concludes with a brief glossary of terms. 1 figure. 1 table.

•

Anemia Source: Camp Hill, PA: Chek-Med Systems, Inc. 200x. [2 p.]. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011-1706. (800) 451-5797 or (717) 761-1170. Fax (717) 761-0216. PRICE: $22.00 per pack of 50 brochures; 3 pack minimum. Summary: This brochure helps patients to understand anemia and what it means when they receive this diagnosis from their health care provider. Anemia is defined as a low red blood cell count. The red blood cell carries oxygen to the body's tissues. Inside each red cell is a protein and iron combination that is called hemoglobin that can be measured; low hemoglobin counts mean anemia. A second way to measure anemia is called the hematocrit, a test which checks how many red cells are packed into a specific amount of blood. The brochure offers the range considered normal for these two measures (different for men and women), then reviews the symptoms and the different

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types of anemia. Mild anemia may be symptomless, and a moderate anemia may cause some fatigue, drowsiness, or even shortness of breath on exertion. However, if the anemia occurs very slowly, the individual often can tolerate a remarkably low red blood cell count, sometimes with very few symptoms. The types of anemia are put into major categories based on cause: blood loss anemia (iron deficiency), large red blood cell anemia (macrocytic anemia), bone marrow failure, red cell destruction (hemolytic anemia), chronic kidney disease, and chronic illness and malignancies. The author of the brochure outlines the tests that may be done to determine the level of anemia and its cause, including blood studies, imaging, endoscopy, and bone marrow biopsy. A final section briefly describes the treatments that may be undertaken for anemia, stressing that taking oral iron or receiving a blood transfusion must also be accompanied by efforts to determine the underlying cause of the anemia. 2 figures. •

Dialysis Report Card: Understanding Your Lab Values Source: New York, NY: National Kidney Foundation. 1998. (chart). Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This chart helps patients on dialysis track important laboratory data and visualize where they stand in relation to established goals. The report card format offers room to record lab values for a 1-year period and is intended to help discussion among patients and the renal health care team about adequacy of treatment. The report card offers space to record 16 values: Kt per V, URR, nPNA, albumin (BCG test), hematocrit, hemoglobin, TSAT, serum ferritin, parathyroid hormone, calcium, phosphorus, potassium, target weight, average daily weight gain, predialysis blood pressure, and postdialysis blood pressure. The card also includes a space for the patient's individual goal numbers in each of these tests. The reverse side of the chart offers a few sentences of explanation for each of the 16 tests. These explanations focus primarily on the daily steps that patients can take to help their own health care be more successful. This report card is one of a series of materials from an educational program of the National Kidney Foundation Dialysis Outcomes Quality Initiative.

•

Interdisciplinary Plan of Care for Patients Receiving EPOGEN (Epoetin alfa) Treatment Source: Nephrology Nursing Update. 2(5): 3, 6. September-October 1990. Contact: Available from American Nephrology Nurses' Association. Box 56, East Holly Avenue, Pitman, NJ 08071. (609) 256-2320. Summary: This chart summarizes an interdisciplinary plan of care for patients receiving EPOGEN (Epoetin alfa) treatment. five topics are covered: hypertension, related to increased peripheral resistance, blood viscosity, and sodium and fluid retention; hyperkalemia, related to increased dietary intake and increased red blood cell destruction during hemodialysis; clotted vascular hematocrit; decreased adequacy of dialysis, related to the reduction in plasma volume; and failure to respond to EPOGEN, related to optimum target dose, iron deficiency, inflammation, aluminum overload, bone marrow loss, and vitan deficiencies. Each section presents the expected patient outcomes, interdisciplinary interventions, and a suggested patient teaching plan.

•

American Hemochromatosis Society (AHS): Prevention Through Genetic Testing Source: Delray Beach, FL: American Hemochromatosis Society. 200x. [2 p].

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Contact: Available from American Hemochromatosis Society. 777 East Atlantic Avenue, PMB Z-363, Delray Beach, FL 33483-5352. (888) 655-IRON or (561) 266-9037. Fax (561) 266-9038. E-mail: [email protected]. Website: www.americanhs.org. PRICE: Single copy free. Summary: This fact sheet describes the work and activities of the American Hemochromatosis Society (AHS) and the indications for testing for hereditary hemochromatosis (HH), also known as iron overload or iron storage disease. Readers are advised to ask their physician for specific diagnostic tests to be performed, including serum iron, TIBC (total iron binding capacity), and serum ferritin. All family members should be tested to confirm HH in the presence of elevated iron studies or to predict genetic risk of developing HH in the future. The fact sheet provides information for readers who wish to order blood tests or DNA genetic testing directly from a lab without a doctor's order. Treatments should average once or twice weekly bloodlettings, identical to blood donation (therapeutic phlebotomies), as long as the hematocrit is 35 percent or greater immediately prior to each treatment. Treatment frequency can vary in some cases and each case should be handled individually. The fact sheet recommends that patients who have tested positive for the HH gene mutations but who have nonelevated or only slightly elevated iron tests donate blood preventively. The fact sheet outlines the circumstances in which liver biopsy may be appropriate, noting that HH diagnosis is generally accomplished with blood tests and DNA testing. Patients are advised to eat a nutritious natural diet void of processed foods with high iron, to reduce red meat intake, to abstain from alcohol, to avoid all vitamin supplements, to avoid raw seafood, and to not cook in cast iron cookware. Readers are encouraged to become members of the AHS (www.americanhs.org). •

Nutrition for Children With Chronic Kidney Disease: A Guide for Parents Source: New York, NY: National Kidney Foundation, Inc. 2002. 6 p. Contact: Available from National Kidney Foundation, Inc. Medical Department, 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax: (212) 689-9261. E-mail: [email protected]. Website: www.kidney.org. PRICE: Single copy free; Full-text available online at no charge. Summary: This fact sheet helps parents of children with chronic kidney disease understand the role of appropriate diet in helping to keep their children healthy. The guidelines are intended for children who have reduced kidney function caused by chronic kidney disease, have kidney failure and are receiving hemodialysis or peritoneal dialysis, or have received a kidney transplant. Topics include a rationale for good nutrition in children with kidney disease; general guidelines regarding caloric intake, protein, phosphorus, potassium, sodium, fluids, and vitamins and minerals; how to monitor a child's nutrition; how to encourage a child to eat healthy foods; growth and development; the use of supplements; and understanding the child's lab values (diagnostic and monitoring tests), including serum albumin, serum bicarbonate, blood pressure, blood urea nitrogen (BUN), body weight, fluid weight gain, calcium, serum creatinine, glomerular filtration rate (GFR), hemoglobin and hematocrit, phosphorus, potassium, urine protein, and TSAT and serum ferritin. The fact sheet offers a blank form for tracking the child's lab values. 1 table.

•

Complete Blood Count (CBC) Contact: University of New Mexico School of Medicine, Infectious Diseases Division, New Mexico AIDS Education and Training Center, New Mexico AIDS InfoNet, PO Box 810, Arroyo Seco, NM, 87514-0810, (505) 776-8032, http://www.aidsinfonet.org.

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Summary: This information sheet provides an overview of the complete blood count (CBC) laboratory test. This common test examines the components of blood, including red and white blood cells and platelets. Red blood cell tests include the red blood cell count, tests for hemoglobin and hematocrit, mean corpuscular volume, red blood cell distribution width, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. The white blood cell count measures the total number of white blood cells. The differential counts five types of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. •

Getting the Most from Your Treatment: What You Need to Know About Peritoneal Dialysis Source: New York, NY: National Kidney Foundation. 1998. 31 p. Contact: Available from National Kidney Foundation (NKF). 30 East 33rd Street, New York, NY 10016. (212) 889-2210. (212) 686-8916. Website: www.kidney.org. PRICE: $0.50 each plus shipping and handling; bulk copies available. Summary: This patient education booklet informs readers about peritoneal dialysis (PD) and how patients can participate in making their PD treatment successful. The information in the booklet is based on the National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF DOQI), a program developed to help patients get the most from their treatments, feel better, and live longer. The booklet describes PD and how it relates to living with kidney failure. PD cleans wastes from the blood by using the patient's peritoneal membrane (the lining of the belly) as a natural filter. The authors guide readers in caring for themselves using PD, answer common questions about how PD works, describe the types of PD available (CAPD or continuous ambulatory peritoneal dialysis, CCPD or continuous cycling peritoneal dialysis, and NIPD or nighttime intermittent peritoneal dialysis), explain why it is important to get enough dialysis, explain why it is important to follow the prescribed dietary restrictions, tell about how anemia is treated, explain about preventing and treating bone disease, provide important facts about preventing heart problems, and stress the importance of patients taking an active role in their own health care. The booklet concludes with a checklist of points that summarize the concepts covered, a list of other sources of information, and a guide to understanding common laboratory test values, including Kt per V, creatinine clearance, albumin, hematocrit, hemoglobin, and blood pressure. The booklet is illustrated with simple line drawings. 7 figures. 2 tables.

•

Results with EPO: A Record Book for Kidney Patients Source: New York, NY: National Kidney Foundation, Inc. 1990. 30 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: Single copy free. Summary: This record book is designed for people with kidney disease who are using self-administration of erythropoietin (EPO). The booklet contains charts that can be used to record EPO dosage, date, injection site, blood pressure, hematocrit, and comments. Each column in the charts is clearly labeled to show what information should be written there. The record book should help the patient keep track of any changes that result from the EPO injections.

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hematocrit. 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/

•

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 hematocrit. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hematocrit. 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 hematocrit. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at

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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hematocrit” (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 “hematocrit”. 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 “hematocrit” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “hematocrit” (or a synonym) into the search box, and click “Submit Query.”

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

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

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

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

21

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

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

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

•

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

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

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

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

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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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

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

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

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

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

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

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

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

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

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

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

22

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

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•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

•

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

•

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

•

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

•

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Medical Libraries

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

165

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

Basic Guidelines for Hematocrit Hematocrit Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm

•

Signs & Symptoms for Hematocrit Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Leukemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001299.htm

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Diagnostics and Tests for Hematocrit Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Complete blood count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Erythrocytosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003644.htm Hemoglobin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003645.htm RBC number Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003644.htm Venipuncture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003423.htm

•

Background Topics for Hematocrit Adolescent test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002054.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Blood loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Burns Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm Hemolysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002372.htm Infant test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002055.htm Preschooler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002057.htm Schoolage test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002058.htm Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm

Online Glossaries 167

Toddler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002056.htm

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

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

•

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

•

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

•

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

169

HEMATOCRIT DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 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] Academic Medical Centers: Medical complexes consisting of medical school, hospitals, clinics, libraries, administrative facilities, etc. [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] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [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] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Diphosphate: Adenosine 5'-(trihydrogen diphosphate). An adenine nucleotide containing two phosphate groups esterified to the sugar moiety at the 5'-position. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU]

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Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

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]

Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] 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] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] 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

Dictionary 171

renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acid Substitution: The naturally occurring or experimentally induced replacement of one or more amino acids in a protein with another. If a functionally equivalent amino acid is substituted, the protein may retain wild-type activity. Substitution may also diminish or eliminate protein function. Experimentally induced substitution is often used to study enzyme activities and binding site properties. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular

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fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [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] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [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] Angiogenesis inhibitor: A substance that may prevent the formation of blood vessels. In anticancer therapy, an angiogenesis inhibitor prevents the growth of blood vessels from surrounding tissue to a solid tumor. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [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

Dictionary 173

or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] 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] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are

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split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Apheresis: Components plateletpheresis. [NIH]

being

separated

out,

as

leukapheresis,

plasmapheresis,

Aplasia: Lack of development of an organ or tissue, or of the cellular products from an organ or tissue. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Asynchronous: Pacing mode where only one timing interval exists, that between the stimuli. While the duration of this interval may be varied, it is not modified by any sensed event once set. As no sensing occurs, the upper and lower rate intervals are the same as the pacema. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH]

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Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [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] 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] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Beta Rays: A stream of positive or negative electrons ejected with high energy from a disintegrating atomic nucleus; most biomedically used isotopes emit negative particles (electrons or negatrons, rather than positrons). Cathode rays are low-energy negative electrons produced in cathode ray tubes, also called television tubes or oscilloscopes. [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] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving

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chemical reactions in living organisms. [EU] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Bleeding Time: Duration of blood flow after skin puncture. This test is used as a measure of capillary and platelet function. [NIH] Blood Banks: Centers for collecting, characterizing, and storing human blood. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH]

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Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Blotting, Western: Identification of proteins or peptides that have been electrophoretically separated by blotting and transferred to strips of nitrocellulose paper. The blots are then detected by radiolabeled antibody probes. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Body Weight Changes: A clinical manifestation consisting of alterations in an individual's weight from his or her norm. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [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 marrow biopsy: The removal of a sample of tissue from the bone marrow with a needle for examination under a microscope. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Hypoxia: Lack of oxygen leading to unconsciousness. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the

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trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogenicity: The ability to cause cancer. [NIH]

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Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] 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] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] 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] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Aggregation: The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. [NIH] Cell Count: A count of the number of cells of a specific kind, usually measured per unit volume of sample. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell

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division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] 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] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti).

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This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [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 Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [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] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with

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cellular arrest in the G2 phase of the cell cycle. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the

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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] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] 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] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] 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 clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] 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 Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [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] Coronary Vessels: The veins and arteries of the heart. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Curative: Tending to overcome disease and promote recovery. [EU]

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Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH] Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [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] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in

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body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] 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] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] 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 Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU]

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Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Diathesis: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the person more than usually susceptible to certain diseases. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [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] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digital rectal examination: DRE. An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [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] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [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 Transmission: The transmission of infectious disease or pathogens. When transmission is within the same species, the mode can be horizontal (disease transmission, horizontal) or vertical (disease transmission, vertical). [NIH] Disease Transmission, Horizontal: The transmission of infectious disease or pathogens from one individual to another in the same generation. [NIH] Disease Transmission, Vertical: The transmission of infectious disease or pathogens from one generation to another. It includes transmission in utero or intrapartum by exposure to blood and secretions, and postpartum exposure via breastfeeding. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required

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to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] 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] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] 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] Electrochemistry: The study of chemical changes resulting from electrical action and electrical activity resulting from chemical changes. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear

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particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endostatin: A drug that is being studied for its ability to prevent the growth of new blood vessels into a solid tumor. Endostatin belongs to the family of drugs called angiogenesis inhibitors. [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, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain

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microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Endotracheal intubation: Insertion of an airtube into the windpipe. [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 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] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] 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] Epoetin alfa: A colony-stimulating factor that is made in the laboratory. It increases the production of red blood cells. [NIH] Erythrocyte Count: A count of the number of red blood cells per unit volume in a sample of venous blood. [NIH] Erythrocyte Deformability: Ability of erythrocytes to change shape as they pass through narrow spaces, such as the microvasculature. [NIH] Erythrocyte Indices: Quantification of size and cell hemoglobin content or concentration of the erythrocyte, usually derived from erythrocyte count, blood hemoglobin concentration, and hematocrit. Includes the mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC). Use also for cell diameter and thickness. [NIH]

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Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [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] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [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 peripheral sense organ. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excrete: To get rid of waste from the body. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exercise Tolerance: The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an exercise test. [NIH]

Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Extender: Any of several colloidal substances of high molecular weight, used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and

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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] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation. [NIH] Extracorporeal Membrane Oxygenation: Application of a life support system that circulates the blood through an oxygenating system, which may consist of a pump, a membrane oxygenator, and a heat exchanger. Examples of its use are to assist victims of smoke inhalation injury, respiratory failure, and cardiac failure. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Febrile: Pertaining to or characterized by fever. [EU] 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] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH]

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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] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescein Angiography: Visualization of a vascular system after intravenous injection of a fluorescein solution. The images may be photographed or televised. It is used especially in studying the retinal and uveal vasculature. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [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] Forearm: The part between the elbow and the wrist. [NIH] Free Radical Scavengers: Substances that influence the course of a chemical reaction by ready combination with free radicals. Among other effects, this combining activity protects pancreatic islets against damage by cytokines and prevents myocardial and pulmonary perfusion injuries. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]

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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] Gadolinium: An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors,

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transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [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] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [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] Globins: The protein constituents of hemoglobin.The term is used for proteins attached to iron-porphyrin molecules such as hemoglobin and myoglobin proteins. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [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] Glucose Oxidase: An enzyme of the oxidoreductase class that catalyzes the conversion of beta-D-glucose and oxygen to D-glucono-1,5-lactone and peroxide. It is a flavoprotein, highly specific for beta-D-glucose. The enzyme is produced by Penicillium notatum and other fungi and has antibacterial activity in the presence of glucose and oxygen. It is used to estimate glucose concentration in blood or urine samples through the formation of colored dyes by the hydrogen peroxide produced in the reaction. (From Enzyme Nomenclature, 1992) EC 1.1.3.4. [NIH]

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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]

Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Graft-versus-host disease: GVHD. A reaction of donated bone marrow or peripheral stem cells against a person's tissue. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [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] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] 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] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Helminths: Commonly known as parasitic worms, this group includes the acanthocephala, nematoda, and platyhelminths. Some authors consider certain species of leeches that can become temporarily parasitic as helminths. [NIH] Hematemesis: Vomiting of blood. [NIH]

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Hemato: A selective mechanism opposing the passage of most large-molecular compounds from the blood to the cerebro-spinal fluid and brain tissue; offers some protection against intoxication. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [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] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemoglobin E: An abnormal hemoglobin that results from the substitution of lysine for glutamic acid at position 26 of the beta chain. It is most frequently observed in southeast Asian populations. [NIH] Hemoglobin M: A group of abnormal hemoglobins in which amino acid substitutions take place in either the alpha or beta chains but near the heme iron. This results in facilitated oxidation of the hemoglobin to yield excess methemoglobin which leads to cyanosis. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations

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within the hemoglobin molecule. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemophilia: Refers to a group of hereditary disorders in which affected individuals fail to make enough of certain proteins needed to form blood clots. [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]

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] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hetastarch: A derivative of starch used as a plasma substitute in the treatment of hemorrhage. [NIH] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] 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

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intestine. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] 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] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hypercapnia: A clinical manifestation of abnormal increase in the amount of carbon dioxide in arterial blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU]

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Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypovolemia: An abnormally low volume of blood circulating through the body. It may result in hypovolemic shock. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Hysterectomy: Excision of the uterus. [NIH] Imaging procedures: Methods of producing pictures of areas inside the body. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] 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] Immunoblotting: Immunologic methods for isolating and quantitatively measuring immunoreactive substances. When used with immune reagents such as monoclonal antibodies, the process is known generically as western blot analysis (blotting, western). [NIH]

Immunogenic: Producing immunity; evoking an immune response. [EU] 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] 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] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] 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]

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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]

Infestation: Parasitic attack or subsistence on the skin and/or its appendages, as by insects, mites, or ticks; sometimes used to denote parasitic invasion of the organs and tissues, as by helminths. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] In-line: A sexually-reproducing population derived from a common parentage. [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] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is

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also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intermittent Claudication: A symptom complex characterized by leg pain and weakness brought on by walking, with the disappearance of the symptoms following a brief rest. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [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] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost.

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Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocyte growth factor: A substance that stimulates the growth of epithelial cells that line the surface of the mouth and intestinal tract. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called

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colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Lenses: Pieces of glass or other transparent materials used for magnification or increased visual acuity. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligase: An enzyme that repairs single stranded discontinuities in double-stranded DNA molecules in the cell. Purified DNA ligase is used in gene cloning to join DNA molecules together. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH]

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Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [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] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with

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acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] 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] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (diagnostic errors), errors in the administration of drugs and other medications (medication errors), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from malpractice in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] 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] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH]

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Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Mice Minute Virus: The type species of parvovirus prevalent in mouse colonies and found as a contaminant of many transplanted tumors or leukemias. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microfilaria: The prelarval stage of Filarioidea in the blood and other tissues of mammals and birds. They are removed from these hosts by blood-sucking insects in which they metamorphose into mature larvae. [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] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Middle Cerebral Artery: The largest and most complex of the cerebral arteries. Branches of the middle cerebral artery supply the insular region, motor and premotor areas, and large regions of the association cortex. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei

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normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocyte: A type of white blood cell. [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] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mycophenolate mofetil: A drug that is being studied for its effectiveness in preventing graft-versus-host disease and autoimmune disorders. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myeloma: Cancer that arises in plasma cells, a type of white blood cell. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] 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

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in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myoglobin: A conjugated protein which is the oxygen-transporting pigment of muscle. It is made up of one globin polypeptide chain and one heme group. [NIH] Nadir: The lowest point; point of greatest adversity or despair. [EU] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] 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] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatology: A subspecialty of pediatrics concerned with the newborn infant. [NIH] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

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] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU]

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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] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] 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] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH]

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Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Oncology: The study of cancer. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osmotic Fragility: Red blood cell sensitivity to change in osmotic pressure. When exposed to a hypotonic concentration of sodium in a solution, red cells take in more water, swell until the capacity of the cell membrane is exceeded, and burst. [NIH] Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic. [NIH]

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Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenase: Enzyme which breaks down heme, the iron-containing oxygen-carrying constituent of the red blood cells. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [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] Pancreatic: Having to do with the pancreas. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute

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hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [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] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Patella: The flat, triangular bone situated at the anterior part of the knee. [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]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] 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] Perineal: Pertaining to the perineum. [EU] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH]

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Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] 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] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phlebotomy: The letting of blood from a vein. Although it is one of the techniques used in drawing blood to be used in diagnostic procedures, in modern medicine, it is used commonly in the treatment of erythrocytosis, hemochromocytosis, polycythemia vera, and porphyria cutanea tarda. Its historical counterpart is bloodletting. (From Cecil Textbook of Medicine, 19th ed & Wintrobe's Clinical Hematology, 9th ed) Venipuncture is not only for the letting of blood from a vein but also for the injecting of a drug into the vein for diagnostic analysis. [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] Phosphorylated: Attached to a phosphate group. [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Photosensitizer: A drug used in photodynamic therapy. When absorbed by cancer cells and exposed to light, the drug becomes active and kills the cancer cells. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH]

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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] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] 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] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [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] Platelet Count: A count of the number of platelets per unit volume in a sample of venous blood. [NIH] Plateletpheresis: The preparation of platelet concentrates with the return of red cells and platelet-poor plasma to the donor. [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

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spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Platinum Compounds: Inorganic compounds which contain platinum as the central atom. [NIH]

Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pneumonia: Inflammation of the lungs. [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] Polycythemia Vera: A myeloproliferative disorder of unknown etiology, characterized by abnormal proliferation of all hematopoietic bone marrow elements and an absolute increase in red cell mass and total blood volume, associated frequently with splenomegaly, leukocytosis, and thrombocythemia. Hematopoiesis is also reactive in extramedullary sites (liver and spleen). In time myelofibrosis occurs. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] 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] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of

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the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Channels: Cell membrane glycoproteins selective for potassium ions. [NIH] Potassium Cyanide: Potassium cyanide (K(CN)). A highly poisonous compound that is an inhibitor of many metabolic processes, but has been shown to be an especially potent inhibitor of heme enzymes and hemeproteins. It is used in many industrial processes. [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] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Preoperative: Preceding an operation. [EU] 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 in the population at a given time. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [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] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proliferating Cell Nuclear Antigen: Nuclear antigen with a role in DNA synthesis, DNA repair, and cell cycle progression. PCNA is required for the coordinated synthesis of both leading and lagging strands at the replication fork during DNA replication. PCNA expression correlates with the proliferation activity of several malignant and non-malignant cell types. [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]

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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] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region.

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Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Diffusing Capacity: The amount of a gas, usually oxygen or carbon dioxide, taken up by pulmonary capillary blood per minute per unit of average oxygen pressure gradient between alveolar gas and pulmonary capillary blood. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulsation: A throb or rhythmical beat, as of the heart. [EU] 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] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Pyruvate Carboxylase: A biotin-dependent enzyme belonging to the ligase family that catalyzes the addition of carbon dioxide to pyruvate. It is occurs in both plants and animals. Deficiency of this enzyme causes severe psychomotor retardation and lactic acidosis in infants. EC 6.4.1.1. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH]

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Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [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] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Radium: A radioactive element symbol Ra, atomic number 88, disintegration of uranium and is is used clinically as a source brachytherapy. [NIH]

of the alkaline earth series of metals. It has the atomic and atomic weight 226. Radium is the product of the present in pitchblende and all ores containing uranium. It of beta and gamma-rays in radiotherapy, particularly

Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by

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inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH]

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Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [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] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory 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 failure: Inability of the lungs to conduct gas exchange. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Reticulocyte Count: Determination of the number of reticulocytes in a measured volume of blood. Values for reticulocytes are expressed as a percentage of the erythrocyte count or in the form of a so-called "corrected" reticulocyte "index". An increase in circulating reticulocytes, often referred to as reticulocytosis, is among the simplest and most reliable signs of accelerated erythrocyte production. Reticulocytosis, or an increased reticulocyte count, occurs during active blood regeneration (stimulation of red bone marrow) and in certain anemias, particularly congenital hemolytic anemia. [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] Retinal Vessels: The vessels which supply and drain the retina. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinoblastoma Protein: Product of the retinoblastoma tumor suppressor gene. It is a nuclear phosphoprotein hypothesized to normally act as an inhibitor of cell proliferation. Rb protein is absent in retinoblastoma cell lines. It also has been shown to form complexes with the adenovirus E1A protein, the SV40 T antigen, and the human papilloma virus E7 protein. [NIH]

Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It

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does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheology: The study of the deformation and flow of matter, usually liquids or fluids, and of the plastic flow of solids. The concept covers consistency, dilatancy, liquefaction, resistance to flow, shearing, thixotrophy, and viscosity. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Ribonucleoside Diphosphate Reductase: An enzyme of the oxidoreductase class that catalyzes the formation of 2'-deoxyribonucleotides from the corresponding ribonucleotides using NADPH as the ultimate electron donor. The deoxyribonucleoside diphosphates are used in DNA synthesis. (From Dorland, 27th ed) EC 1.17.4.1. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rickettsiae: One of a group of obligate intracellular parasitic microorganisms, once regarded as intermediate in their properties between bacteria and viruses but now classified as bacteria in the order Rickettsiales, which includes 17 genera and 3 families: Rickettsiace. [NIH]

Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] 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]

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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] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] 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] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [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] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] 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]

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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] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoke Inhalation Injury: Pulmonary injury following the breathing in of toxic smoke from burning materials such as plastics, synthetics, building materials, etc. This injury is the most frequent cause of death in burn patients. [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] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrophotometry: The art or process of comparing photometrically the relative intensities of the light in different parts of the spectrum. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH]

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Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenectomy: An operation to remove the spleen. [NIH] Splenomegaly: Enlargement of the spleen. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steady state: Dynamic equilibrium. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] 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] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] 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] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU]

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Subcutaneous: Beneath the skin. [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] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU]

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Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thiourea: A photographic fixative used also in the manufacture of resins. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), this substance may reasonably be anticipated to be a carcinogen (Merck Index, 9th ed). Many of its derivatives are antithryoid agents and/or free radical scavengers. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH]

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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] 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] Ticks: Blood-sucking arachnids of the order Acarina. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonicity: The normal state of muscular tension. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH]

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Transgenes: Genes that are introduced into an organism using gene transfer techniques. [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] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor suppressor gene: Genes in the body that can suppress or block the development of cancer. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ubiquitin: A highly conserved 76 amino acid-protein found in all eukaryotic cells. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [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] Umbilical Arteries: Either of a pair of arteries originating from the internal iliac artery and passing through the umbilical cord to carry blood from the fetus to the placenta. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Uranium: A radioactive element of the actinide series of metals. It has an atomic symbol U, atomic number 92, and atomic weight 238.03. U-235 is used as the fissionable fuel in nuclear weapons and as fuel in nuclear power reactors. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urea Breath Test: A test used to detect Helicobacter pylori infection. The test measures breath samples for urease, an enzyme H. pylori makes. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH]

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Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [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] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH]

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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] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] 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] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [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]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH]

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

235

INDEX A Abdominal, 19, 169, 207, 212, 214, 223 Academic Medical Centers, 42, 169 Acceptor, 169, 212 Acetaminophen, 26, 169 Acetylcholine, 169, 181, 210 Acetylcysteine, 90, 169 Acidosis, 90, 169, 219 Acoustic, 57, 113, 169 Acute renal, 32, 60, 77, 169, 198 Adaptability, 169, 180 Adenine, 169 Adenosine, 28, 47, 169, 178, 214, 228 Adenosine Diphosphate, 47, 169 Adenovirus, 28, 169, 222 Adjustment, 4, 169 Adjuvant, 20, 169 Adolescence, 17, 170, 213 Adrenal Cortex, 170, 184 Adrenal Medulla, 170, 190 Adrenergic, 170, 173, 188, 190, 227 Adrenergic beta-Antagonists, 170, 173 Adverse Effect, 6, 23, 24, 131, 133, 170, 224 Aerosol, 170, 227 Affinity, 170, 225 Agar, 170 Agarose, 48, 170 Agonist, 170, 188, 210 Airway, 170, 225 Albumin, 11, 28, 45, 63, 70, 114, 124, 152, 153, 155, 170, 215 Alertness, 171, 178 Algorithms, 119, 171, 176 Alkaline, 169, 171, 178, 220, 228 Alkaloid, 171, 210, 228 Alpha Particles, 171, 219 Alternative medicine, 136, 171 Aluminum, 153, 171 Alveolar Process, 171, 222 Ameliorated, 30, 171 Ameliorating, 11, 171 Amino acid, 171, 173, 174, 185, 195, 196, 197, 199, 205, 213, 214, 216, 217, 218, 227, 229, 230 Amino Acid Sequence, 171, 173, 195 Amino Acid Substitution, 171, 197 Ammonia, 171, 230 Amniotic Fluid, 171, 195

Ampulla, 171, 189 Amyloid, 171 Anabolic, 36, 172 Anaesthesia, 172, 200 Analgesic, 169, 172, 187, 189 Analysis of Variance, 19, 172 Analytes, 32, 99, 100, 111, 114, 117, 172 Anaphylatoxins, 172, 183 Anatomical, 172, 175, 180, 184, 187, 200 Anemic, 24, 33, 50, 61, 122, 125, 151, 172 Anesthesia, 43, 46, 55, 57, 66, 70, 78, 103, 133, 170, 172 Anesthetics, 172, 190 Aneurysm, 172, 174, 231 Angiogenesis, 126, 172, 189 Angiogenesis inhibitor, 172, 189 Angiotensin-Converting Enzyme Inhibitors, 172, 173 Animal model, 24, 26, 172 Anions, 170, 173, 202, 224 Anomalies, 6, 173 Antagonism, 173, 178, 228 Antibacterial, 173, 195, 225 Antibiotic, 23, 24, 173, 225, 228 Antibiotic Prophylaxis, 23, 24, 173 Antibodies, 33, 34, 96, 173, 196, 198, 199, 200, 205, 208, 215 Antibody, 34, 170, 173, 177, 182, 185, 196, 198, 200, 201, 206, 208, 219, 220 Anticoagulant, 121, 173, 218 Antigen, 18, 34, 170, 173, 183, 198, 199, 200, 201, 206, 217, 220, 222 Antigen-Antibody Complex, 173, 183 Antihypertensive, 5, 133, 173 Antihypertensive Agents, 133, 173 Anti-infective, 173, 199 Anti-inflammatory, 14, 169, 173, 174, 187 Anti-Inflammatory Agents, 173, 174 Antineoplastic, 173, 199 Antioxidant, 12, 173 Antipyretic, 169, 174, 187 Antiviral, 169, 174 Anxiety, 18, 20, 21, 170, 174 Aorta, 174, 179, 232 Aortic Aneurysm, 128, 174, 194 Apheresis, 64, 118, 174 Aplasia, 76, 174 Apnea, 174

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Hematocrit

Apolipoproteins, 36, 174, 204 Apoptosis, 36, 75, 174 Aqueous, 114, 117, 174, 185, 199 Arginine, 21, 29, 172, 174, 210 Arteries, 15, 174, 176, 180, 184, 202, 205, 207, 208, 230 Arterioles, 31, 35, 174, 176, 178, 207, 208, 231 Arteriovenous, 35, 123, 174, 207 Aspiration, 11, 174 Aspirin, 14, 174 Assay, 18, 34, 111, 124, 174, 200, 220 Asymptomatic, 76, 174, 212 Asynchronous, 120, 174 Atmospheric Pressure, 174, 199 Atrial, 43, 49, 74, 175 Atrial Fibrillation, 43, 49, 175 Atrium, 175, 179, 232 Attenuated, 175, 187, 231 Attenuation, 123, 175 Autodigestion, 175, 212 Autologous, 14, 59, 119, 175 Autonomic, 169, 175, 194, 214, 227 Autonomic Nervous System, 175, 214, 227 B Bacteria, 94, 95, 124, 173, 175, 189, 191, 192, 194, 198, 207, 215, 220, 223, 225, 231 Bacterium, 175, 198 Bacteriuria, 175, 231 Basophils, 155, 175, 196, 204 Bed Rest, 49, 175 Beta Rays, 175, 188 Bile, 175, 194, 204, 226 Biliary, 175, 212 Biliary Tract, 175, 212 Bilirubin, 12, 21, 123, 170, 175 Bioavailability, 36, 175 Biochemical, 31, 35, 114, 121, 175, 176, 193, 203, 204 Biological Transport, 176, 187 Biopsy, 18, 64, 154, 176, 213 Biotechnology, 37, 38, 136, 145, 176 Biotransformation, 176 Bladder, 176, 183, 218, 223, 231, 232 Bleeding Time, 79, 176 Blood Banks, 115, 176 Blood Cell Count, 110, 121, 152, 155, 176 Blood Coagulation, 176, 178, 228 Blood Flow Velocity, 78, 176 Blood Glucose, 42, 83, 99, 114, 176, 197, 201 Blood Platelets, 176, 228

Blood transfusion, 23, 33, 119, 153, 176, 197 Blood urea, 138, 151, 154, 176, 203 Blood Viscosity, 11, 34, 40, 57, 66, 71, 83, 153, 176, 197 Blood Volume, 10, 14, 26, 29, 39, 45, 46, 48, 49, 96, 98, 102, 103, 104, 105, 122, 177, 216 Blot, 36, 177, 200 Blotting, Western, 177, 200 Body Fluids, 177, 178, 188, 225 Body Image, 36, 177 Body Mass Index, 20, 177 Body Weight Changes, 132, 177 Bolus, 26, 29, 98, 118, 177 Bolus infusion, 177 Bone Marrow, 33, 45, 137, 150, 153, 177, 185, 191, 195, 196, 205, 216, 222, 225 Bone marrow biopsy, 153, 177 Bone Resorption, 27, 177 Bowel, 177, 187, 201, 202, 214, 226 Bowel Movement, 177, 187, 226 Brachytherapy, 177, 202, 219, 220 Bradykinin, 177, 210, 215 Brain Hypoxia, 177 Brain Infarction, 177 Brain Ischemia, 8, 177 Bronchi, 177, 178, 190, 228, 229 Bronchial, 178, 228 Bronchitis, 178, 181 Bypass, 7, 13, 43, 44, 60, 62, 77, 178, 209 C Caffeine, 9, 22, 178 Calcium, 27, 31, 40, 114, 151, 152, 153, 154, 173, 178, 183, 209, 213, 218, 228 Calcium channel blocker, 173, 178 Calcium Channel Blockers, 173, 178 Calibration, 26, 32, 104, 178 Caloric intake, 154, 178 Capillary, 12, 28, 35, 82, 83, 95, 97, 102, 104, 109, 114, 116, 122, 176, 177, 178, 195, 219, 232 Capsules, 178, 192, 195 Carbohydrate, 10, 178, 216 Carbon Dioxide, 31, 115, 178, 194, 199, 215, 219, 222, 230, 231 Carcinogen, 178, 228 Carcinogenic, 178, 211, 218, 226 Carcinogenicity, 21, 178 Cardiac Output, 98, 179 Cardiomyopathy, 26, 179

237

Cardiopulmonary, 7, 12, 15, 41, 43, 44, 46, 58, 60, 66, 70, 77, 78, 82, 179, 197 Cardiopulmonary Bypass, 7, 12, 15, 41, 43, 46, 58, 60, 66, 70, 77, 78, 82, 179, 197 Cardiovascular, 4, 6, 13, 14, 15, 23, 24, 41, 44, 58, 59, 60, 62, 73, 82, 98, 103, 136, 179, 191 Cardiovascular disease, 4, 13, 23, 24, 73, 136, 179 Carnitine, 90, 179 Carotene, 179, 222 Carrier Proteins, 179, 215, 220 Case report, 179, 182 Case series, 179, 182 Catecholamines, 13, 19, 170, 179, 188 Catheter, 6, 40, 179, 202 Cathode, 175, 179, 188 Causal, 179, 198, 202 Cell Adhesion, 10, 11, 179, 201 Cell Aggregation, 25, 35, 74, 179 Cell Count, 18, 110, 153, 155, 179 Cell Cycle, 36, 179, 182, 217 Cell Death, 174, 180, 209 Cell Division, 175, 180, 185, 207, 215 Cell membrane, 176, 178, 179, 180, 211, 214, 217 Cell proliferation, 180, 222 Cell Size, 116, 180, 193 Cell Survival, 21, 81, 180 Cellulose, 180, 215 Central Nervous System, 15, 169, 175, 178, 180, 194, 196, 211, 228 Centrifugation, 104, 109, 112, 116, 120, 121, 122, 129, 130, 180 Cerebellar, 39, 180 Cerebellum, 177, 180 Cerebral Arteries, 180, 207 Cerebrospinal, 180, 224 Cerebrospinal fluid, 180, 224 Cerebrovascular, 6, 11, 45, 178, 179, 180 Cerebrum, 180 Chemotactic Factors, 180, 183 Chemotherapeutic agent, 127, 180 Chemotherapy, 20, 96, 112, 127, 180 Chin, 180, 207 Chloroquine, 16, 181 Cholesterol, 52, 70, 73, 75, 90, 114, 117, 138, 151, 175, 181, 184, 204, 205, 226 Cholesterol Esters, 181, 204 Cholinergic, 181, 210 Choroid, 181, 222 Chromatin, 174, 181, 190

Chromium, 81, 181 Chromosomal, 181, 215, 223 Chromosome, 181, 196, 204, 223 Chronic Disease, 17, 181 Chronic Obstructive Pulmonary Disease, 62, 181 Chronic renal, 3, 6, 8, 24, 44, 78, 131, 150, 152, 181, 216, 230 Chylomicrons, 181, 204 Circadian, 49, 181 Circulatory system, 106, 181 Cirrhosis, 74, 181, 197 CIS, 181, 222 Cisplatin, 127, 181 Clamp, 14, 182 Clinical Medicine, 9, 56, 90, 122, 182, 217 Clinical Protocols, 103, 182 Clinical study, 14, 182, 184 Clinical trial, 7, 14, 30, 37, 145, 182, 184, 185, 188, 218, 220 Cloning, 176, 182, 204 Coenzyme, 111, 182 Cofactor, 182, 218, 228 Cognition, 6, 9, 182 Colitis, 182, 201 Collagen, 27, 171, 182, 192, 215, 217 Collapse, 182, 225 Colloidal, 170, 182, 191, 224, 227 Colon, 182, 201, 203, 204 Colorectal, 68, 182 Colorectal Cancer, 68, 182 Complement, 33, 34, 172, 182, 183, 201, 215 Complementary and alternative medicine, 89, 91, 183 Complementary medicine, 89, 183 Compliance, 9, 183 Computational Biology, 145, 183 Computer Simulation, 11, 183 Cones, 183, 222 Confidence Intervals, 23, 24, 183 Confounding, 36, 183 Confusion, 183, 187, 199, 230, 231 Congestive heart failure, 28, 183 Conjugated, 183, 185, 209 Connective Tissue, 177, 182, 183, 184, 186, 194, 205, 223, 227 Consciousness, 172, 184, 186, 219, 222 Constriction, 14, 184, 202, 223, 231 Constriction, Pathologic, 184, 231 Consultation, 18, 184 Contractility, 19, 172, 184

238

Hematocrit

Contraindications, ii, 184 Control group, 20, 184, 220 Controlled clinical trial, 20, 184 Coronary, 13, 26, 41, 43, 47, 55, 56, 58, 60, 62, 73, 77, 127, 133, 179, 184, 207, 208 Coronary Arteriosclerosis, 184, 208 Coronary Disease, 26, 184 Coronary heart disease, 55, 73, 179, 184 Coronary Thrombosis, 184, 207, 208 Coronary Vessels, 184 Cortex, 9, 180, 184, 191, 207 Cortisol, 13, 19, 170, 184 Creatinine, 32, 70, 73, 101, 138, 151, 154, 155, 184, 203, 230 Creatinine clearance, 73, 155, 184 Critical Care, 8, 40, 49, 134, 184 Curative, 184, 228 Cyanide, 116, 185, 217 Cyanosis, 185, 197 Cyclic, 178, 185, 196, 210, 228 Cyclosporine, 42, 185 Cyst, 66, 185 Cysteine, 32, 169, 185 Cystine, 185 Cytochrome, 11, 185 Cytogenetics, 185, 223 Cytokines, 15, 185, 193 Cytoplasm, 174, 175, 180, 185, 189, 190, 196 Cytoskeleton, 185, 201 Cytotoxicity, 127, 181, 185 D Deamination, 185, 230 Decompression, 44, 185 Decompression Sickness, 185 Degenerative, 186, 198 Deletion, 174, 186 Delirium, 23, 186 Dendrites, 186, 210 Dermis, 186, 229 Deuterium, 186, 199 Developing Countries, 122, 186 Diabetes Mellitus, 44, 186, 195, 197 Diabetic Retinopathy, 16, 186 Diagnostic Errors, 186, 206 Diagnostic procedure, 93, 136, 186, 214 Dialysate, 32, 100, 103, 186 Dialyzer, 32, 100, 105, 106, 113, 186, 197 Diastole, 186 Diastolic, 5, 133, 186, 187, 199 Diastolic blood pressure, 5, 187 Diathesis, 32, 187

Diclofenac, 14, 187 Diclofenac Sodium, 187 Dietitian, 132, 187 Diffusion, 48, 100, 111, 176, 187, 230 Digestion, 175, 177, 187, 202, 204, 213, 226 Digestive system, 187, 194 Digital rectal examination, 36, 187 Dilatation, Pathologic, 187, 231 Dilation, 12, 177, 187, 231 Dilution, 26, 48, 103, 187, 191, 215 Diploid, 187, 215 Direct, iii, 24, 35, 122, 182, 187, 188, 217, 221 Disease Transmission, 119, 187 Disease Transmission, Horizontal, 187 Disease Transmission, Vertical, 187 Disorientation, 183, 186, 187 Distal, 127, 187, 188 Diuresis, 178, 187, 228 Diuretics, Thiazide, 173, 187 Dopamine, 188, 210, 214 Double-blind, 59, 188 Drive, ii, vi, 4, 5, 6, 85, 107, 134, 138, 152, 188 Drug Interactions, 188 Duct, 171, 188, 191, 226 Duodenum, 175, 188, 189, 194, 213, 226 Dyes, 172, 175, 188, 193, 195 E Edema, 186, 188, 209, 230 Effector, 169, 182, 188 Efficacy, 6, 15, 23, 24, 33, 36, 59, 78, 126, 127, 188 Elastin, 182, 188 Elective, 69, 74, 75, 188 Electrochemistry, 115, 188 Electrode, 99, 111, 115, 116, 117, 179, 188 Electrolyte, 100, 102, 116, 133, 186, 188, 197, 203, 217, 225, 230 Electromyography, 18, 188 Electrons, 99, 111, 174, 175, 179, 188, 202, 212, 219, 220 Elementary Particles, 188, 210, 218 Emboli, 7, 44, 189 Embolus, 189, 201 Embryo, 189, 200, 230 Emphysema, 181, 189 Empirical, 40, 189 Endemic, 16, 189, 205, 226 Endocrinology, 189, 196 Endogenous, 26, 188, 189 Endorphin, 19, 189

239

Endoscope, 189 Endoscopic, 14, 134, 189 Endoscopy, 15, 134, 153, 189 Endostatin, 126, 189 Endothelial cell, 31, 189, 228 Endothelium, 31, 35, 126, 189, 210 Endothelium, Lymphatic, 189 Endothelium, Vascular, 189 Endothelium-derived, 189, 210 Endotoxins, 183, 189 Endotracheal intubation, 15, 190 End-stage renal, 3, 41, 65, 138, 181, 190, 216 Environmental Health, 81, 144, 146, 190 Enzymatic, 171, 178, 179, 183, 190, 222 Enzyme Inhibitors, 41, 190, 215 Eosinophils, 155, 190, 196, 204 Epidemic, 4, 190, 226 Epidemiological, 5, 190 Epidermal, 190, 203, 206 Epidermis, 186, 190, 203, 217 Epigastric, 190, 212 Epinephrine, 89, 170, 188, 190, 210, 230 Epithelial, 176, 190, 198, 203, 212 Epithelial Cells, 190, 198, 203 Epithelium, 189, 190 Epoetin alfa, 5, 57, 151, 153, 190 Erythrocyte Count, 42, 49, 105, 190, 222 Erythrocyte Deformability, 73, 190 Erythrocyte Indices, 176, 190 Erythrocyte Volume, 33, 177, 191 Erythrocytes, 11, 33, 38, 57, 77, 105, 109, 120, 172, 176, 177, 190, 191, 197, 198, 221 Erythropoiesis, 33, 191 Esophagitis, 134, 191 Esophagus, 187, 191, 194, 213, 226 Estrogen, 9, 191 Eukaryotic Cells, 191, 211, 230 Evoke, 191, 226 Excitation, 191, 193, 210 Excrete, 191, 203 Exercise Test, 191 Exercise Tolerance, 3, 66, 191 Exhaustion, 137, 173, 191, 205 Exocrine, 191, 212 Exogenous, 176, 189, 191 Expander, 57, 107, 191 Extender, 191 Extensor, 191, 218 External-beam radiation, 191, 219 Extracellular, 37, 171, 184, 191, 192, 201, 225, 228

Extracellular Matrix, 184, 191, 192, 201 Extracorporeal, 32, 42, 46, 98, 113, 117, 118, 119, 192, 197 Extracorporeal Circulation, 46, 192 Extracorporeal Membrane Oxygenation, 42, 192 Extraction, 34, 192 Extravasation, 11, 192 Extravascular, 121, 192 Eye Infections, 169, 192 F Family Planning, 145, 192 Fat, 13, 36, 177, 179, 184, 189, 192, 204, 223, 225 Fatigue, 20, 36, 137, 153, 192, 196 Febrile, 119, 192, 205, 206 Feces, 192, 226 Femoral, 23, 24, 179, 192 Femoral Artery, 179, 192 Femur, 192 Ferritin, 75, 152, 153, 154, 192 Fetal Blood, 63, 192 Fetus, 191, 192, 215, 230, 231 Fibrinogen, 43, 50, 60, 74, 192, 215, 228 Fibroblasts, 192, 202 Filler, 99, 111, 192 Filtration, 41, 53, 97, 107, 193, 203 Fish Products, 193, 224 Fistula, 6, 106, 193, 194 Flatus, 193, 194 Flow Cytometry, 80, 193 Fluorescein Angiography, 75, 193 Fluorescence, 12, 27, 75, 95, 193 Fluorescent Dyes, 193 Folate, 193 Fold, 10, 193, 211, 212 Folic Acid, 150, 193 Forearm, 83, 176, 193 Free Radical Scavengers, 193, 228 Free Radicals, 173, 193, 209 Functional magnetic resonance imaging, 9, 22, 193 Fungi, 192, 194, 195, 196, 207, 231 G Gadolinium, 29, 194 Gallbladder, 169, 175, 187, 194 Gamma Rays, 194, 219, 220 Ganglia, 169, 177, 194, 209, 214, 227 Ganglionic Blockers, 173, 194 Gas, 44, 57, 115, 171, 178, 186, 187, 193, 194, 199, 210, 219, 222, 227, 231 Gas exchange, 194, 222, 231

240

Hematocrit

Gastric, 17, 175, 179, 194, 213 Gastric Juices, 194, 213 Gastrin, 194, 198 Gastroduodenal, 14, 194 Gastroenterology, 17, 70, 72, 80, 194 Gastrointestinal, 14, 128, 134, 177, 190, 194, 206, 226, 227 Gastrointestinal tract, 194, 226 Gels, 48, 194 Gene, 19, 24, 28, 75, 108, 154, 169, 176, 194, 204, 215, 230 Gene Expression, 19, 24, 194 Gene Therapy, 24, 108, 169, 194 Genetic Code, 195, 210 Genetic testing, 154, 195 Genital, 195, 196 Genotype, 30, 195 Gestational, 14, 54, 68, 195 Gestational Age, 14, 54, 68, 195 Ginseng, 91, 195 Gland, 170, 195, 205, 209, 212, 213, 218, 224, 226, 229 Globins, 115, 195 Glomerular, 154, 195, 202, 203, 221 Glomerular Filtration Rate, 154, 195, 203 Glomerulus, 195 Glucose Intolerance, 186, 195 Glucose Oxidase, 99, 111, 114, 195 Glucuronic Acid, 196, 198 Glutamic Acid, 193, 196, 197, 210, 217 Glycoprotein, 191, 192, 196, 208, 228 Governing Board, 196, 217 Graft, 196, 208, 209 Grafting, 60, 62, 196 Graft-versus-host disease, 196, 208 Granulocytes, 196, 232 Grasses, 193, 196 Guanylate Cyclase, 196, 210 Gynecology, 54, 61, 63, 70, 71, 74, 78, 80, 119, 196 H Half-Life, 27, 196 Haploid, 196, 215 Haptens, 170, 196, 220 Headache, 178, 196, 199 Health Status, 9, 17, 120, 196 Heart attack, 179, 196 Heart failure, 26, 60, 133, 172, 196 Helminths, 196, 201 Hematemesis, 134, 196 Hemato, 94, 95, 197 Hematology, 14, 101, 129, 138, 197, 214

Heme, 11, 175, 185, 197, 209, 212, 216, 217 Hemochromatosis, 150, 153, 154, 197 Hemodiafiltration, 197, 230 Hemodilution, 7, 15, 39, 49, 55, 59, 61, 67, 70, 197 Hemodynamics, 14, 15, 16, 22, 26, 28, 38, 74, 197 Hemofiltration, 60, 133, 197, 230 Hemoglobin C, 41, 42, 67, 99, 101, 110, 113, 116, 120, 122, 125, 152, 155, 172, 190, 197 Hemoglobin E, 11, 49, 197 Hemoglobin M, 80, 115, 185, 197, 198 Hemoglobinopathies, 32, 195, 197 Hemolysis, 21, 49, 57, 115, 166, 198 Hemolytic, 153, 198, 222, 228 Hemophilia, 107, 198 Hemorrhage, 50, 80, 103, 128, 134, 196, 198, 209, 226, 232 Hemostasis, 28, 57, 60, 70, 73, 134, 198, 201 Heparin, 51, 81, 198 Hepatic, 26, 128, 170, 186, 198, 216 Hepatitis, 23, 50, 198 Hepatocellular, 26, 128, 198 Hepatocytes, 26, 198 Hereditary, 154, 198, 222, 228 Heredity, 194, 198 Hetastarch, 45, 198 Heterodimers, 198, 201 Heterogeneity, 16, 170, 198 Histology, 12, 198 Homeostasis, 28, 198 Homogeneous, 15, 16, 198 Homologous, 119, 195, 197, 198, 227 Hormonal, 18, 198 Hormone, 13, 28, 137, 138, 150, 184, 190, 191, 194, 198, 201, 207, 212, 223, 228, 229 Hybridomas, 199, 202 Hydrogen, 114, 169, 178, 186, 195, 199, 208, 210, 212, 218 Hydrogen Peroxide, 114, 195, 199 Hydrolysis, 176, 181, 199, 216, 218 Hydrophobic, 199, 204 Hydroxylysine, 182, 199 Hydroxyproline, 171, 182, 199 Hydroxyurea, 29, 30, 199 Hyperbaric, 90, 199 Hyperbaric oxygen, 199 Hypercapnia, 10, 31, 199 Hyperlipidemia, 132, 199 Hypersensitivity, 199, 223 Hypertrophy, 26, 133, 199

241

Hypoglycaemia, 186, 199 Hypoglycemia, 9, 199 Hypotension, 35, 103, 133, 134, 194, 199 Hypotensive, 82, 199 Hypothermia, 197, 199, 200 Hypovolemia, 103, 200 Hypoxia, 24, 28, 29, 31, 35, 58, 108, 172, 186, 200 Hypoxic, 11, 12, 28, 200 Hysterectomy, 45, 55, 200 I Imaging procedures, 200, 229 Immersion, 18, 50, 79, 200 Immune response, 33, 38, 169, 173, 196, 200, 227, 232 Immune system, 200, 205, 232 Immunoassay, 60, 200 Immunoblotting, 12, 200 Immunogenic, 200, 220 Immunoglobulins, 200, 215 Immunologic, 14, 180, 195, 200, 220 Immunology, 169, 170, 193, 200 Immunosuppressive, 200, 228 Impairment, 3, 7, 46, 73, 186, 192, 200 Implant radiation, 200, 202, 219 In situ, 25, 35, 200 In vitro, 8, 10, 19, 21, 25, 31, 32, 34, 37, 49, 75, 176, 179, 195, 200, 228 In vivo, 10, 19, 24, 25, 31, 32, 34, 35, 37, 65, 80, 100, 195, 198, 200, 228 Incision, 200, 202, 218, 223 Induction, 21, 33, 133, 194, 200 Infancy, 21, 200 Infarction, 127, 177, 201, 221 Infection, 16, 17, 23, 33, 50, 101, 122, 175, 180, 186, 192, 201, 205, 221, 223, 226, 230, 232 Infestation, 16, 201 Inflammatory bowel disease, 134, 201 Infusion, 12, 103, 201, 209, 229 In-line, 40, 45, 48, 201 Inorganic, 181, 201, 216 Insight, 3, 15, 25, 35, 201 Insomnia, 20, 201 Insulin, 13, 64, 128, 136, 201 Insulin-dependent diabetes mellitus, 201 Integrins, 11, 201 Intensive Care, 71, 120, 201 Interleukin-6, 21, 201 Intermittent, 67, 155, 202, 214 Intermittent Claudication, 67, 202 Internal radiation, 202, 219

Interstitial, 28, 47, 114, 177, 202, 221 Intervention Studies, 21, 202 Intestinal, 179, 202, 203 Intestine, 177, 182, 202, 203 Intoxication, 186, 197, 202, 233 Intracellular, 31, 37, 47, 178, 201, 202, 207, 210, 217, 223 Intracellular Membranes, 202, 207 Intramuscular, 24, 36, 75, 202 Intravascular, 26, 70, 128, 202 Intravenous, 4, 57, 70, 79, 81, 193, 201, 202 Intrinsic, 9, 15, 170, 202 Intubation, 202 Inulin, 195, 202 Invasive, 8, 9, 16, 26, 32, 100, 102, 103, 113, 120, 121, 123, 202, 205, 212 Involuntary, 202, 209 Ionization, 202 Ionizing, 29, 171, 202, 220 Ions, 188, 199, 202, 217, 218 Ischemia, 11, 12, 65, 127, 134, 177, 202, 209, 221 Ischemic stroke, 74, 202 K Kb, 144, 203 Keratin, 203 Keratinocyte growth factor, 19, 203 Keratinocytes, 19, 203 Kidney Failure, 8, 154, 155, 190, 203 Kidney Failure, Acute, 203 Kidney Failure, Chronic, 203 Kidney stone, 203, 231 Kidney Transplantation, 4, 203 Kinetic, 202, 203 L Labile, 182, 203 Lactation, 27, 203, 212 Large Intestine, 182, 187, 202, 203, 221, 225 Latency, 9, 204 Lavage, 134, 204 Least-Squares Analysis, 204, 221 Lectin, 204, 207 Lenses, 98, 130, 204, 221 Lesion, 134, 204 Lethal, 185, 204 Leukapheresis, 45, 174, 204 Leukemia, 165, 195, 204 Leukocytes, 10, 107, 120, 175, 176, 177, 180, 185, 190, 196, 204 Leukocytosis, 204, 216 Ligament, 204, 218 Ligands, 10, 201, 204

242

Hematocrit

Ligase, 204, 219 Likelihood Functions, 204, 221 Linear Models, 204, 221 Linkage, 108, 204 Lipid, 174, 201, 204 Lipoprotein, 36, 204, 205 Localized, 64, 100, 177, 201, 205, 215 Locomotion, 205, 215 Logistic Models, 205, 221 Loop, 96, 205 Low-density lipoprotein, 204, 205 Lymph, 181, 189, 205, 209 Lymph node, 205, 209 Lymphatic, 189, 201, 205, 225, 226 Lymphatic system, 205, 225, 226 Lymphocyte, 90, 173, 205, 206 Lymphocyte Count, 90, 205 Lymphoid, 173, 205 Lysine, 197, 199, 205 M Magnetic Resonance Imaging, 29, 59, 205 Malaria, 16, 33, 38, 205, 206 Malaria, Falciparum, 205, 206 Malaria, Vivax, 205, 206 Malignancy, 134, 206 Malignant, 173, 206, 217, 220 Malnutrition, 170, 206 Mandible, 171, 180, 206, 222 Meat, 154, 206 Mediator, 99, 110, 111, 115, 206 Medical Errors, 23, 24, 206 Medical Records, 13, 206 Medicament, 108, 206 Medication Errors, 206 MEDLINE, 145, 206 Medullary, 27, 206 Megaloblastic, 193, 206 Melanin, 206, 214, 230 Melanocytes, 206 Melanoma, 126, 206 Membrane Proteins, 34, 207 Memory, 186, 207 Meninges, 180, 207 Mental, iv, 7, 27, 137, 144, 146, 181, 182, 183, 186, 187, 192, 207, 219, 223, 230, 231 Mercury, 193, 207 Mesentery, 31, 35, 207, 214 Metabolite, 50, 176, 207 Metastasis, 10, 207 MI, 167, 207 Mice Minute Virus, 207, 213 Microbe, 207, 229

Microcirculation, 28, 31, 49, 57, 72, 79, 103, 197, 207 Microfilaria, 95, 207 Microorganism, 182, 207, 232 Microspheres, 35, 207 Middle Cerebral Artery, 50, 59, 207 Mitochondrial Swelling, 207, 209 Mitosis, 174, 207 Modeling, 22, 31, 63, 64, 208 Modification, 171, 208, 219 Molecular, 36, 48, 111, 138, 145, 147, 176, 183, 185, 191, 192, 197, 198, 208 Molecule, 173, 182, 183, 188, 189, 191, 199, 204, 208, 212, 215, 220, 221, 231 Monitor, 32, 45, 48, 94, 103, 120, 138, 151, 152, 154, 184, 208, 210 Monoclonal, 199, 200, 208, 219 Monoclonal antibodies, 200, 208 Monocyte, 34, 208 Morphological, 133, 189, 206, 208 Morphology, 34, 129, 197, 208 Mucins, 208 Mucolytic, 169, 208 Mutagenesis, 32, 208 Mutagens, 208 Mycophenolate mofetil, 52, 208 Mydriatic, 187, 208 Myeloma, 44, 208 Myocardial infarction, 23, 24, 58, 127, 184, 207, 208, 209 Myocardial Ischemia, 127, 133, 184, 208 Myocardial Reperfusion, 209, 222 Myocardial Reperfusion Injury, 209, 222 Myocardium, 26, 127, 207, 208, 209 Myoglobin, 195, 209 N Nadir, 12, 209 Nasogastric, 134, 209 Natriuresis, 28, 172, 209 Nausea, 209, 230, 231 Necrosis, 128, 174, 177, 201, 207, 208, 209, 221, 222 Neonatal, 14, 48, 63, 64, 209 Neonatology, 14, 209 Nephrectomy, 19, 209 Nephropathy, 203, 209 Nerve, 170, 172, 181, 186, 206, 209, 210, 211, 223, 226, 230 Nervous System, 175, 180, 206, 209, 210, 214, 227 Neural, 10, 18, 103, 172, 194, 209 Neurologic, 15, 209

243

Neuronal, 7, 22, 34, 209 Neurons, 22, 186, 194, 209, 210, 227 Neurosurgery, 119, 210 Neurotoxic, 27, 210 Neurotoxicity, 12, 210 Neurotransmitter, 169, 171, 177, 188, 196, 210, 227 Neutrons, 171, 210, 219 Neutrophil, 10, 129, 210 Nicotine, 9, 210 Nitric Oxide, 11, 12, 28, 30, 31, 32, 210 Nitrogen, 138, 151, 154, 170, 171, 185, 203, 210, 230 Nuclear, 63, 188, 191, 194, 209, 210, 217, 222, 230 Nuclei, 171, 188, 195, 205, 207, 210, 211, 218 Nucleic acid, 108, 195, 208, 210 Nucleus, 174, 175, 181, 185, 186, 189, 190, 191, 194, 210, 218 Nutritional Status, 17, 133, 210 O Odds Ratio, 211, 221 Oliguria, 203, 211 Omentum, 35, 211 Oncogenic, 201, 211 Oncology, 20, 69, 211 On-line, 32, 103, 165, 211 Opacity, 186, 211 Opsin, 211, 222, 223 Optic Nerve, 211, 222 Organ Transplantation, 128, 211 Organelles, 180, 185, 206, 211 Orthopedics, 119, 211 Orthostatic, 134, 211 Osmolality, 28, 67, 211 Osmoles, 211 Osmosis, 211 Osmotic, 90, 170, 207, 211, 224 Osmotic Fragility, 90, 211 Osteonecrosis, 30, 211 Outpatient, 21, 212 Oxidation, 99, 111, 114, 169, 174, 176, 185, 197, 212 Oxidation-Reduction, 111, 176, 212 Oximetry, 8, 100, 123, 212 Oxygen Consumption, 25, 98, 191, 212, 222 Oxygenase, 11, 15, 212 Oxygenation, 9, 12, 14, 15, 22, 26, 29, 34, 51, 100, 120, 186, 212 Oxygenator, 179, 192, 212

Oxytocin, 19, 212 P Palliative, 212, 228 Pancreas, 4, 56, 169, 187, 194, 197, 201, 212 Pancreatic, 179, 193, 212 Pancreatitis, 56, 70, 72, 80, 212 Papilloma, 212, 222 Parasite, 16, 33, 38, 212 Parasitic, 196, 201, 212, 223 Parathyroid, 152, 153, 212, 213, 228 Parathyroid Glands, 212, 213 Parathyroid hormone, 152, 153, 213 Paroxysmal, 43, 213 Particle, 10, 11, 213 Parvovirus, 76, 207, 213 Patch, 213, 229 Patella, 27, 213 Pathogenesis, 32, 213 Pathologic, 25, 169, 174, 176, 184, 199, 213, 217, 219, 222 Pathologic Processes, 174, 213 Pathologies, 18, 35, 213 Patient Education, 132, 150, 155, 160, 162, 167, 213 Pediatrics, 8, 47, 48, 62, 63, 64, 65, 66, 69, 209, 213 Pelvic, 213, 218 Pepsin, 213 Peptic, 134, 213 Peptic Ulcer, 134, 213 Peptide, 13, 74, 80, 171, 203, 213, 216, 218 Perception, 36, 213, 223 Percutaneous, 64, 213 Perfusion, 12, 14, 16, 22, 26, 29, 40, 193, 200, 213 Perineal, 213, 220 Perioperative, 15, 58, 68, 133, 213 Peripheral blood, 101, 214 Peripheral Nervous System, 210, 214, 227 Peritoneal, 8, 65, 131, 133, 154, 155, 186, 214 Peritoneal Cavity, 214 Peritoneal Dialysis, 8, 65, 131, 154, 155, 186, 214 Peritoneum, 207, 211, 214 Peroxide, 114, 195, 214 Pharmacokinetic, 214 Pharmacologic, 13, 172, 196, 214, 229 Phenylalanine, 72, 214, 230 Phlebotomy, 30, 33, 70, 214 Phospholipids, 192, 204, 214

244

Hematocrit

Phosphorus, 151, 152, 153, 154, 178, 213, 214 Phosphorylated, 36, 182, 214 Photodynamic therapy, 214 Photosensitizer, 37, 214 Physical Examination, 195, 214 Physiologic, 3, 11, 22, 170, 196, 202, 215, 221, 222 Pigment, 175, 206, 209, 215 Pilot study, 23, 74, 215 Placenta, 192, 215, 230 Plants, 89, 171, 178, 195, 202, 204, 208, 215, 219, 229 Plasma cells, 173, 208, 215 Plasma protein, 49, 71, 83, 103, 170, 189, 215, 218, 224 Plasma Volume, 14, 19, 44, 49, 53, 64, 80, 153, 177, 215 Plasmapheresis, 174, 215 Plasmid, 24, 215, 231 Plasticity, 197, 215 Platelet Aggregation, 172, 210, 215 Platelet Count, 60, 68, 94, 95, 121, 129, 215 Plateletpheresis, 174, 215 Platelets, 51, 68, 96, 107, 111, 112, 117, 118, 129, 130, 138, 151, 155, 210, 215, 228, 229 Platinum, 127, 181, 205, 215, 216 Platinum Compounds, 127, 216 Plethysmography, 65, 104, 105, 121, 216 Pneumonia, 23, 24, 184, 216 Poisoning, 186, 202, 207, 209, 216 Polycystic, 38, 68, 137, 216 Polycythemia Vera, 46, 214, 216 Polyethylene, 34, 216 Polymers, 25, 34, 216, 218 Polypeptide, 171, 182, 192, 209, 216, 228, 233 Polyposis, 182, 216 Polysaccharide, 170, 173, 180, 216, 218 Porphyria, 214, 216 Porphyria Cutanea Tarda, 214, 216 Port, 97, 216 Port-a-cath, 216 Posterior, 180, 181, 212, 216 Postoperative, 15, 23, 24, 67, 120, 133, 217 Postoperative Complications, 23, 24, 217 Potassium, 11, 106, 116, 151, 152, 153, 154, 188, 217 Potassium Channels, 11, 217 Potassium Cyanide, 116, 217 Practice Guidelines, 131, 146, 217 Precursor, 188, 190, 214, 217, 218, 230

Pregnancy Tests, 195, 217 Preoperative, 45, 55, 59, 133, 217 Prevalence, 13, 17, 211, 217 Prickle, 203, 217 Probe, 48, 102, 113, 217 Prognostic factor, 72, 217 Progression, 126, 172, 217, 232 Progressive, 30, 181, 203, 209, 217, 221 Proliferating Cell Nuclear Antigen, 36, 217 Proliferative Retinopathy, 30, 217 Proline, 182, 199, 217 Promoter, 19, 218 Prophylaxis, 23, 24, 218 Prospective study, 6, 9, 27, 80, 218 Prostate, 21, 75, 126, 218, 220, 223 Prostatectomy, 218, 220 Protein C, 36, 110, 121, 170, 171, 174, 192, 195, 203, 204, 218, 230 Protein S, 36, 176, 195, 218, 228 Proteinuria, 151, 218 Proteoglycans, 28, 218 Proteolytic, 183, 192, 218 Prothrombin, 218, 228 Protocol, 103, 218 Protons, 171, 199, 202, 218, 219 Protozoa, 207, 218, 231 Protozoan, 205, 218 Psoriasis, 126, 218 Psychic, 207, 219, 224 Psychoactive, 219, 233 Psychomotor, 186, 219 Public Policy, 145, 219 Publishing, 38, 219 Pulmonary, 14, 48, 74, 128, 133, 176, 191, 193, 197, 203, 219, 225, 232 Pulmonary Artery, 176, 219, 232 Pulmonary Diffusing Capacity, 74, 219 Pulmonary Edema, 203, 219 Pulsation, 101, 219 Pulse, 8, 9, 34, 57, 77, 100, 106, 120, 123, 151, 208, 212, 219 Pupil, 187, 208, 219 Purifying, 113, 219 Pyruvate Carboxylase, 26, 219 Q Quality of Life, 3, 6, 8, 21, 52, 59, 128, 137, 219 R Race, 13, 219 Radiation, 21, 29, 102, 113, 189, 191, 193, 194, 199, 202, 219, 220, 233

245

Radiation therapy, 21, 191, 199, 202, 219 Radical prostatectomy, 68, 220 Radioactive, 196, 199, 200, 202, 208, 210, 211, 219, 220, 230 Radiography, 195, 220 Radioimmunoassay, 15, 18, 220 Radioisotope, 191, 220, 229 Radiolabeled, 26, 177, 219, 220 Radiological, 213, 220 Radiotherapy, 177, 219, 220 Radium, 62, 220 Random Allocation, 220 Randomization, 23, 24, 220 Randomized, 5, 7, 14, 15, 20, 23, 59, 188, 220 Randomized clinical trial, 23, 24, 220 Reactive Oxygen Species, 37, 220 Reagent, 42, 97, 99, 114, 117, 122, 124, 221 Receptor, 11, 28, 42, 53, 62, 126, 173, 188, 220, 221 Recombinant, 3, 5, 6, 33, 45, 53, 59, 66, 67, 72, 79, 221, 231 Recombination, 195, 221 Rectal, 221 Rectum, 177, 182, 187, 193, 194, 201, 203, 218, 221 Refer, 1, 182, 194, 205, 210, 221 Refraction, 221, 225 Regeneration, 221, 222 Regimen, 182, 188, 221, 223 Regression Analysis, 20, 221 Reinfection, 17, 221 Relative risk, 23, 24, 221 Renal failure, 90, 101, 137, 186, 221 Reperfusion, 127, 209, 221, 222 Reperfusion Injury, 127, 221, 222 Resorption, 27, 222 Respiration, 174, 178, 208, 222 Respiratory distress syndrome, 128, 222 Respiratory failure, 192, 222 Resuscitation, 14, 102, 134, 222 Reticulocyte Count, 30, 33, 68, 129, 222 Retina, 16, 181, 183, 186, 211, 217, 222, 223, 232 Retinal, 16, 75, 186, 193, 211, 222, 223, 232 Retinal Vessels, 75, 222 Retinoblastoma, 36, 222 Retinoblastoma Protein, 36, 222 Retinol, 222, 223 Retreatment, 70, 222 Retropubic, 218, 220, 223 Retropubic prostatectomy, 220, 223

Retroviral vector, 194, 223 Rheology, 10, 35, 223 Rheumatism, 223 Rheumatoid, 126, 181, 223 Rheumatoid arthritis, 126, 181, 223 Rhodopsin, 211, 222, 223 Ribonucleoside Diphosphate Reductase, 199, 223 Ribose, 169, 223 Rickettsiae, 223, 231 Risk factor, 4, 60, 138, 205, 218, 221, 223 Rod, 175, 182, 223 S Saline, 44, 98, 103, 105, 223 Satellite, 36, 42, 223 Schizoid, 223, 233 Schizophrenia, 223, 233 Schizotypal Personality Disorder, 223, 233 Screening, 8, 24, 27, 74, 100, 115, 182, 224, 231 Seafood, 154, 224 Secondary tumor, 207, 224 Secretion, 28, 201, 203, 208, 224 Sediment, 224, 231 Sedimentation, 53, 69, 71, 76, 78, 120, 180, 224 Seizures, 186, 213, 224 Semen, 218, 224 Sensor, 32, 120, 128, 129, 224 Serologic, 200, 224 Serous, 189, 224 Serum Albumin, 9, 32, 132, 138, 154, 220, 224 Sex Characteristics, 170, 224, 228 Shock, 36, 103, 166, 200, 224, 230 Shunt, 6, 105, 224 Side effect, 133, 152, 170, 224, 229 Signs and Symptoms, 151, 224, 230 Skeletal, 34, 36, 86, 182, 211, 224 Skeleton, 192, 224, 225 Skull, 225, 228 Sleep apnea, 36, 225 Small intestine, 181, 188, 199, 202, 209, 225 Smoke Inhalation Injury, 192, 225 Smooth muscle, 172, 178, 225, 227 Social Environment, 219, 225 Sodium, 28, 38, 101, 151, 153, 154, 187, 188, 209, 211, 225 Soft tissue, 177, 225 Solid tumor, 127, 172, 189, 225 Solvent, 211, 225 Somatic, 170, 208, 214, 225

246

Hematocrit

Specialist, 156, 187, 225 Species, 32, 187, 190, 196, 205, 207, 208, 211, 212, 213, 219, 220, 225, 227, 230, 232, 233 Spectrophotometry, 122, 225 Spectrum, 102, 225 Spinal cord, 128, 180, 181, 207, 209, 210, 214, 225, 227 Spinous, 190, 203, 225 Spleen, 33, 77, 205, 216, 226 Splenectomy, 33, 226 Splenomegaly, 216, 226 Sporadic, 216, 222, 226 Statistically significant, 4, 226 Steady state, 99, 226 Steel, 182, 226 Stem Cells, 191, 196, 226 Stenosis, 22, 226 Stent, 47, 226 Sterile, 130, 212, 226 Steroid, 184, 226 Stimulant, 178, 226 Stimulus, 12, 20, 36, 184, 188, 191, 204, 226, 228 Stomach, 169, 175, 187, 191, 194, 198, 204, 209, 211, 213, 214, 225, 226 Stool, 18, 182, 203, 226 Stress, 6, 13, 31, 71, 126, 133, 155, 175, 184, 209, 223, 226 Stricture, 226 Stroke, 8, 12, 22, 23, 24, 33, 39, 45, 55, 103, 144, 179, 203, 226 Subacute, 201, 226 Subarachnoid, 50, 196, 226 Subclinical, 201, 224, 226 Subcutaneous, 57, 77, 82, 99, 100, 188, 227 Subspecies, 225, 227 Substance P, 117, 207, 224, 227 Substrate, 12, 125, 190, 227 Suction, 193, 227 Supplementation, 30, 36, 90, 152, 227 Suspensions, 37, 46, 67, 123, 130, 227, 231 Sympathetic Nervous System, 19, 172, 175, 210, 227 Sympathomimetic, 188, 190, 227 Symphysis, 180, 218, 227 Symptomatic, 23, 24, 30, 212, 227 Synaptic, 210, 227 Synaptic Transmission, 210, 227 Systemic, 14, 19, 128, 174, 176, 177, 181, 186, 190, 197, 201, 219, 227, 231 Systemic lupus erythematosus, 181, 227

Systemic therapy, 181, 227 Systolic, 5, 59, 199, 227 T Tachycardia, 126, 228 Tacrolimus, 60, 228 Temporal, 22, 29, 228 Testosterone, 36, 53, 75, 228 Tetany, 213, 228 Tetracycline, 19, 228 Thalassemia, 21, 228 Theophylline, 81, 228 Therapeutics, 228 Thigh, 36, 192, 228 Thiourea, 26, 228 Threshold, 22, 23, 36, 199, 228 Thrombin, 79, 192, 215, 218, 228 Thrombocytes, 215, 228 Thrombocytopenia, 128, 228 Thrombomodulin, 218, 228 Thrombosis, 6, 68, 79, 201, 218, 226, 228 Thrombus, 184, 201, 203, 208, 209, 215, 229 Thyroid, 138, 212, 213, 229, 230 Thyroid Gland, 212, 213, 229 Thyroxine, 170, 214, 229 Ticks, 201, 229 Tomography, 16, 29, 229 Tonicity, 198, 229 Topical, 199, 229 Torsion, 201, 229 Toxic, iv, 21, 185, 196, 210, 225, 229 Toxicity, 14, 37, 188, 207, 229 Toxicokinetics, 229 Toxicology, 146, 229 Toxins, 32, 173, 189, 196, 201, 208, 229 Trace element, 181, 229 Tracer, 26, 229 Trachea, 178, 229 Traction, 182, 229 Transcutaneous, 65, 101, 229 Transdermal, 75, 229 Transfection, 176, 195, 229 Transfusion, 7, 11, 14, 22, 23, 33, 37, 50, 68, 70, 72, 74, 82, 96, 107, 112, 118, 134, 191, 229 Transgenes, 19, 29, 230 Transmitter, 169, 188, 206, 230 Transplantation, 4, 9, 14, 19, 41, 42, 45, 47, 52, 59, 71, 181, 230 Trauma, 8, 56, 76, 81, 102, 103, 105, 119, 186, 191, 196, 209, 212, 230 Tryptophan, 182, 230 Tumor suppressor gene, 222, 230

247

Tyrosine, 126, 179, 188, 230 U Ubiquitin, 36, 230 Ulceration, 213, 230 Ultrafiltration, 105, 113, 197, 230 Ultrasonography, 195, 230 Umbilical Arteries, 230 Umbilical Cord, 14, 230 Uraemia, 212, 230 Uranium, 220, 230 Urea, 4, 18, 27, 32, 46, 101, 106, 176, 230, 231 Urea Breath Test, 18, 230 Urease, 230 Uremia, 52, 133, 203, 221, 231 Urethra, 218, 231 Uric, 151, 231 Urinalysis, 54, 231 Urinary, 27, 80, 175, 211, 218, 223, 230, 231 Urinate, 231, 232 Urine, 27, 30, 114, 151, 154, 175, 176, 184, 187, 195, 203, 209, 211, 218, 231 Uterine Contraction, 212, 231 Uterus, 200, 231 V Vaccines, 33, 231, 232 Vagina, 231 Vaginal, 54, 61, 231 Vascular Resistance, 25, 231 Vasculitis, 212, 231 Vasoactive, 28, 231 Vasoconstriction, 11, 190, 231 Vasodilation, 11, 52, 172, 231 Vasodilator, 173, 177, 188, 209, 231 Vasomotor, 10, 231 Vector, 108, 231 Vein, 50, 122, 129, 172, 174, 202, 210, 214, 223, 230, 231

Venous, 26, 38, 40, 44, 45, 77, 79, 81, 82, 98, 106, 113, 121, 174, 176, 177, 190, 215, 218, 231 Venous blood, 26, 113, 121, 176, 177, 190, 215, 231 Ventricle, 219, 227, 232 Ventricular, 26, 55, 133, 209, 232 Ventricular Dysfunction, 26, 232 Venules, 31, 35, 176, 178, 189, 207, 232 Vertebrae, 225, 232 Veterinary Medicine, 145, 232 Viral, 23, 90, 169, 211, 232 Viral Load, 90, 232 Virulence, 175, 229, 232 Virus, 37, 50, 222, 223, 232 Viscera, 207, 225, 232 Viscosity, 11, 13, 25, 34, 43, 44, 45, 69, 82, 169, 176, 223, 232 Visual Acuity, 204, 232 Vitreous, 186, 222, 232 Vitreous Body, 222, 232 Vitreous Hemorrhage, 186, 232 Vitro, 31, 34, 37, 198, 232 Vivo, 17, 19, 24, 25, 31, 34, 35, 37, 100, 101, 104, 105, 232 Void, 154, 232 W Wakefulness, 186, 232 White blood cell, 35, 118, 121, 129, 138, 155, 173, 204, 205, 208, 210, 215, 232 Windpipe, 190, 229, 232 Withdrawal, 106, 186, 233 Wound Healing, 201, 233 X Xenograft, 173, 233 X-ray, 27, 179, 193, 194, 210, 219, 220, 233 Z Zymogen, 218, 233

248

Hematocrit

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