Acetyl-L-Carnitine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

ACETYL-L-CARNITINE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J...

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ACETYL-L-CARNITINE 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., 1960Acetyl-L-Carnitine: 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: 0-497-00008-3 1. Acetyl-L-Carnitine-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 acetyl-L-carnitine. 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 ACETYL-L-CARNITINE ............................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Acetyl-L-Carnitine........................................................................ 5 E-Journals: PubMed Central ......................................................................................................... 7 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND ACETYL-L-CARNITINE.................................................................... 17 Overview...................................................................................................................................... 17 Finding Nutrition Studies on Acetyl-L-Carnitine ...................................................................... 17 Federal Resources on Nutrition ................................................................................................... 21 Additional Web Resources ........................................................................................................... 21 CHAPTER 3. ALTERNATIVE MEDICINE AND ACETYL-L-CARNITINE ............................................. 23 Overview...................................................................................................................................... 23 National Center for Complementary and Alternative Medicine.................................................. 23 Additional Web Resources ........................................................................................................... 27 General References ....................................................................................................................... 29 CHAPTER 4. PATENTS ON ACETYL-L-CARNITINE .......................................................................... 31 Overview...................................................................................................................................... 31 Patents on Acetyl-L-Carnitine..................................................................................................... 31 Patent Applications on Acetyl-L-Carnitine................................................................................. 35 Keeping Current .......................................................................................................................... 36 CHAPTER 5. BOOKS ON ACETYL-L-CARNITINE .............................................................................. 37 Overview...................................................................................................................................... 37 Book Summaries: Federal Agencies.............................................................................................. 37 Chapters on Acetyl-L-Carnitine................................................................................................... 38 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 41 Overview...................................................................................................................................... 41 NIH Guidelines............................................................................................................................ 41 NIH Databases............................................................................................................................. 43 Other Commercial Databases....................................................................................................... 45 APPENDIX B. PATIENT RESOURCES ................................................................................................. 47 Overview...................................................................................................................................... 47 Patient Guideline Sources............................................................................................................ 47 Finding Associations.................................................................................................................... 49 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 51 Overview...................................................................................................................................... 51 Preparation................................................................................................................................... 51 Finding a Local Medical Library.................................................................................................. 51 Medical Libraries in the U.S. and Canada ................................................................................... 51 ONLINE GLOSSARIES.................................................................................................................. 57 Online Dictionary Directories ..................................................................................................... 57 ACETYL-L-CARNITINE DICTIONARY..................................................................................... 59 INDEX ................................................................................................................................................ 89

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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 acetyl-L-carnitine 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 acetyl-L-carnitine, 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 acetyl-L-carnitine, 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 acetyl-L-carnitine. 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 acetyl-L-carnitine, 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 acetyl-L-carnitine. 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 ACETYL-L-CARNITINE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on acetyl-L-carnitine.

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

Acetyl L-Carnitine Slows Decline in Younger Patients With Alzheimer's Disease: a Reanalysis of a Double-Blind, Placebo-Controlled Study Using the Source: International Psychogeriatrics. 10(2): 193-203. June 1998. Summary: This article assesses the longitudinal effects of acetyl-L-carnitine (ALC) on patients diagnosed with Alzheimer's disease (AD). Researchers studied 334 diagnosed subjects from 24 sites across the United States by administering the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS) every 3 months for 1 year. Data showed that both the ALC group and the placebo group exhibited the same mean rate of change on the ADAS. Analysis revealed a statistically significant Age x Drug interaction characterized by younger subjects benefiting more from ALC treatment than older subjects. Further analyses suggested that the optimal, though not statistically significant,

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cutoff point for ALC benefits was age 61. The authors concluded that ALC slows the progression of AD in younger subjects, and the use of a trilinear approach to estimate the average rate of change may prove valuable in pharmacological trials. 3 figures, 3 tables, 20 references. •

New Treatments for Diabetic Neuropathy Source: Current Opinion in Endocrinology and Diabetes. 3(4): 330-334. August 1996. Contact: Available from Rapid Science Publishers. 400 Market Street, Suite 700, Philadelphia, PA 19106. (215) 574-2266. Fax (215) 574-2292. Summary: This article reviews new treatments for diabetic neuropathy. The author focuses on chronic peripheral diabetic sensorimotor neuropathy, with some mention of therapies for certain of the autonomic neuropathies and for the end stage of peripheral neuropathology, i.e., nonischemic foot ulceration. The author notes that the benefits of near-normoglycemia on nerve function were confirmed recently by the Diabetes Control and Complications Trial (DCCT). With respect to treatment of symptomatic neuropathy, parenteral administration of the antioxidant alpha-lipoic acid has been shown to relieve neuropathic pain, whereas topical application of clonidine or capsaicin may benefit some patients. Use of the aldose reductase inhibitor tolrestat was shown to reduce the development of autonomic and somatic nerve abnormalities, without any major safety concerns. Further confirmation of the efficacy of gamma-linolenic acid and possible of free-radical scavengers has also been provided. Recent clinical trials of acetyl-Lcarnitine have been less encouraging. Topical glycopyrrolate has been confirmed as the first specific therapy for gustatory sweating, and topically applied growth factors appear to speed healing of neuropathic foot ulcers. 38 references (9 annotated). (AA-M).

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Alzheimer's Medicines: Sixteen Medicines in Testing Source: American Journal of Alzheimer's Care and Related Disorders and Research. 5(1): 4-6. January-February 1990. Contact: Available from Prime National Publishing Corp. 470 Boston Post Road, Weston, MA 02193. (617) 899-2702. PRICE: Single issue $8.00. Call for information. Summary: This journal article lists 16 Alzheimer's disease medicines being developed by 11 pharmaceutical companies. The medications are intended to treat symptoms of the disease. Medicines under investigation include: cholinesterase inhibitors, including THA (Cognex or tacrine) and velnacrine maleate; milacemide, suronacrine maleate, and acetyl-L-carnitine (Alcar), which improve the effectiveness of other neurotransmitters and receptors; Avan or Idebenone, a cerebral metabolic enhancer; nimodipine (Nimotop), a calcium channel blocker; captopril (Capoten), an angiotensin-converting enzyme inhibitor; and BMY 21502, SQ29852, DuP 996, HOE 427, Sabeluzole, Guanfacine, Zacopride, and Oxiracetam, all of which are listed but not described in this article. The stages involved in seeing a new drug through Food and Drug Administration approval are discussed as well.

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Complementary and Alternative Medicines for Alzheimer's Disease Source: Journal of Geriatric Psychology and Neurology. 11: 163-173. 1998. Summary: This journal article reviews some of the more common complementary and alternative medicine (CAM) therapies for dementia that a physician may encounter. It is organized into the following sections: dietary factors, including alcohol intake; vitamins, including thiamine (vitamin B1), cobalamin (vitamin B12), ascorbic acid (vitamin C),

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beta-carotene, and alpha-tocopherol (vitamin E); other metabolic agents, including acetyl-L-carnitine, choline and lecithin, dimethylaminoethanol, phosphatidylserine, and coenzyme Q10; herbs, including ginkgo biloba, and ginseng; and hormones, including pregnenolone, dehydroepiandrosterone, and melatonin. The authors caution that these CAM therapies are considered unproven treatments, and there are insufficient data about safety and efficacy upon which to make specific recommendations. 2 tables, 117 references. •

Treatment of Alzheimer's Disease Source: New England Journal of Medicine. 341(22): 1670-1679. November 25, 1999. Summary: This journal article reviews the literature on drugs approved by the Food and Drug Administration specifically for Alzheimer's disease (AD), drugs approved for other conditions but used in AD, and drugs under consideration for approval. The first section discusses the cholinesterase inhibitors physostigmine, tacrine (Cognex), donepezil, metrifonate, revastigmine, and eptastigmine, which are aimed at symptomatic treatment. The second section reviews drugs aimed at slowing the progression of AD; these include alpha-tocopherol (vitamin E) and selegiline, idebenone, propentofylline, ginkgo biloba, and acetyl-L-carnitine. The third section focuses on drugs used to treat behavioral manifestations of AD such as depression, delusions and psychosis, sleep disturbance, and wandering. 5 tables, 111 references.

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One-Year Multicenter Placebo-Controlled Study of Acetyl-Carnitine in Patients With Alzheimer's Disease Source: Neurology. 47(3): 705-711. September 1996. Summary: This study compares the efficacy and safety of acetyl-L-carnitine hydrochloride (ALCAR) to placebo in patients with probable Alzheimer's disease (AD). Researchers treated 431 subjects, 50 years or older and diagnosed with mild to moderate AD, with ALCAR or placebo for 12 months. Both groups of patients declined at the same rate on primary and secondary measures of the Clinical Dementia Rating Scale and the cognitive component of the Alzheimer's Disease Assessment Scale. The data showed that early-onset patients (65 or younger at study entry) on ALCAR declined more slowly than early-onset patients on placebo; early-onset patients tended to decline more rapidly than late onset patients (66 or older at study entry) in the placebo group; late-onset patients on ALCAR tended to progress more rapidly than similarly treated early-onset patients; and ALCAR was well tolerated. The authors' post hoc analysis suggests that AD patients age 65 or younger may benefit from ALCAR treatment, but older patients may not. 4 tables, 51 references.

Federally Funded Research on Acetyl-L-Carnitine The U.S. Government supports a variety of research studies relating to acetyl-L-carnitine. 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

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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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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 acetyl-L-carnitine. 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 acetyl-L-carnitine. The following is typical of the type of information found when searching the CRISP database for acetyl-L-carnitine: •

Project Title: MODELING PHARMACOLOGICAL TREATMENTS IN THE TS65DN MOUSE Principal Investigator & Institution: Moran, Timothy H.; Paul R. Mchugh Professor & Vice Chair; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002 Summary: The development of mouse models of Down Syndrome, with appropriate gene expression to mimic what takes place with a trisomy of human chromosome 21, provides test systems for potential therapeutic interventions aimed at improving cognitive performance. As detailed under Dr. Davisson's Project, the Ts65Dn mouse containing homologs to the majority of the genes on human chromosome 21. This segmental trisomy model has a number of distinct advantages over previous models, not the least of which is survival to adulthood. We and others have demonstrative a cognitive phenotype in the Ts65Dn mouse which has clear similarities to that seen in Down Syndrome. Ts65Dn mice demonstrate performance deficits in tests of learning and memory against a background of relatively intact motor and sensory abilities. Both acetylcholine and glutamate play important roles in learning and memory and are involved in neural organization during development. Alterations of cholinergic and glutamatergic activity in DS have been identified. The proposed experiments will 1) provide a more complete characterization of the development of cholinergic and glutamatergic systems in Ts65Dn mice. This characterization will provide a necessary background for proposed experiments aimed at, 2) assessing whether strategies aimed at blocking cholinergic degradation with the acetyl cholinesterase at, 2) assessing whether strategies aimed at blocking cholinergic degradation with the acetyl cholinesterase inhibitor donepezil or producing a development increase in cholinergic function with prenatal choline can improve performance in the Ts65Dn mouse, 3) assessing whether developmental treatment with piracetan alone, or piracetam combined with prenatal choline administration, improves performance in the Ts65Dn, and 4) assessing wheth4r developmental treatment with the neuroprotective agent acetyl-L-carnitine prevents cholinergic degeneration and results in improved cognitive performance in the Ts65Dn mouse. In these studies, we will assess performance in the Morris water maze and a cued and contextual conditioning paradigm. We will also monitor activity over the 24 hour cycle and in elevated plus maze paradigm. Behavioral assessments will be followed up by appropriate neurobiological analyses to determine whether the neurochemical systems impacted by these treatments respond similar in Ts65Dn and control mice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Feeding acetyl-L-carnitine and lipoic acid to old rats significantly improves metabolic function while decreasing oxidative stress. by Hagen TM, Liu J, Lykkesfeldt J, Wehr CM, Ingersoll RT, Vinarsky V, Bartholomew JC, Ames BN.; 2002 Feb 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=122286

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Memory loss in old rats is associated with brain mitochondrial decay and RNA /DNA oxidation: Partial reversal by feeding acetyl-L-carnitine and /or R-[alpha]-lipoic acid. by Liu J, Head E, Gharib AM, Yuan W, Ingersoll RT, Hagen TM, Cotman CW, Ames BN.; 2002 Feb 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=122369

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

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

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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31P-MRS study of acetyl-L-carnitine treatment in geriatric depression: preliminary results. Author(s): Pettegrew JW, Levine J, Gershon S, Stanley JA, Servan-Schreiber D, Panchalingam K, McClure RJ. Source: Bipolar Disorders. 2002 February; 4(1): 61-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12047496

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A 1-year controlled trial of acetyl-L-carnitine in early-onset AD. Author(s): Barrett AM. Source: Neurology. 2001 February 13; 56(3): 425. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11171924

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A 1-year controlled trial of acetyl-L-carnitine in early-onset AD. Author(s): Thal LJ, Calvani M, Amato A, Carta A. Source: Neurology. 2000 September 26; 55(6): 805-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10994000

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A 1-year multicenter placebo-controlled study of acetyl-L-carnitine in patients with Alzheimer's disease. Author(s): Thal LJ, Carta A, Clarke WR, Ferris SH, Friedland RP, Petersen RC, Pettegrew JW, Pfeiffer E, Raskind MA, Sano M, Tuszynski MH, Woolson RF. Source: Neurology. 1996 September; 47(3): 705-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8797468

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Acetyl-L-carnitine (levacecarnine) in the treatment of diabetic neuropathy. A longterm, randomised, double-blind, placebo-controlled study. Author(s): De Grandis D, Minardi C. Source: Drugs in R&D. 2002; 3(4): 223-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12455197

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Acetyl-L-carnitine acutely administered raises beta-endorphin and cortisol plasma levels in humans. Author(s): Martignoni E, Facchinetti F, Sances G, Petraglia F, Nappi G, Genazzani AR. Source: Clinical Neuropharmacology. 1988 October; 11(5): 472-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2975529

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Acetyl-L-carnitine administration increases insulin-like growth factor 1 levels in asymptomatic HIV-1-infected subjects: correlation with its suppressive effect on lymphocyte apoptosis and ceramide generation. Author(s): Di Marzio L, Moretti S, D'Alo S, Zazzeroni F, Marcellini S, Smacchia C, Alesse E, Cifone MG, De Simone C. Source: Clinical Immunology (Orlando, Fla.). 1999 July; 92(1): 103-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10413658

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Acetyl-L-carnitine and Alzheimer's disease: pharmacological considerations beyond the cholinergic sphere. Author(s): Carta A, Calvani M, Bravi D, Bhuachalla SN. Source: Annals of the New York Academy of Sciences. 1993 September 24; 695: 324-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8239306

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Acetyl-L-Carnitine as possible drug in the treatment of hypothalamic amenorrhea. Author(s): Genazzani AD, Petraglia F, Algeri I, Gastaldi M, Calvani M, Botticelli G, Genazzani AR. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1991; 70(6): 487-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1763615

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Acetyl-L-carnitine for dementia. Author(s): Hudson S, Tabet N. Source: Cochrane Database Syst Rev. 2003; (2): Cd003158. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804452

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Acetyl-L-carnitine for symptomatic diabetic neuropathy. Author(s): Quatraro A, Roca P, Donzella C, Acampora R, Marfella R, Giugliano D. Source: Diabetologia. 1995 January; 38(1): 123. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7744218

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Acetyl-L-carnitine in Alzheimer disease: a short-term study on CSF neurotransmitters and neuropeptides. Author(s): Bruno G, Scaccianoce S, Bonamini M, Patacchioli FR, Cesarino F, Grassini P, Sorrentino E, Angelucci L, Lenzi GL. Source: Alzheimer Disease and Associated Disorders. 1995 Fall; 9(3): 128-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8534410

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Acetyl-L-carnitine in the treatment of mildly demented elderly patients. Author(s): Passeri M, Cucinotta D, Bonati PA, Iannuccelli M, Parnetti L, Senin U. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 75-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2201659

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Acetyl-L-carnitine infusion increases glucose disposal in type 2 diabetic patients. Author(s): Giancaterini A, De Gaetano A, Mingrone G, Gniuli D, Liverani E, Capristo E, Greco AV. Source: Metabolism: Clinical and Experimental. 2000 June; 49(6): 704-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10877193

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Acetyl-L-carnitine physical-chemical, metabolic, and therapeutic properties: relevance for its mode of action in Alzheimer's disease and geriatric depression. Author(s): Pettegrew JW, Levine J, McClure RJ. Source: Molecular Psychiatry. 2000 November; 5(6): 616-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11126392

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Acetyl-L-carnitine protects against amyloid-beta neurotoxicity: roles of oxidative buffering and ATP levels. Author(s): Dhitavat S, Ortiz D, Shea TB, Rivera ER. Source: Neurochemical Research. 2002 June; 27(6): 501-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12199155

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Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. Author(s): Biagiotti G, Cavallini G. Source: Bju International. 2001 July; 88(1): 63-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11446848

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Acetyl-L-carnitine: a drug able to slow the progress of Alzheimer's disease? Author(s): Carta A, Calvani M. Source: Annals of the New York Academy of Sciences. 1991; 640: 228-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1776743

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Action of acetyl-L-carnitine in neurodegeneration and Alzheimer's disease. Author(s): Calvani M, Carta A, Caruso G, Benedetti N, Iannuccelli M. Source: Annals of the New York Academy of Sciences. 1992 November 21; 663: 483-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1482095

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Acute effects of acetyl-L-carnitine on regional cerebral blood flow in patients with brain ischaemia. Author(s): Rosadini G, Marenco S, Nobili F, Novellone G, Rodriguez G. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 123-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2117587

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Circadian stage-dependence of acetyl-L-carnitine effects on blood pressure and heart rate of clinically healthy subjects. Author(s): Portela A, Cornelissen G, Blank M, Kumagai Y, Bingham C, Bartolomucci G, Halberg F. Source: Chronobiologia. 1993 January-June; 20(1-2): 63-76. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8354102

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Clinical and neurochemical effects of acetyl-L-carnitine in Alzheimer's disease. Author(s): Pettegrew JW, Klunk WE, Panchalingam K, Kanfer JN, McClure RJ. Source: Neurobiology of Aging. 1995 January-February; 16(1): 1-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7723928

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Clinical pharmacodynamics of acetyl-L-carnitine in patients with Parkinson's disease. Author(s): Puca FM, Genco S, Specchio LM, Brancasi B, D'Ursi R, Prudenzano A, Miccoli A, Scarcia R, Martino R, Savarese M. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 139-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2387661

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Determination of L-carnitine, acetyl-L-carnitine and propionyl-L-carnitine in human plasma by high-performance liquid chromatography after pre-column derivatization with 1-aminoanthracene. Author(s): Longo A, Bruno G, Curti S, Mancinelli A, Miotto G. Source: Journal of Chromatography. B, Biomedical Applications. 1996 November 15; 686(2): 129-39. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8971593

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Double-blind, placebo controlled study of acetyl-L-carnitine in patients with Alzheimer's dementia. Author(s): Rai G, Wright G, Scott L, Beston B, Rest J, Exton-Smith AN. Source: Current Medical Research and Opinion. 1990; 11(10): 638-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2178869

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Effect of acetyl-L-carnitine in the treatment of painful peripheral neuropathies in HIV+ patients. Author(s): Scarpini E, Sacilotto G, Baron P, Cusini M, Scarlato G. Source: Journal of the Peripheral Nervous System : Jpns. 1997; 2(3): 250-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10975731

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Effect of acetyl-L-carnitine on geriatric patients suffering from dysthymic disorders. Author(s): Bella R, Biondi R, Raffaele R, Pennisi G. Source: Int J Clin Pharmacol Res. 1990; 10(6): 355-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2099360

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Effect of L-carnitine and acetyl-L-carnitine on the human erythrocyte membrane stability and deformability. Author(s): Arduini A, Rossi M, Mancinelli G, Belfiglio M, Scurti R, Radatti G, Shohet SB. Source: Life Sciences. 1990; 47(26): 2395-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2263166

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Effects of acetyl-L-carnitine and myo-inositol on high-energy phosphate and membrane phospholipid metabolism in zebra fish: a 31P-NMR-spectroscopy study. Author(s): Levine J, Panchalingam K, McClure RJ, Gershon S, Pettegrew JW. Source: Neurochemical Research. 2003 May; 28(5): 687-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12716017

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Effects of acetyl-L-carnitine in Alzheimer's disease patients unresponsive to acetylcholinesterase inhibitors. Author(s): Bianchetti A, Rozzini R, Trabucchi M. Source: Current Medical Research and Opinion. 2003; 19(4): 350-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12841930

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Effects of acetyl-L-carnitine on reaction times in patients with cerebrovascular insufficiency. Author(s): Arrigo A, Casale R, Buonocore M, Ciano C. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 133-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2387660

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Effects of acetyl-L-carnitine oral administration on lymphocyte antibacterial activity and TNF-alpha levels in patients with active pulmonary tuberculosis. A randomized double blind versus placebo study. Author(s): Jirillo E, Altamura M, Munno I, Pellegrino NM, Sabato R, Di Fabio S, De Simone C. Source: Immunopharmacology and Immunotoxicology. 1991; 13(1-2): 135-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1770216

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Effects of nerve growth factor and acetyl-L-carnitine arginyl amide on the human neuronal line HCN-1A. Author(s): Westlund KN, Lu Y, Werrbach-Perez K, Hulsebosch CE, Morgan B, Pizzo DP, Eisenberg HM, Perez-Polo JR. Source: International Journal of Developmental Neuroscience : the Official Journal of the International Society for Developmental Neuroscience. 1992 October; 10(5): 361-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1283485

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Idiopathic facial paralysis: new therapeutic prospects with acetyl-L-carnitine. Author(s): Mezzina C, De Grandis D, Calvani M, Marchionni A, Pomes A. Source: Int J Clin Pharmacol Res. 1992; 12(5-6): 299-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1301409

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Influence of acetyl-L-carnitine infusion on haemodynamic parameters and survival of circulatory-shock patients. Author(s): Gasparetto A, Corbucci GG, De Blasi RA, Antonelli M, Bagiella E, D'Iddio S, Trevisani C. Source: Int J Clin Pharmacol Res. 1991; 11(2): 83-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1879992

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Intravenous L-carnitine and acetyl-L-carnitine in medium-chain acyl-coenzyme A dehydrogenase deficiency and isovaleric acidemia. Author(s): Van Hove JL, Kahler SG, Millington DS, Roe DS, Chace DH, Heales SJ, Roe CR. Source: Pediatric Research. 1994 January; 35(1): 96-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8134205

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L-carnitine and acetyl-L-carnitine in human nerves from normal and diabetic subjects. Author(s): Scarpini E, Doneda P, Pizzul S, Chiodi P, Ramacci MT, Baron P, Conti G, Sacilotto G, Arduini A, Scarlato G. Source: Journal of the Peripheral Nervous System : Jpns. 1996; 1(2): 157-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10975724

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L-carnitine and acetyl-L-carnitine status during hemodialysis with acetate in humans: a kinetic analysis. Author(s): Jackson JM, Lee HA. Source: The American Journal of Clinical Nutrition. 1996 December; 64(6): 922-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8942418

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Long-term acetyl-L-carnitine treatment in Alzheimer's disease. Author(s): Spagnoli A, Lucca U, Menasce G, Bandera L, Cizza G, Forloni G, Tettamanti M, Frattura L, Tiraboschi P, Comelli M, et al. Source: Neurology. 1991 November; 41(11): 1726-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1944900

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Long-term effect of acetyl-L-carnitine on myocardial 123I-MIBG uptake in patients with diabetes. Author(s): Turpeinen AK, Kuikka JT, Vanninen E, Yang J, Uusitupa MI. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 2000 February; 10(1): 13-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10750638

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Mental impairment in aging: selection of patients, methods of evaluation and therapeutic possibilities of acetyl-L-carnitine. Author(s): Passeri M, Iannuccelli M, Ciotti G, Bonati PA, Nolfe G, Cucinotta D. Source: Int J Clin Pharmacol Res. 1988; 8(5): 367-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3229874

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Meta-analysis of double blind randomized controlled clinical trials of acetyl-Lcarnitine versus placebo in the treatment of mild cognitive impairment and mild Alzheimer's disease. Author(s): Montgomery SA, Thal LJ, Amrein R. Source: International Clinical Psychopharmacology. 2003 March; 18(2): 61-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12598816

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Metabolism and disposition of intravenously administered acetyl-L-carnitine in healthy volunteers. Author(s): Marzo A, Arrigoni Martelli E, Urso R, Rocchetti M, Rizza V, Kelly JG. Source: European Journal of Clinical Pharmacology. 1989; 37(1): 59-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2591464

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Modulation of methylation in the FMR1 promoter region after long term treatment with L-carnitine and acetyl-L-carnitine. Author(s): Pascale E, Battiloro E, Cimino Reale G, Pietrobono R, Pomponi MG, Chiurazzi P, Nicolai R, Calvani M, Neri G, D'Ambrosio E. Source: Journal of Medical Genetics. 2003 June; 40(6): E76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12807975

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Neuroprotective activity of acetyl-L-carnitine: studies in vitro. Author(s): Forloni G, Angeretti N, Smiroldo S. Source: Journal of Neuroscience Research. 1994 January; 37(1): 92-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7908343

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Neuropsychological changes in demented patients treated with acetyl-L-carnitine. Author(s): Sinforiani E, Iannuccelli M, Mauri M, Costa A, Merlo P, Bono G, Nappi G. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 69-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2387665

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Pharmaco-electroencephalographic and clinical effects of the cholinergic substance-acetyl-L-carnitine--in patients with organic brain syndrome. Author(s): Herrmann WM, Dietrich B, Hiersemenzel R. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 81-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2201660

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Pharmacokinetics of IV and oral acetyl-L-carnitine in a multiple dose regimen in patients with senile dementia of Alzheimer type. Author(s): Parnetti L, Gaiti A, Mecocci P, Cadini D, Senin U. Source: European Journal of Clinical Pharmacology. 1992; 42(1): 89-93. Erratum In: Eur J Clin Pharmacol 1993; 44(6): 604. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1541322

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Pharmacokinetics of oral acetyl-L-carnitine in renal impairment. Author(s): Kelly JG, Hunt S, Doyle GD, Laher MS, Carmody M, Marzo A, Arrigoni Martelli E. Source: European Journal of Clinical Pharmacology. 1990; 38(3): 309-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2340852

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Role of acetyl-L-carnitine in the treatment of cognitive deficit in chronic alcoholism. Author(s): Tempesta E, Troncon R, Janiri L, Colusso L, Riscica P, Saraceni G, Gesmundo E, Calvani M, Benedetti N, Pola P. Source: Int J Clin Pharmacol Res. 1990; 10(1-2): 101-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2201652

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Role of free L-carnitine and acetyl-L-carnitine in post-gonadal maturation of mammalian spermatozoa. Author(s): Jeulin C, Lewin LM. Source: Human Reproduction Update. 1996 March-April; 2(2): 87-102. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9079406

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Semen treatment with progesterone and/or acetyl-L-carnitine does not improve sperm motility or membrane damage after cryopreservation-thawing. Author(s): Duru NK, Morshedi M, Schuffner A, Oehninger S. Source: Fertility and Sterility. 2000 October; 74(4): 715-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11020512

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Spatial-frequency-dependent changes in the human pattern electroretinogram after acute acetyl-L-carnitine administration. Author(s): Falsini B, Porciatti V, Bolzani R, Marchionni A. Source: Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie. 1991; 229(3): 262-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1869064

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The association of acetyl-L-carnitine with glucose and lipid metabolism in human muscle in vivo: the effect of hyperinsulinemia. Author(s): Ebeling P, Tuominen JA, Arenas J, Garcia Benayas C, Koivisto VA. Source: Metabolism: Clinical and Experimental. 1997 December; 46(12): 1454-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9439542

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The effect of L-carnitine and acetyl-L-carnitine on the disappearance of DNA singlestrand breaks in human peripheral blood lymphocytes. Author(s): Boerrigter ME, Franceschi C, Arrigoni-Martelli E, Wei JY, Vijg J. Source: Carcinogenesis. 1993 October; 14(10): 2131-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8222066

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Treatment with acetyl-L-carnitine has the potential to improve the clinical course of painful peripheral neuropathies in HIV-positives patients. Author(s): Famularo G, De Simone C. Source: Journal of the Peripheral Nervous System : Jpns. 1998; 3(3): 227-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10959254

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CHAPTER 2. NUTRITION AND ACETYL-L-CARNITINE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and acetyl-L-carnitine.

Finding Nutrition Studies on Acetyl-L-Carnitine 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 “acetyl-L-carnitine” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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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 “acetyl-L-carnitine” (or a synonym): •

Attenuation by acetyl-L-carnitine of neurological damage and biochemical derangement following brain ischemia and reperfusion. Author(s): Sigma-Tau S.p.A, Pomezia, Rome, Italy. Source: Calvani, M Arrigoni Martelli, E Int-J-Tissue-React. 1999; 21(1): 1-6 0250-0868

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Carnitine and acetyl-L-carnitine content of human hippocampus and erythrocytes in Alzheimer's disease. Author(s): Argyll and Bute Hospital, Lochgilphead, Argyll PA31 8LD (United Kingdom) Source: Corrigan, F.M. Rhijn, A.G. van Best, P.V. Besson, J.A.O. Cooper, M.B. Journal-ofNutritional-Medicine (United Kingdom). (1995). volume 5(1) page 35-39. mankind human diseases aging erythrocytes brain carnitine nutritional status

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Dietary acetyl-L-carnitine improves spatial behaviour of old rats. Author(s): Department of Psychology, Johns Hopkins University, Baltimore, Maryland. Source: Markowska, A L Olton, D S Int-J-Clin-Pharmacol-Res. 1990; 10(1-2): 65-8 02511649

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Disposition of L-carnitine and acetyl-L-carnitine in the isolated perfused rat kidney. Author(s): Sigma Tau SpA, Pomezia, Rome, Italy. Source: Mancinelli, A Longo, A Shanahan, K Evans, A M J-Pharmacol-Exp-Ther. 1995 September; 274(3): 1122-8 0022-3565

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Dissection of metabolic, vascular, and nerve conduction interrelationships in experimental diabetic neuropathy by cyclooxygenase inhibition and acetyl-Lcarnitine administration. Author(s): Division of Endocrinology and Metabolism, Department of Internal Medicine, Michigan Diabetes Research and Training Center, University of Michigan, Ann Arbor Veterans Administration Hospitals, 48109-0678, USA. Source: Pop Busui, Rodica Marinescu, Victor Van Huysen, Carol Li, Fei Sullivan, Kelli Greene, Douglas A Larkin, Dennis Stevens, Martin J Diabetes. 2002 August; 51(8): 261928 0012-1797

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Effect of acute acetyl-L-carnitine treatment on daytime melatonin synthesis in the rat. Author(s): Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, USA. Source: Olatunji Bello, I I Reiter, R J Afr-J-Med-Med-Sci. 1997 Sep-December; 26(3-4): 175-7 0309-3913

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Effect of aging and acetyl-L-carnitine on the activity of cytochrome oxidase and adenine nucleotide translocase in rat heart mitochondria. Author(s): Department of Biochemistry and Molecular Biology, University of Bari, Italy. Source: Paradies, G Ruggiero, F M Petrosillo, G Gadaleta, M N Quagliariello, E FEBSLett. 1994 August 22; 350(2-3): 213-5 0014-5793

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Effect of long-term feeding with acetyl-L-carnitine on the age-related changes in rat brain lipid composition: a study by 31P NMR spectroscopy. Author(s): Department of Biochemistry, Sigma-Tau Labs, Pomezia, Italy. Source: Aureli, T Di Cocco, M E Capuani, G Ricciolini, R Manetti, C Miccheli, A Conti, F Neurochem-Res. 2000 March; 25(3): 395-9 0364-3190

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Effects of chronic acetyl-L-carnitine treatment on brain lipid hydroperoxide level and passive avoidance learning in senescence-accelerated mice. Author(s): Department of Applied Chemistry and Biotechnology, Faculty of Engineering, Yamanashi University, Yamanashi 400-8511, Japan.

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Source: Yasui, F Matsugo, S Ishibashi, M Kajita, T Ezashi, Y Oomura, Y Kojo, S Sasaki, K Neurosci-Lett. 2002 December 16; 334(3): 177-80 0304-3940 •

Effects of long-term acetyl-L-carnitine administration in rats: I. increased dopamine output in mesocorticolimbic areas and protection toward acute stress exposure. Author(s): Department of Neuroscience, Pharmacology Unit, University of Siena, Siena, Italy. Source: Tolu, P Masi, F Leggio, B Scheggi, S Tagliamonte, A De Montis, M G Gambarana, C Neuropsychopharmacology. 2002 September; 27(3): 410-20 0893-133X

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Enantiomeric purity determination of acetyl-L-carnitine by reversed-phase highperformance liquid chromatography using chiral derivatization. Author(s): Analytical Research Laboratory, Tanabe Seiyaku Co. Ltd., Osaka, Japan. [email protected] Source: Kagawa, M Machida, Y Nishi, H J-Chromatogr-A. 1999 October 1; 857(1-2): 12735

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Feeding acetyl-L-carnitine and lipoic acid to old rats significantly improves metabolic function while decreasing oxidative stress. Author(s): Department of Biochemistry and Biophysics, Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, USA. Source: Hagen, Tory M Liu, Jiankang Lykkesfeldt, Jens Wehr, Carol M Ingersoll, Russell T Vinarsky, Vladimir Bartholomew, James C Ames, Bruce N Proc-Natl-Acad-Sci-U-S-A. 2002 February 19; 99(4): 1870-5 0027-8424

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Functional relevance of carnitine transporter OCTN2 to brain distribution of Lcarnitine and acetyl-L-carnitine across the blood-brain barrier. Author(s): Faculty of Pharmaceutical Sciences, Kanazawa University, Kanazawa, Japan. Source: Kido, Y Tamai, I Ohnari, A Sai, Y Kagami, T Nezu, J Nikaido, H Hashimoto, N Asano, M Tsuji, A J-Neurochem. 2001 December; 79(5): 959-69 0022-3042

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Memory loss in old rats is associated with brain mitochondrial decay and RNA/DNA oxidation: partial reversal by feeding acetyl-L-carnitine and/or R-alpha -lipoic acid. Author(s): Division of Biochemistry and Molecular Biology, University of California, Berkeley, CA 94720, USA. Source: Liu, Jiankang Head, Elizabeth Gharib, Afshin M Yuan, WenJune Ingersoll, Russell T Hagen, Tory M Cotman, Carl W Ames, Bruce N Proc-Natl-Acad-Sci-U-S-A. 2002 February 19; 99(4): 2356-61 0027-8424

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Mitochondrial decay in aging. Reversal through supplementation of acetyl-Lcarnitine and N-tert-butyl-alpha-phenyl-nitrone. Author(s): Department of Molecular and Cell Biology, University of California at Berkeley 94720, USA. [email protected] Source: Hagen, T M Wehr, C M Ames, B N Ann-N-Y-Acad-Sci. 1998 November 20; 854214-23 0077-8923

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Modifications of the cerebral electric activity induced by the intracerebroventricular injection of acetyl-L-carnitine in cats. Author(s): Institute of Human Physiology II, University of Milan, Italy. Source: Mancia, M Imeri, L Giglio, R Int-J-Clin-Pharmacol-Res. 1990; 10(1-2): 115-21 0251-1649

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Pharmacological enhancement of peripheral nerve regeneration in the rat by systemic acetyl-L-carnitine treatment. Author(s): Blond-McIndoe Centre, Royal Free and University College Medical School, University Department of Surgery, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Source: McKay Hart, A Wiberg, M Terenghi, G Neurosci-Lett. 2002 December 16; 334(3): 181-5 0304-3940

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Protective actions of L-carnitine and acetyl-L-carnitine on the neurotoxicity evoked by mitochondrial uncoupling or inhibitors. Author(s): Sigma-Tau, Pomezia, Rome. Source: Virmani, M A Biselli, R Spadoni, A Rossi, S Corsico, N Calvani, M Fattorossi, A De Simone, C Arrigoni Martelli, E Pharmacol-Res. 1995 December; 32(6): 383-9 1043-6618

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Restoration of hepatic cytochrome c oxidase activity and expression with acetyl-Lcarnitine treatment in spf mice with an ornithine transcarbamylase deficiency. Author(s): Division of Medical Genetics, Sainte-Justine Hospital and University of Montreal, Quebec, Canada. Source: Mawal, Y R Rama Rao, K V Qureshi, I A Biochem-Pharmacol. 1998 June 1; 55(11): 1853-60 0006-2952

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Role of acetyl-L-carnitine in rat brain lipogenesis: implications for polyunsaturated fatty acid biosynthesis. Author(s): Department of Biochemistry, Sigma Tau Pharmaceutical Industries, Pomezia, Italy. Source: Ricciolini, R Scalibastri, M Kelleher, J K Carminati, P Calvani, M Arduini, A JNeurochem. 1998 December; 71(6): 2510-7 0022-3042

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Systemic acetyl-L-carnitine eliminates sensory neuronal loss after peripheral axotomy: a new clinical approach in the management of peripheral nerve trauma. Author(s): University Department of Surgery, Blond-McIndoe Centre, Royal Free & University College Medical School, London, UK. Source: Hart, A M Wiberg, M Youle, M Terenghi, G Exp-Brain-Res. 2002 July; 145(2): 182-9 0014-4819

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The effect of aging and acetyl-L-carnitine on the pyruvate transport and oxidation in rat heart mitochondria. Author(s): Department of Biochemistry and Molecular Biology, University of Bari, Italy. [email protected] Source: Paradies, G Petrosillo, G Gadaleta, M N Ruggiero, F M FEBS-Lett. 1999 July 9; 454(3): 207-9 0014-5793

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The effects of acetyl-L-carnitine on experimental models of learning and memory deficits in the old rat. Author(s): Institute of Pharmacology, University of Catania Medical School, Italy. Source: Valerio, C Clementi, G Spadaro, F D'Agata, V Raffaele, R Grassi, M Lauria, N Drago, F Funct-Neurol. 1989 Oct-December; 4(4): 387-90 0393-5264

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Trophic action of acetyl-L-carnitine in neuronal cultures. Author(s): Institute of Neurology, School of Medicine, University of Catania, Italy. Source: Rampello, L Giammona, G Aleppo, G Favit, A Fiore, L Acta-Neurol-(Napoli). 1992 February; 14(1): 15-21 0001-6276

Nutrition

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Acetyl-L-Carnitine

The following is a specific Web list relating to acetyl-L-carnitine; 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: •

Minerals Acetyl-L-Carnitine Source: Healthnotes, Inc.; www.healthnotes.com Carnitine Source: Prima Communications, Inc.www.personalhealthzone.com Carnitine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10012,00.html

23

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

“Brain-specific” nutrients: a memory cure? Author(s): McDaniel MA, Maier SF, Einstein GO. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2003 November-December; 19(11-12): 957-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14624946

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A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Author(s): Kidd PM. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 1999 June; 4(3): 144-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10383479

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Acetyl-L-carnitine supplementation differently influences nutrient partitioning, serum leptin concentration and skeletal muscle mitochondrial respiration in young and old rats. Author(s): Iossa S, Mollica MP, Lionetti L, Crescenzo R, Botta M, Barletta A, Liverini G. Source: The Journal of Nutrition. 2002 April; 132(4): 636-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11925454

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Acetyl-L-carnitine supplementation restores decreased tissue carnitine levels and impaired lipid metabolism in aged rats. Author(s): Tanaka Y, Sasaki R, Fukui F, Waki H, Kawabata T, Okazaki M, Hasegawa K, Ando S. Source: Journal of Lipid Research. 2004 April; 45(4): 729-35. Epub 2004 January 01. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14703509

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Acylcarnitine profile in tissues and body fluids of biotin-deficient rats with and without L-carnitine supplementation. Author(s): Shigematsu Y, Bykov IL, Liu YY, Nakai A, Kikawa Y, Sudo M, Fujioka M. Source: Journal of Inherited Metabolic Disease. 1994; 17(6): 678-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7707691

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Alterations of urinary acetylcarnitine in valproate-treated rats: the effect of Lcarnitine supplementation. Author(s): Murakami K, Sugimoto T, Nishida N, Woo M, Araki A, Kobayashi Y. Source: Journal of Child Neurology. 1992 October; 7(4): 404-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1469250

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Bioenergetic approaches for neuroprotection in Parkinson's disease. Author(s): Beal MF. Source: Annals of Neurology. 2003; 53 Suppl 3: S39-47; Discussion S47-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12666097

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Effect of acetyl-L-carnitine on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) neurotoxicity. Author(s): Harik SI, Hritz MA. Source: Biochemical Pharmacology. 1993 May 25; 45(10): 2170-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8512600

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Effect of acetyl-L-carnitine on VIP-ergic neurons in the jejunum submucous plexus of diabetic rats. Author(s): Defani MA, Zanoni JN, Natali MR, Bazotte RB, de Miranda-Neto MH.

Alternative Medicine 25

Source: Arquivos De Neuro-Psiquiatria. 2003 December; 61(4): 962-7. Epub 2004 January 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14762599 •

Interference of heparin in plasma levocarnitine determination with radioenzyme assay. Author(s): Marzo A, Cardace G, Corbelletta C, Verga P, Vinciguerra C. Source: Arzneimittel-Forschung. 1995 December; 45(12): 1303-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8595089

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L-carnitine supplementation in breeding pigeons: impact on zootechnical performance and carnitine metabolism. Author(s): Janssens GP, Hesta M, Debal V, Debraekeleer J, De Wilde RO. Source: Reproduction, Nutrition, Development. 2000 November-December; 40(6): 53548. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11286283

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L-carnitine supplementation of a soybean-based formula in early infancy: plasma and urine levels of carnitine and acylcarnitines. Author(s): Novak M, Monkus EF, Buch M, Silverio J, Clouston OM, Cassady JC. Source: Journal of Pediatric Gastroenterology and Nutrition. 1988 March-April; 7(2): 220-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3351707

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Mitochondrial decay in aging. Reversal through supplementation of acetyl-Lcarnitine and N-tert-butyl-alpha-phenyl-nitrone. Author(s): Hagen TM, Wehr CM, Ames BN. Source: Annals of the New York Academy of Sciences. 1998 November 20; 854: 214-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9928432

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Mitochondrial decay in the aging rat heart: evidence for improvement by dietary supplementation with acetyl-L-carnitine and/or lipoic acid. Author(s): Hagen TM, Moreau R, Suh JH, Visioli F. Source: Annals of the New York Academy of Sciences. 2002 April; 959: 491-507. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11976222

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New treatments for dementia. Myth, magic, and science. Author(s): Ganesan R, Standish T, Molloy DW, Darzins P, Orange JB. Source: Can Fam Physician. 1994 June; 40: 1149-57. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8019192

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Acetyl-L-Carnitine

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Nutrients and HIV: part three - N-acetylcysteine, alpha-lipoic acid, L-glutamine, and L-carnitine. Author(s): Patrick L. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2000 August; 5(4): 290-305. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10956377

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Opportunities in nutraceuticals. Author(s): Bertelli A. Source: Drug News Perspect. 2000 May; 13(4): 255-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12937631

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Parkinson's disease as multifactorial oxidative neurodegeneration: implications for integrative management. Author(s): Kidd PM. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2000 December; 5(6): 502-29. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11134975

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Pharmacological treatment of diabetic peripheral neuropathy: challenges and possibilities. Author(s): Schoemaker JH. Source: Br J Clin Pract. 1994 March-April; 48(2): 91-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8024999

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Potential role of levocarnitine supplementation for the treatment of chemotherapyinduced fatigue in non-anaemic cancer patients. Author(s): Graziano F, Bisonni R, Catalano V, Silva R, Rovidati S, Mencarini E, Ferraro B, Canestrari F, Baldelli AM, De Gaetano A, Giordani P, Testa E, Lai V. Source: British Journal of Cancer. 2002 June 17; 86(12): 1854-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12085175

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Protective actions of L-carnitine and acetyl-L-carnitine on the neurotoxicity evoked by mitochondrial uncoupling or inhibitors. Author(s): Virmani MA, Biselli R, Spadoni A, Rossi S, Corsico N, Calvani M, Fattorossi A, De Simone C, Arrigoni-Martelli E. Source: Pharmacological Research : the Official Journal of the Italian Pharmacological Society. 1995 December; 32(6): 383-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8736490

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Pyruvate overrides inhibition of PDH during exercise after a low-carbohydrate diet. Author(s): St Amand TA, Spriet LL, Jones NL, Heigenhauser GJ.


Source: American Journal of Physiology. Endocrinology and Metabolism. 2000 August; 279(2): E275-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10913026 •

The influence of L-acetylcarnitine on reinnervation of the oculomotor nerve. Author(s): Pettorossi VE, Draicchio F, Fernandez E, Pallini R. Source: Int J Clin Pharmacol Res. 1993; 13(3): 193-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8225703

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The lowdown on Ginkgo biloba. Author(s): Gold PE, Cahill L, Wenk GL. Source: Scientific American. 2003 April; 288(4): 86-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12661320

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

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

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

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

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

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

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

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

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

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

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

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Acetyl-L-Carnitine

The following is a specific Web list relating to acetyl-L-carnitine; 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 Age-Related Cognitive Decline Source: Healthnotes, Inc.; www.healthnotes.com Alzheimer's Disease Source: Healthnotes, Inc.; www.healthnotes.com Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Amenorrhea Source: Healthnotes, Inc.; www.healthnotes.com Brain Cancer Source: Integrative Medicine Communications; www.drkoop.com Depression Source: Healthnotes, Inc.; www.healthnotes.com Depression (Mild to Moderate) Source: Prima Communications, Inc.www.personalhealthzone.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com Shock Source: Integrative Medicine Communications; www.drkoop.com TIAs Source: Integrative Medicine Communications; www.drkoop.com Transient Ischemic Attacks Source: Integrative Medicine Communications; www.drkoop.com

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Herbs and Supplements Amino Acids Overview Source: Healthnotes, Inc.; www.healthnotes.com Didanosine Source: Healthnotes, Inc.; www.healthnotes.com Garcinia Cambogia Alternative names: Citrin, Gambooge 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 ACETYL-L-CARNITINE 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 “acetyl-Lcarnitine” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on acetyl-L-carnitine, we have not necessarily excluded nonmedical patents in this bibliography.

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

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

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Acetyl-L-Carnitine

The following is an example of the type of information that you can expect to obtain from a patent search on acetyl-L-carnitine: •

L-carnitine and acetyl-L-carnitine combined for prevention and treatment of syndromes related to diseases of energy metabolism Inventor(s): Howard; James R. (Box 191, Brawley, CA 92227) Assignee(s): none reported Patent Number: 5,889,055 Date filed: April 4, 1997 Abstract: A combination can be of L-carnitine and acetyl-L-carnitine administered orally or as parenteral injection in domesticated animals, especially pet animals, and humans for prevention or treatment of syndromes or diseases arising from dysfunctional energy metabolism. Syndromes involving skeletal and cardiac muscle benefited from L-carnitine, syndromes related to the central nervous system improved with acetyl-L-carnitine. Although the two cofactors do not substitute metabolically for each other effects of the combination are found to be synergistic. Excerpt(s): The present invention relates to dysfunctional energy metabolism of both glucose and lipids in animals and humans. More particularly, a novel combination of metabolic cofactors, L-carnitine combined with acetyl-L-carnitine, restores normal mental and physical activity to aged patients with dysfunctional energy metabolism and, when employed prophylactically, prevents development of related syndromes. In the normal course of aging an organism's ability to synthesize, conserve, and absorb crucial metabolic cofactors declines. Conversion of nutrients to useful energy within cells involves highly specific enzymatic processes which are sensitive to presence or absence of these cofactors. In the higher order of animals, especially with respect to humans, as well as laboratory rodents, enzyme pathways of energy metabolism are known with relative precision. Despite extensive research efforts, however, interrelationship of many metabolic processes and enzymatic cofactors remain imprecisely known. Indeed, metabolic interrelationships of enzymatic cofactors Lcarnitine and acetyl-L-carnitine in cardiac and skeletal muscle have not been completely defined. The same is true in nervous tissue, especially the brain, where available research data concerning function of these cofactors are often contradictory and inconclusive owing to the inordinate difficulty in establishing truly controlled experimental formats. Much of what is known has been gained from the organ's response to traumatic, toxic, and ischemic insults as well as investigations of these cofactors' effects in chronically diseased brains. Such information provides little or no guidance to those concerned with psychophysiologic and psychomotor disturbances or confronting syndromes affecting multiple tissues. The following brief notations are believed to illustrate the complexity of the state of the art knowledge of diseases of energy metabolism. The study of disease of energy metabolism commonly referred to as mitochondrial diseases is an emerging specialty in human medicine. Most of these diseases arise from mutation of the mitochondrial genomes and, to a lesser extent, nuclear genes. Such mutations result in specific dysfunctional enzymes in metabolic pathways and in structural changes of mitochondria which disrupt enzyme orientation in metabolic pathways thereby impairing their efficiency. Mitochondrial genome mutations may exist at birth but typically occur over time as base dilutions, substitutions, and insertions during the course of replication; or in response to environmental factors, disease, and accumulation of toxic metabolites. Clinical syndromes presented depend upon the metabolic pathway affected and the proportion

Patents 33

of dysfunctional mitochondria that has been attained. Organs normally effected by disease of energy metabolism are highly differentiated, nonregenerating tissues requiring high levels of oxygen and energy, such as brain and skeletal and heart muscle. Treatment of these diseases is directed to sustaining life by supplementing high levels of metabolic cofactors in an effort to skew metabolism along specific pathways and to providing substrates for the pathways. Rarely, in human medicine, do deficiencies of cofactors or substrates cause diseases of energy metabolism. In veterinary medicine only a few genetically based diseases of energy metabolism are recognized. Among them are dilated cardiomyopathy in dogs and stress syndrome in swine. However, deficiencies of metabolic cofactors in dogs have been investigated. A study of commonly encountered age-related syndromes in old dogs, examples of which are included in this application, revealed them to be due to dysfunctional energy metabolism. More specially, syndromes involving heart and skeletal muscle were relieved by L-carnitine supplemention while a syndrome affecting the brain was relieved by increased acetyl-Lcarnitine intake. However, complex interrelationships exist. For example, a treatment for a psychotic syndrome with acetyl-L-carnitine was successful but resulted in emergence of a heart failure syndrome and both cofactors were required to normalize the dog. In another case, synergistic effects were realized with the two cofactors combined as opposed to their individual use in treating a syndrome involving skeletal muscle. And, in yet another case, a dog that heretofore had required heavy sedation to control an epileptic syndrome, experienced unexpected improvement in after it had been treated with combined L-carnitine and acetyl-L-carnitine for several weeks. Web site: http://www.delphion.com/details?pn=US05889055__ •

Medical food for diabetics Inventor(s): Cavazza; Claudio (Rome, IT) Assignee(s): Sigma-Tau Industrie Farmaceutiche Riunite S.p.A. (Rome, IT) Patent Number: 6,063,820 Date filed: March 18, 1998 Abstract: A medical food for diabetics is disclosed which comprises as characterizing active ingredients.gamma.-linolenic acid and at least one alkanoyl-L-carnitine, e.g. acetyl-L-carnitine and/or propionyl-L-carnitine. Excerpt(s): The present invention relates to a therapeutic/nutritional composition (medical food) for diabetics. Diabetes mellitus is a complex syndrome of differing genetic, environmental and pathogenetic origin. This syndrome in any event is characterised by hyperglycaemia due to impaired insulin secretion and/or efficiency, associated with a risk of diabetic ketoacidosis or non-ketotic hyper-glycaemichyperosmolar coma. Among the late complications of the disease, those worthy of particular mention are nephropathy, retinopathy, atherosclerotic coronary disease, peripheral arteriopathies and neuropathies of the autonomic nervous system. Web site: http://www.delphion.com/details?pn=US06063820__

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Acetyl-L-Carnitine

Method of assaying for acyl-L-carnitines and short-chain acyl-carnitines Inventor(s): Takahashi; Mamoru (Shizuoka, JP), Ueda; Shigeru (Shizuoka, JP) Assignee(s): Asahi Kasei Kogyo Kabushiki Kaisha (Tokyo, JP) Patent Number: 5,385,829 Date filed: October 9, 1991 Abstract: A method of assaying for acyl-L-carnitines including short chain acylcarnitines including acetyl-L-carnitine and propionyl-L-carnitine in a substance, comprises subjecting a sample of the substance to be analyzed to an enzymatic hydrolysis using an acyl-carnitine esterase. The esterase is produced by Alcaligenes sp. FERM BP-2570 and it has substrate specificity for acyl-L-carnitines including short-chain acyl-L-carnitines. In addition the esterase demonstrates substrate specificity for acetyl-Lcarnitine and propionyl-L-carnitine. The enzyme facilitates the hydrolysis reaction of one mole each of the acyl-L-carnitines with one mole of water in which to form one mole each of the corresponding fatty acid and L-carnitine. The amount of the fatty acid and Lcarnitine formed is determined by this method. Excerpt(s): The invention relates to a novel acyl-carnitine esterase which is useful for analyzing acyl-L-carnitines in, for example, biochemical clinical inspections, screening inspections in food products and so on; a process for the production thereof; and a process comprising the use thereof for analyzing acyl-L-carnitines. L-carnitine, called also vitamin B.gamma., is a substance necessary for the transportation of fatty acids through mitochondrial membranes in animals. In the cells of animals, there are also acylated derivatives of L-carnitine, namely, acyl-L-carnitines. Acyl-L-carnitines are excreted from the animal and are found in urine. Therefore, quantitative determination of the content of acyl-L-carnitines in blood etc. is very important in, for example, monitoring the existence of functional disorders of mitochondria in order to detect any defect in the intramuscular energy transference in animals. Heretofore, the analysis of acyl-L-carnitines in substances to be examined has been effected by hydrolyzing the acyl-L-carnitines with alkali and determining the amount of liberated free L-carnitine quantitatively. Several reports have proposed the conditions of such hydrolysis of acylL-carnitines, for example, Pearson et al. in "Methods in Enzymology", Vol. 14, 621 (1969), Bieber et al. in "Methods in Enzymology", Vol. 72, 276 (1981) and Pace et al. in "Clin. Chem.", 24, 32 (1978). Web site: http://www.delphion.com/details?pn=US05385829__

•

Neuroprotective composition for the prevention and/or treatment of nervous and behavioural alterations due to anxiety states or depression, comprising acetyl-Lcarnitine and hypericin Inventor(s): Cavazza; Claudio (Rome, IT) Assignee(s): Sigma-Tau Healthscience S.p.A. (Pomezia, IT) Patent Number: 6,346,282 Date filed: December 26, 2000 Abstract: This invention relates to a composition of acetyl-L-carnitine in combination with hypericin and/or Hypericum extract (Hypericum perforatum L. (St. John's Wort)) in synergistically effective amounts. The composition is effective at treating a nervous alteration due to an anxiety state, irritability, or depression.

Patents 35

Excerpt(s): The present invention relates to a composition for the prevention and/or treatment of nervous and behavioural alterations due to anxiety states or depression. Accordingly the composition may take the form and exert the action of a dietary supplement or of an actual medicine, depending upon the support or preventive action, or the strictly therapeutic action, which the composition is intended to exert in relation to the particular individuals it is to be used in. (b) 1,3,4,6,8,13-hexahydroxy-10,11dimethylphenanthro[1,10,9,8-opqra]perylene- 7,14-dione (hypericin) or Hypericum extract (Hypericum perforatum L., "Saint-John's-wort") comprising at least 0.3% by weight of hypericin. Web site: http://www.delphion.com/details?pn=US06346282__

Patent Applications on Acetyl-L-Carnitine 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 acetyl-L-carnitine: •

Chemical synergy to elevate growth hormone release in vertebrates Inventor(s): Parr, Tyler B.; (San Diego, CA) Correspondence: Tyler Parr, PH.D.; P.O. Box 371; Chula Vista; CA; 91912; US Patent Application Number: 20020002198 Date filed: April 16, 2001 Abstract: Growth hormone (GH) release in vertebrates may be augmented by an oral dietary supplement composed of acetyl-L-carnitine and l-ornithine acting in synergy. Augmentation is most efficacious by ingestion at night sleep after a short fast, but may be used during the day. Human dosages in subgram levels allow precise and reliable control of the level of augmented GH release over greater than one order of magnitude range above normal levels. This method can: return aging declined GH release to young adult levels, cause rapid fat loss without protein loss or extreme hunger, enable prolonged wakeful alertness and strength during emergencies, promote anabolic function in catabolic disease or trauma, and rapidly mature domestic animals. Excerpt(s): This invention relates to endocrinology, as a method to augment normal growth hormone release in humans and other vertebrates. Growth hormone (hereafter abbreviated as `GH`) exercises the highest hormonal control level of anabolism (biological synthetic processes) in the vertebrates. GH has a major influence on growth rates and also on maintenance of healthy tissue. GH is released from the pituitary gland by a secretion process that we will refer to as GH release. GH arises in evolution with the vertebrate group, all vertebrates are subject to the technique described in this patent application. Gradual decline in the GH release during aging and the more rapid declines in pathological conditions are detrimental to health maintenance. Rates of growth maturation of domestic animals are also increased by augmented GH release levels. Elevation of GH release has a downstream consequence of elevating insulin like growth factor 1 (IGF-1). Elevation of IGF-1 leads to elevated protein synthesis and other anabolic activities. For these reasons, a wide variety of techniques have been employed

9

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

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to increase the level of GH in vertebrates. These various techniques can be divided into two general categories: 1.) delivery of exogenous GH (not made by internal body), and 2.) drugs, chemicals or regimes to augment endogenous (one's own) GH release. Human GH produced by recombinant DNA technology is described in U.S. Pat. No. 5,855,920. Recombinant created GH has been delivered by injection and topical mucus membrane absorption techniques. The topical mucus membrane absorption has been described in PCT Pat. No. WO9959543-A. An untoward consequence of delivery of exogenous (external sourced) GH is the feedback suppression of endogenous production. A control region of the brain called the hypothalamus senses circulating GH and the down stream levels IGF-1. Sensed levels cause feedback modulation of new production of GH. The hypothalamus acts to maintain a age specific set levels of GH. Both the number of GH producing cells and the amount of endogenous GH release are declined by this feedback. Thus, GH augmentation by exogenous delivery does nothing to solve the underlying problem at the level of the hypothalamus. This is recognized to be a fundamentally flawed way to intervene in complicated hormonal feedback systems. A corresponding example is the feedback shrinking of testicular tissue in athletes who seek muscle bulk by injection of exogenous androgens. Exogenous hormone delivery is used when absolutely critical, as in the case of insulin. It is rarely simple or without untoward consequences. 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 acetyl-Lcarnitine, 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 “acetyl-L-carnitine” (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 acetyl-L-carnitine. You can also use this procedure to view pending patent applications concerning acetyl-Lcarnitine. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

37

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

Numb Toes and Aching Soles: Coping with Peripheral Neuropathy Source: San Antonio, TX: MedPress. 1999. 300 p. Contact: Available from MedPress. P.O. Box 691546, San Antonio, TX 78269. (888) 6339898. Website: www.medpress.com. PRICE: $19.95 for soft back book; $29.95 for case bound book; plus shipping and handling. ISBN 0967110726. Summary: This book serves as a resource for people who experience pain related to peripheral neuropathy. About one half of peripheral neuropathies are related to complications from diabetes mellitus. The book focuses on traditional, conventional, and alternative treatments for neuropathic pain. The book begins with a chapter that defines peripheral neuropathy and discusses this condition in terms of its types, symptoms and effects, causes, and evaluation. The next chapter explains the physical and psychological aspects of peripheral neuropathic pain. The following chapter discusses medications for

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treating peripheral neuropathic pain, including nonopioid drugs, opioids, and topical medications. A discussion of nonopioid drug costs is included. The fourth chapter focuses on other medical therapies for treating peripheral neuropathic pain, including hematologic treatments such as plasmapheresis, immunosuppressant medications, and nerve based treatments such as nerve blocks and direct nerve stimulation. This is followed by a chapter on alternative treatments, including physical therapy; psychotherapeutic methods such as relaxation and meditation training, biofeedback, self hypnosis, and prayer; hyperbaric oxygen therapy; acupuncture; touch therapies such as massage, reflexology, Reiki, Qigong, and therapeutic touch; magnets; and chelation. Treating peripheral neuropathic pain with various nutrients (vitamins A, B, C, and E; minerals such as selenium, magnesium, chromium, and zinc; and herbs such as ginkgo biloba, St. John's wart, bioflavonoids, and others) is the topic of the next chapter. In addition, the chapter provides information on other supplements such as alpha-lipoic acid, gamma linolenic acid, acetyl-L-carnitine, N-acetyl cysteine, glutamine, coenzyme Q10, S-adenosylmethionine, dimethyl sulfoxide, and methyl sulfonyl methane. The focus of the next chapter is on experimental or unapproved drugs, including aldose reductase inhibitors; aminoguanidine; COX-2; ABT-594; SNX-111; lamotrigine; memantine; natural pain relievers such as bimoclomol, cannabinoids, endorphins, and nocistatin/OFQ2; nerve regenerating compounds such as NGF, IGF-1, neutrophin-3, and GPI 1046; nimodipine; peptide T; and PN 401. This is followed by a chapter that examines diabetes and HIV. Diabetes classifications and diabetic neuropathy (types, risk factors, blood sugar control, and treatment approaches) are discussed. The final chapter presents ways of coping with peripheral neuropathy, including exercising, using heat or cold therapy, creating conducive conditions for sleeping, avoiding certain foods, and selecting appropriate footwear. The book concludes with an index.

Chapters on Acetyl-L-Carnitine In order to find chapters that specifically relate to acetyl-L-carnitine, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and acetyl-L-carnitine 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 “acetyl-Lcarnitine” (or synonyms) into the “For these words:” box.

39

APPENDICES

41

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

10

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Physician Resources

43

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

11

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

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•

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

•

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

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “acetyl-L-carnitine” (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 756 2 280 2 11 1051

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 “acetyl-L-carnitine” (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.

Physician Resources

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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 acetyl-L-carnitine 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 acetyl-L-carnitine. 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 acetyl-L-carnitine. 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 “acetyl-L-carnitine”:

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Amyotrophic Lateral Sclerosis http://www.nlm.nih.gov/medlineplus/amyotrophiclateralsclerosis.html Genetic Disorders http://www.nlm.nih.gov/medlineplus/geneticdisorders.html Leukodystrophies http://www.nlm.nih.gov/medlineplus/leukodystrophies.html Metabolic Disorders http://www.nlm.nih.gov/medlineplus/metabolicdisorders.html Neuromuscular Disorders http://www.nlm.nih.gov/medlineplus/neuromusculardisorders.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 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 acetyl-L-carnitine. 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: •


•

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

Patient Resources

49

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to acetyl-L-carnitine. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with acetyl-L-carnitine. 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 acetyl-L-carnitine. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “acetyl-L-carnitine” (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 “acetyl-L-carnitine”. 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 “acetyl-L-carnitine” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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

51

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

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

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

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

21

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

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

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

22

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

Finding Medical Libraries

53

•

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

•

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

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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

•

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

•

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

•

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

•

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

•

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

•

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/

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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/

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

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

•

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

57

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

59

ACETYL-L-CARNITINE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine: A dopaminergic neurotoxic compound which produces irreversible clinical, chemical, and pathological alterations that mimic those found in Parkinson disease. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetylcarnitine: An acetic acid ester of carnitine that facilitates movement of acetyl CoA into the matrices of mammalian mitochondria during the oxidation of fatty acids. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] 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] Acidemia: Increased acidity of blood. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenine Nucleotide Translocase: An abundant mitochondrial protein and integral component of the inner mitochondrial membrane. It facilitates the exchange of ADP and ATP between the cytosol and the mitochondria, thereby linking the subcellular compartment of ATP production to those of ATP utilization. It has several known isoforms, ANT1, ANT2, & ANT3 that should not be confused with the Ant1 and Ant2 proteins that are encoded by the Ant gene, which is an antirepressor gene that antagonizes the C1 repressor. EC 2.7.7.-. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [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] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [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

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substances. [EU] Aldose Reductase Inhibitor: A class of drugs being studied as a way to prevent eye and nerve damage in people with diabetes. Aldose reductase is an enzyme that is normally present in the eye and in many other parts of the body. It helps change glucose (sugar) into a sugar alcohol called sorbitol. Too much sorbitol trapped in eye and nerve cells can damage these cells, leading to retinopathy and neuropathy. Drugs that prevent or slow (inhibit) the action of aldose reductase are being studied as a way to prevent or delay these complications of diabetes. [NIH] 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] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] 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] 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] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] 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] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [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

Dictionary 61

a targeted site. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] 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] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antigens: Substances that are recognized by the immune system and induce an immune reaction. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antispasmodic: An agent that relieves spasm. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] 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] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [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] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] 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

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afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Avoidance Learning: A response to a cue that is instrumental in avoiding a noxious experience. [NIH] Axotomy: Transection or severing of an axon. This type of denervation is used often in experimental studies on neuronal physiology and neuronal death or survival, toward an understanding of nervous system disease. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Beta-Endorphin: A peptide consisting of amino acid sequence 61-91 of the endogenous pituitary hormone beta-lipotropin. The first four amino acids show a common tetrapeptide sequence with methionine- and leucine enkephalin. The compound shows opiate-like activity. Injection of beta-endorphin induces a profound analgesia of the whole body for several hours. This action is reversed after administration of naloxone. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH]

Dictionary 63

Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] 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] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [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] Cannabidiol: Compound isolated from Cannabis sativa extract. [NIH] Cannabinoids: Compounds extracted from Cannabis sativa L. and metabolites having the cannabinoid structure. The most active constituents are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH] Cannabinol: A physiologically inactive constituent of Cannabis sativa L. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH]

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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] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [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 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 Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] 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] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] 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). 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] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter

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acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central nervous system. [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] 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] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [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] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the

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alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled 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] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [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 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 Vessels: The veins and arteries of the heart. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that

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has ruptured and discharged its ovum. [NIH] Corpuscle: A small mass or body; a sensory nerve end bulb; a cell, especially that of the blood or the lymph. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cryofixation: Fixation of a tissue by localized cooling at very low temperature. [NIH] Cryopreservation: Preservation of cells, tissues, organs, or embryos by freezing. In histological preparations, cryopreservation or cryofixation is used to maintain the existing form, structure, and chemical composition of all the constituent elements of the specimens. [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] 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] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure.

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The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic procedure: A method used to identify a disease. [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] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Dimethyl Sulfoxide: A highly polar organic liquid, that is used widely as a chemical solvent. Because of its ability to penetrate biological membranes, it is used as a vehicle for topical application of pharmaceuticals. It is also used to protect tissue during cryopreservation. Dimethyl sulfoxide shows a range of pharmacological activity including analgesia and anti-inflammation. [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] Disposition: A tendency either physical or mental toward certain diseases. [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] Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [NIH] Donepezil: A drug used in the treatment of Alzheimer's disease. It belongs to the family of drugs called cholinesterase inhibitors. It is being studied as a treatment for side effects caused by radiation therapy to the brain. [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] Drug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (fees, pharmaceutical or

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prescription fees). [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] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [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] 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] Electroretinogram: The electrical effect recorded from the surface of the eyeball and originated by a pulse of light. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] 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]

Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] 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

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anesthetics. [NIH] Erythrocyte Membrane: The semipermeable outer portion of the red corpuscle. It is known as a 'ghost' after hemolysis. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Estrogen: One of the two female sex hormones. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Facial: Of or pertaining to the face. [EU] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fees, Pharmaceutical: Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] 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 Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Gamma-Endorphin: An endogenous opioid peptide derived from the pro-opiomelanocortin precursor peptide. It differs from alpha-endorphin by one amino acid. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH]

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Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] 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] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] 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] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Ginkgo biloba: Exclusive species of the genus Ginkgo, family Ginkgoacea. It produces extracts of medicinal interest. Ginkgo may refer to the genus or species. [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] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [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]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH]

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Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [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] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] 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,

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odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] 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] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Ileum: The lower end of the small intestine. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunosuppressant: An agent capable of suppressing immune responses. [EU] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called

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intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a

Dictionary 75

fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kinetic: Pertaining to or producing motion. [EU] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] 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] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Memantine: Amantadine derivative that has some dopaminergic effects. It has been

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proposed as an antiparkinson agent. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Metabolic acidosis: (met-ah-BOL-ik as-id-O-sis): A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream). [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] 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] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Motility: The ability to move spontaneously. [EU] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [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

Dictionary 77

thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [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] Nephropathy: Disease of the kidneys. [EU] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nerve Regeneration: Renewal or physiological repair of damaged nerve tissue. [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] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [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] Nimodipine: A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure. [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] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used

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pharmacologically as a sympathomimetic. [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] 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] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Oculomotor Nerve: The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the enkephalins, the dynorphins, and the endorphins. Each of these families derives from different precursors, proenkephalin, prodynorphin, and proopiomelanocortin, respectively. There are also at least three classes of opioid receptors, but the peptide families do not map to the receptors in a simple way. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH]

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Pancreatic: Having to do with the pancreas. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [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] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Perylene: Dibenz(de, kl)anthracene. Polycyclic hydrocarbon soil and water pollutant; also used as fluorescent lipid probe in cytochemistry of membranes and other lipid structures; derivatives may be carcinogenic. Synonyms: peri-dinaphthalene. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [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] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

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Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Piracetam: A compound suggested to be both a nootropic and a neuroprotective agent. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other 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] 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] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnenolone: Steroid hormone. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prescription Fees: The charge levied on the consumer for drugs or therapy prescribed under

Dictionary 81

written order of a physician or other health professional. [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] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Pro-Opiomelanocortin: A precursor protein, MW 30,000, synthesized mainly in the anterior pituitary gland but also found in the hypothalamus, brain, and several peripheral tissues. It incorporates the amino acid sequences of ACTH and beta-lipotropin. These two hormones, in turn, contain the biologically active peptides MSH, corticotropin-like intermediate lobe peptide, alpha-lipotropin, endorphins, and methionine enkephalin. [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] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [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] 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]

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]

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Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] 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] Reaction Time: The time from the onset of a stimulus until the organism responds. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [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] 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] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into

Dictionary 83

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] 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] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [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] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Selegiline: A selective, irreversible inhibitor of Type B monoamine oxidase. It is used in newly diagnosed patients with Parkinson's disease. It may slow progression of the clinical disease and delay the requirement for levodopa therapy. It also may be given with levodopa upon onset of disability. (From AMA Drug Evaluations Annual, 1994, p385) The compound without isomeric designation is Deprenyl. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Sella Turcica: A bony prominence situated on the upper surface of the body of the sphenoid bone. It houses the pituitary gland. [NIH] Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Senescence: The bodily and mental state associated with advancing age. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of

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old age. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures.

Dictionary 85

It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Sperm: The fecundating fluid of the male. [NIH] Sperm Motility: Ability of the spermatozoon to move by flagellate swimming. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spermatozoon: The mature male germ cell. [NIH] SPF: Sun protection factor, scale for rating the level of sunburn protection in sunscreen products. The higher the SPF, the more sunburn protection it provides. Sunscreens with an SPF value of 2 through 11 provide minimal protection against sunburns. Sunscreens with an SPF of 12 through 29 provide moderate protection, which is adequate for most people. Those with an SPF of 30 or higher provide high protection against sunburn and are sometimes recommended for people who are highly sensitive to the sun. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] 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] 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] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH]

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Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Submucous: Occurring beneath the mucosa or a mucous membrane. [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] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] 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] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Tacrine: A cholinesterase inhibitor that crosses the blood-brain barrier. Tacrine has been used to counter the effects of muscle relaxants, as a respiratory stimulant, and in the treatment of Alzheimer's disease and other central nervous system disorders. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the

Dictionary 87

skull, and containing the organs of hearing. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetrahydrocannabinol: A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. Dronabinol is a synthetic form of delta-9-THC. [NIH] Thiamine: 3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2methylthiazolium chloride. [NIH]

hydroxyethyl)-4-

Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH]

Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [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] 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] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of

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urine. [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] 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] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] 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] 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] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [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] Wart: A raised growth on the surface of the skin or other organ. [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]

X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

89

INDEX 1 1-Methyl-4-phenyl-1,2,3,6tetrahydropyridine, 24, 59 A Accommodation, 59, 78 Acetylcarnitine, 24, 27, 59 Acetylcholine, 6, 59, 64, 65, 77 Acetylcholinesterase, 12, 59 Acetylcysteine, 26, 59 Acidemia, 13, 59 Acyl, 13, 34, 59 Adenine, 18, 59 Adenine Nucleotide Translocase, 18, 59 Adipocytes, 59, 75 Adrenal Cortex, 59, 67, 81, 82 Adrenergic, 59, 68, 69, 86 Aerobic, 59, 76 Afferent, 59, 75 Agonist, 59, 68, 77, 86 Aldose Reductase Inhibitor, 4, 38, 60 Alertness, 35, 60 Algorithms, 60, 62 Alimentary, 60, 79 Alkaline, 60, 63 Alkaloid, 60, 63 Alternative medicine, 60 Amenorrhea, 9, 28, 60 Amino Acid Sequence, 60, 62, 81 Amino Acids, 28, 60, 62, 79, 81, 87 Ammonia, 60, 71, 87 Amyloid, 10, 60 Anabolic, 35, 60 Anatomical, 60, 64, 73 Androgens, 36, 59, 60 Anesthetics, 60, 70, 72 Antibacterial, 12, 61 Antibody, 61, 65, 73, 82, 85 Anticholinergic, 61, 80 Antigens, 61, 73, 85 Antioxidant, 4, 61, 78 Antispasmodic, 61, 72 Antiviral, 59, 61 Anxiety, 34, 35, 61 Apoptosis, 8, 61 Aqueous, 61, 62, 67 Arginine, 61, 78 Arterial, 61, 63, 81 Arteries, 61, 62, 66, 76

Artery, 61, 81, 82 Ascorbic Acid, 4, 61 Assay, 25, 61 Asymptomatic, 8, 61 Atmospheric Pressure, 61, 73 Autonomic Nervous System, 33, 61, 84, 86 Avoidance Learning, 18, 62 Axotomy, 20, 62 B Bacteria, 59, 61, 62, 72, 76 Base, 32, 59, 62, 74, 86 Beta-Endorphin, 8, 62 Beta-pleated, 60, 62 Biochemical, 18, 24, 34, 62, 79 Biological therapy, 62, 72 Biosynthesis, 20, 62 Biotechnology, 7, 18, 43, 62 Biotin, 24, 62 Bladder, 62, 65, 87, 88 Blood Coagulation, 62, 63 Blood pressure, 10, 62, 63, 76, 77 Blood vessel, 62, 64, 69, 74, 87, 88 Blood-Brain Barrier, 19, 63, 75, 80, 86 Body Fluids, 24, 63 Brain Hypoxia, 63 Brain Infarction, 63 Brain Ischemia, 18, 63 Breeding, 25, 63 C Calcium, 4, 63, 65, 77, 84 Cannabidiol, 63 Cannabinoids, 38, 63 Cannabinol, 63 Capsaicin, 4, 63 Captopril, 4, 63 Carbohydrate, 26, 63 Carbon Dioxide, 63, 80, 83 Carcinogenic, 63, 79, 81, 85 Carcinogens, 63, 65 Cardiac, 32, 63, 66, 69, 76, 85 Cardiomyopathy, 63 Carotene, 5, 64 Catecholamine, 64, 68 Caudal, 64, 73 Cell, 19, 59, 61, 62, 64, 65, 67, 69, 70, 71, 72, 74, 76, 77, 78, 79, 80, 82, 83, 84, 85, 86, 87, 88 Cell Death, 61, 64, 77

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Cell Division, 62, 64, 72, 76, 80 Cell Respiration, 64, 76, 83 Cell Survival, 64, 72 Central Nervous System, 32, 59, 61, 64, 65, 70, 71, 75, 80, 86 Ceramide, 8, 64 Cerebral, 4, 10, 19, 63, 64, 69, 70, 87 Cerebral Cortex, 64, 70 Cerebrovascular, 12, 64, 77 Cerebrum, 64 Chelation, 38, 64 Chemotherapy, 26, 64 Chin, 64, 76 Cholesterol, 64, 85, 86 Choline, 5, 6, 59, 64 Cholinergic, 6, 9, 14, 64, 65 Cholinesterase Inhibitors, 4, 5, 64, 68 Chromatin, 61, 65, 75, 85 Chromium, 38, 65 Chromosome, 6, 65, 87 Chronic, 4, 15, 18, 65, 73, 75 Ciliary, 65, 78 Clinical study, 65, 66 Clinical trial, 4, 6, 43, 65, 66, 68, 82 Cloning, 62, 65 Coenzyme, 5, 13, 38, 61, 65 Cofactor, 65, 81 Complement, 65, 66 Complementary and alternative medicine, 4, 23, 29, 66 Complementary medicine, 23, 66 Computational Biology, 43, 66 Conduction, 18, 66 Conjugated, 66, 67 Conjunctiva, 66, 80 Connective Tissue, 61, 66, 70 Consciousness, 66, 67 Constipation, 66, 70, 74 Constriction, 66, 74, 78 Contraindications, ii, 66 Controlled clinical trial, 14, 66 Controlled study, 8, 11, 66 Coronary, 33, 66, 76 Coronary Disease, 33, 66 Coronary Vessels, 66 Corpus, 66, 81, 87 Corpus Luteum, 66, 81 Corpuscle, 67, 70 Cortisol, 8, 67 Cranial, 67, 78 Cryofixation, 67 Cryopreservation, 15, 67, 68

Cysteine, 38, 59, 67 Cystine, 67 Cytochrome, 18, 20, 67 Cytoplasm, 61, 67, 75 D Degenerative, 67, 83 Dehydroepiandrosterone, 5, 67 Deletion, 61, 67 Delusions, 5, 67, 81 Dementia, 4, 5, 9, 11, 15, 25, 67 Dendrites, 67, 68, 77 Dentate Gyrus, 67, 72 Diabetes Mellitus, 37, 68, 71, 72 Diabetic Ketoacidosis, 33, 68 Diagnostic procedure, 31, 68 Dialyzer, 68, 72 Diarrhea, 68, 70, 74 Dilated cardiomyopathy, 33, 68 Dimethyl, 38, 68 Dimethyl Sulfoxide, 38, 68 Diploid, 68, 80, 87 Direct, iii, 38, 68, 82, 86 Disposition, 14, 18, 68 Distal, 68, 79 Domesticated, 32, 68 Donepezil, 5, 6, 68 Dopamine, 19, 68, 75, 76, 77 Double-blind, 8, 11, 68 Drug Costs, 38, 68 Duodenum, 69, 74, 85 Dyes, 60, 69 E Effector, 59, 65, 69 Effector cell, 69 Efficacy, 4, 5, 69 Electrons, 61, 62, 69, 74, 78, 81 Electroretinogram, 15, 69 Endocrine System, 69 Endocrinology, 4, 18, 27, 35, 69 Endogenous, 36, 62, 68, 69, 70, 78 Endorphin, 62, 69, 70 Endothelial cell, 63, 69 Energy balance, 69, 75 Enhancer, 4, 69 Enkephalin, 62, 69, 81 Entorhinal Cortex, 69, 72 Environmental Health, 42, 44, 69 Enzymatic, 32, 34, 63, 64, 65, 69 Enzyme, 4, 32, 34, 59, 60, 65, 69, 72, 76, 82, 84, 86, 88 Epinephrine, 59, 68, 69, 77, 87 Erythrocyte Membrane, 11, 70

91

Erythrocytes, 18, 70, 72 Estrogen, 70, 83, 86 Exogenous, 36, 63, 69, 70 Expiration, 70, 83 Extracellular, 60, 66, 70 Extrapyramidal, 68, 70 F Facial, 12, 70, 84 Facial Paralysis, 12, 70 Family Planning, 43, 70 Fat, 35, 59, 64, 70, 74, 75, 80 Fatigue, 26, 70, 72 Fatty acids, 34, 59, 68, 70 Fees, Pharmaceutical, 68, 70 Fetus, 70, 80, 88 Foot Ulcer, 4, 70 Forearm, 62, 70 Free Radicals, 61, 70 Functional Disorders, 34, 70 G Gamma-Endorphin, 70 Ganglia, 59, 63, 70, 71, 77, 86 Ganglion, 71, 78 Gas, 60, 63, 70, 71, 73, 74, 77 Gastric, 63, 71 Gastrin, 71, 72 Gastrointestinal, 65, 69, 71, 72, 84, 86 Gastrointestinal tract, 65, 71, 72 Gene, 6, 59, 62, 71 Gene Expression, 6, 71 Genotype, 71, 79 Geriatric, 4, 8, 10, 11, 71 Germ Cells, 71, 84, 85, 87 Ginkgo biloba, 5, 27, 38, 71 Ginseng, 5, 71 Gland, 59, 71, 78, 80, 83, 85 Glucose, 9, 15, 32, 60, 61, 65, 68, 71, 72, 74, 84 Glucose Intolerance, 68, 71 Glucuronic Acid, 71, 72 Glutamate, 6, 71 Glutamic Acid, 71, 77 Glutamine, 26, 38, 71 Glutathione Peroxidase, 72, 83 Glycopyrrolate, 4, 72 Gonad, 72 Gonadal, 15, 72, 85 Governing Board, 72, 80 Growth factors, 4, 72 H Heart failure, 33, 72 Hemodialysis, 13, 68, 72

Hemoglobin, 70, 72, 75 Hemolysis, 70, 72 Heparin, 25, 72 Hepatic, 20, 72 Heredity, 71, 72 Hippocampus, 18, 67, 72, 86 Hormonal, 35, 72 Hormone, 35, 62, 67, 69, 71, 72, 74, 75, 80, 81, 83, 84 Hydrogen, 62, 63, 72, 75, 76, 78 Hydrolysis, 34, 59, 73 Hyperbaric, 38, 73 Hyperbaric oxygen, 38, 73 Hyperglycaemia, 33, 73 Hypothalamic, 9, 73 Hypothalamus, 36, 61, 69, 73, 80, 81, 87 I Ileum, 73, 74 Imidazole, 62, 73 Immune response, 73, 86, 88 Immunosuppressant, 38, 73 Impairment, 14, 15, 73, 76, 81 In vitro, 14, 73 In vivo, 15, 72, 73 Induction, 60, 73 Infancy, 25, 73 Infarction, 63, 73, 77, 82 Infection, 62, 65, 73, 75, 77, 88 Inflammation, 65, 68, 70, 73, 80, 83 Infusion, 9, 13, 73 Ingestion, 35, 74 Inorganic, 74, 76 Inositol, 12, 74, 83 Inotropic, 68, 74 Insulin, 8, 33, 35, 68, 74 Insulin-dependent diabetes mellitus, 74 Insulin-like, 8, 74 Internal Medicine, 18, 69, 74 Intestinal, 64, 74 Intracellular, 73, 74, 83, 84 Intramuscular, 34, 74, 79 Intravenous, 13, 74, 79 Involuntary, 74, 82 Ion Channels, 74 Ions, 62, 73, 74 Irritable Bowel Syndrome, 70, 74 Ischemia, 63, 74, 82 J Jejunum, 24, 74 K Kb, 42, 74 Ketone Bodies, 68, 74, 75

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Ketosis, 68, 75 Kinetic, 13, 75 L Leprosy, 70, 75 Leptin, 24, 75 Lesion, 70, 75 Leucine, 62, 75 Levodopa, 75, 83 Libido, 60, 75 Ligaments, 66, 75 Lipid, 15, 18, 24, 64, 74, 75, 78, 79 Lipid Peroxidation, 75, 78 Liver, 62, 63, 71, 72, 75, 82, 87 Lymphatic, 73, 75, 80 Lymphocytes, 16, 75, 88 Lymphoid, 75 M Mammary, 75, 86 Manic, 75, 81 Manic-depressive psychosis, 75, 81 Mediate, 68, 75 MEDLINE, 43, 75 Memantine, 38, 75 Membrane, 12, 15, 36, 59, 66, 68, 74, 76, 79, 83, 84, 86 Memory, 6, 7, 19, 20, 23, 67, 76 Meninges, 64, 76 Menstrual Cycle, 76, 81 Menstruation, 60, 76 Mental, iv, 5, 14, 32, 42, 44, 64, 67, 68, 70, 76, 81, 83 Mental Disorders, 76, 81 Metabolic acidosis, 68, 76 Metabolite, 68, 76 Mitochondria, 18, 20, 32, 34, 59, 76 Mitosis, 61, 76 Molecular, 10, 18, 19, 20, 43, 45, 62, 66, 67, 72, 76 Molecule, 62, 65, 69, 73, 76, 78, 82, 84, 86 Monitor, 6, 76, 78 Monoamine, 76, 83 Motility, 70, 76 Motor nerve, 76, 78 Mucolytic, 59, 76 Mucosa, 76, 86 Mucus, 36, 76 Muscular Diseases, 70, 76 Myocardial Ischemia, 66, 76 N Naloxone, 62, 77 Necrosis, 61, 63, 73, 77, 82 Nephropathy, 33, 77

Nerve Growth Factor, 12, 77 Nerve Regeneration, 20, 77 Nervous System, 11, 13, 16, 59, 61, 62, 64, 77, 86 Neural, 6, 59, 60, 77 Neuromuscular, 48, 59, 70, 77 Neuromuscular Junction, 59, 77 Neuronal, 12, 20, 62, 77 Neurons, 24, 67, 68, 70, 75, 77, 86 Neuropathy, 4, 8, 9, 18, 37, 60, 77, 79 Neuropeptides, 9, 77 Neurotoxic, 59, 77 Neurotoxicity, 10, 20, 24, 26, 77 Neurotransmitter, 59, 64, 68, 71, 74, 77, 83, 84, 86 Nimodipine, 4, 38, 77 Nitrogen, 60, 71, 77 Norepinephrine, 59, 68, 77 Nuclear, 32, 69, 71, 77, 78 Nuclei, 69, 70, 76, 78 Nucleus, 61, 65, 67, 75, 78, 84, 85 Nutritional Status, 18, 78 O Oculomotor, 27, 78 Oculomotor Nerve, 27, 78 Opiate, 62, 69, 77, 78 Opioid Peptides, 78 Optic Chiasm, 73, 78 Ornithine, 20, 35, 78 Ovum, 67, 78, 81 Oxidation, 7, 19, 20, 59, 61, 67, 68, 72, 75, 78 Oxidative Stress, 7, 19, 78 Oxygen Consumption, 78, 83 P Pancreas, 62, 74, 78, 79 Pancreatic, 63, 79 Parenteral, 4, 32, 79 Paresis, 70, 79 Pathologic, 61, 66, 79 Pathologic Processes, 61, 79 Peptide, 38, 62, 70, 75, 78, 79, 81 Peripheral blood, 16, 79 Peripheral Neuropathy, 26, 37, 79 Perylene, 35, 79 Pharmacodynamics, 11, 79 Pharmacologic, 79, 87 Phenotype, 6, 79 Phenyl, 19, 25, 79 Phospholipids, 70, 74, 79 Phosphorus, 63, 79 Phosphorylated, 65, 79

93

Physical Therapy, 38, 79 Physiologic, 59, 62, 76, 79, 82 Physiology, 19, 27, 62, 69, 80 Physostigmine, 5, 80 Pigments, 64, 80 Piracetam, 6, 80 Pituitary Gland, 35, 80, 81, 83 Placenta, 80, 81 Plants, 60, 63, 64, 71, 77, 80 Plasma, 8, 11, 25, 71, 72, 80, 82 Plasmapheresis, 38, 80 Plexus, 24, 80 Pneumonia, 66, 80 Polyunsaturated fat, 20, 80 Pons, 70, 80 Potentiation, 65, 80, 84 Practice Guidelines, 44, 80 Precursor, 64, 68, 69, 70, 75, 77, 80, 81, 87 Pregnenolone, 5, 80 Prenatal, 6, 80 Prescription Fees, 69, 80 Probe, 79, 81 Progesterone, 15, 81, 85 Progression, 4, 5, 81, 83 Progressive, 67, 77, 81 Promoter, 14, 81 Pro-Opiomelanocortin, 70, 78, 81 Protein S, 35, 62, 81 Proteins, 59, 60, 62, 65, 76, 77, 79, 80, 81, 84 Psychic, 75, 76, 81 Psychosis, 5, 81 Public Policy, 43, 81 Publishing, 4, 7, 81 Pulmonary, 12, 62, 81, 88 Pulmonary Artery, 62, 81, 88 Pulse, 69, 76, 81 R Radiation, 68, 70, 73, 81, 82, 88 Radiation therapy, 68, 73, 82 Radioactive, 73, 78, 82 Randomized, 12, 14, 69, 82 Reaction Time, 12, 82 Reality Testing, 81, 82 Receptor, 68, 82, 84 Recombinant, 36, 82 Reductase, 60, 82 Refer, 1, 35, 65, 71, 81, 82 Reflex, 38, 82 Regimen, 15, 69, 82 Renin, 63, 82 Renin-Angiotensin System, 63, 82 Reperfusion, 18, 82

Reperfusion Injury, 82 Repressor, 59, 82 Respiration, 24, 63, 76, 82 Retina, 78, 83 Retinopathy, 33, 60, 83 Risk factor, 38, 83 S Salivation, 72, 83 Screening, 34, 65, 83 Second Messenger Systems, 83 Secretion, 33, 35, 74, 76, 83 Segmental, 6, 83 Segmentation, 83 Selective estrogen receptor modulator, 83, 86 Selegiline, 5, 83 Selenium, 38, 83 Sella, 80, 83 Sella Turcica, 80, 83 Seminiferous tubule, 83, 85 Senescence, 18, 83 Senile, 15, 83 Serum, 24, 65, 84 Sex Characteristics, 60, 84 Shock, 13, 28, 84, 87 Side effect, 62, 68, 84, 87 Signal Transduction, 74, 84 Skeletal, 24, 32, 60, 65, 76, 84 Skeleton, 84 Small intestine, 69, 72, 73, 74, 84 Solitary Nucleus, 61, 84 Solvent, 68, 84 Soma, 84 Somatic, 4, 76, 79, 84 Sorbitol, 60, 84 Sound wave, 66, 85 Soybean Oil, 80, 85 Specialist, 49, 85 Species, 63, 68, 69, 71, 76, 85, 87 Specificity, 34, 85 Sperm, 15, 60, 65, 83, 85 Sperm Motility, 15, 85 Spermatozoa, 15, 85 Spermatozoon, 85 SPF, 20, 85 Spinal cord, 64, 71, 76, 77, 82, 85, 86 Statistically significant, 3, 85 Steroid, 67, 80, 85 Stimulant, 85, 86 Stimulus, 69, 74, 82, 85 Stomach, 71, 72, 75, 84, 85 Strand, 16, 85

94

Acetyl-L-carnitine

Stress, 19, 33, 61, 64, 67, 70, 74, 78, 86 Subcutaneous, 59, 79, 86 Subiculum, 72, 86 Submucous, 24, 86 Substance P, 76, 83, 86 Substrate, 34, 86 Substrate Specificity, 34, 86 Supplementation, 19, 24, 25, 26, 86 Suppression, 36, 86 Suppressive, 8, 86 Sympathetic Nervous System, 61, 86 Sympathomimetic, 68, 69, 78, 86 Symptomatic, 4, 5, 9, 86 Symptomatic treatment, 5, 86 Synapses, 65, 86 Synergistic, 32, 33, 86 Systemic, 20, 62, 63, 69, 73, 82, 86 T Tacrine, 4, 5, 86 Tamoxifen, 10, 83, 86 Temporal, 72, 86 Testicular, 36, 87 Testis, 87 Tetrahydrocannabinol, 63, 87 Thiamine, 4, 87 Third Ventricle, 73, 87 Thrombosis, 77, 81, 87 Tissue, 18, 24, 32, 35, 59, 62, 63, 66, 67, 68, 70, 75, 76, 77, 80, 82, 83, 84, 85, 86, 87 Topical, 4, 36, 38, 68, 87 Toxic, iv, 32, 77, 83, 87 Toxicity, 80, 87 Toxicology, 44, 87 Trace element, 65, 87 Transfection, 62, 87

Transmitter, 59, 68, 74, 77, 86, 87 Trauma, 20, 35, 77, 87 Trisomy, 6, 87 Tuberculosis, 12, 87 Tyrosine, 68, 87 U Urea, 78, 87 Urethra, 87, 88 Urinary, 24, 65, 87 Urine, 25, 34, 62, 74, 87, 88 Uterus, 66, 76, 81, 88 V Vascular, 18, 73, 80, 88 Vasodilator, 68, 88 Vein, 74, 78, 88 Venous, 63, 81, 88 Ventral, 73, 78, 80, 88 Ventricle, 72, 81, 87, 88 Veterinary Medicine, 33, 43, 88 Viral, 59, 88 Virus, 69, 88 Viscera, 84, 88 Visceral, 61, 88 Visceral Afferents, 62, 88 Viscosity, 59, 88 Vitamin A, 74, 88 Vitro, 72, 88 Vivo, 88 W Wart, 38, 88 White blood cell, 61, 75, 76, 88 X X-ray, 78, 82, 88 Y Yeasts, 79, 88

95

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Acetyl-L-carnitine

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