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

CALCIUM CITRATE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AM...

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CALCIUM CITRATE 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., 1960Calcium Citrate: 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: 0-497-00198-5 1. Calcium Citrate-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 calcium citrate. 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 CALCIUM CITRATE ................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Calcium Citrate............................................................................. 5 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. NUTRITION AND CALCIUM CITRATE.......................................................................... 11 Overview...................................................................................................................................... 11 Finding Nutrition Studies on Calcium Citrate ........................................................................... 11 Federal Resources on Nutrition ................................................................................................... 12 Additional Web Resources ........................................................................................................... 13 CHAPTER 3. ALTERNATIVE MEDICINE AND CALCIUM CITRATE ................................................... 15 Overview...................................................................................................................................... 15 National Center for Complementary and Alternative Medicine.................................................. 15 Additional Web Resources ........................................................................................................... 20 General References ....................................................................................................................... 21 CHAPTER 4. PATENTS ON CALCIUM CITRATE ................................................................................ 23 Overview...................................................................................................................................... 23 Patents on Calcium Citrate.......................................................................................................... 23 Patent Applications on Calcium Citrate...................................................................................... 37 Keeping Current .......................................................................................................................... 41 CHAPTER 5. BOOKS ON CALCIUM CITRATE .................................................................................... 43 Overview...................................................................................................................................... 43 Chapters on Calcium Citrate ....................................................................................................... 43 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 47 Overview...................................................................................................................................... 47 NIH Guidelines............................................................................................................................ 47 NIH Databases............................................................................................................................. 49 Other Commercial Databases....................................................................................................... 51 APPENDIX B. PATIENT RESOURCES ................................................................................................. 53 Overview...................................................................................................................................... 53 Patient Guideline Sources............................................................................................................ 53 Finding Associations.................................................................................................................... 55 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 57 Overview...................................................................................................................................... 57 Preparation................................................................................................................................... 57 Finding a Local Medical Library.................................................................................................. 57 Medical Libraries in the U.S. and Canada ................................................................................... 57 ONLINE GLOSSARIES.................................................................................................................. 63 Online Dictionary Directories ..................................................................................................... 63 CALCIUM CITRATE DICTIONARY .......................................................................................... 65 INDEX ................................................................................................................................................ 91

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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 calcium citrate 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 calcium citrate, 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 calcium citrate, 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 calcium citrate. 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 calcium citrate, 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 calcium citrate. 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 CALCIUM CITRATE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on calcium citrate.

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

Citrate and Renal Calculi: New Insights and Future Directions Source: American Journal of Kidney Diseases. 17(4): 420-425. April 1991. Summary: This article discusses new insights and future directions in studying the role of citrate in renal calculi formation. Citrate is pathogenetically important in stone formation, because it retards the crystallization of stone-forming calcium salts and because its level in urine is low in many patients with nephrolithiasis. Potassium citrate is useful therapeutically, because it can often restore normal urinary citrate. Hypocitraturia often results from dietary aberrations, including sodium excess, and exaggerated intake of animal proteins. Hypocitraturia is frequently accompanied by a low net gastrointestinal absorption of alkali. New drugs, including effervescent calcium citrate, and potassium-magnesium citrate, are under development as improvements or refinements of currently available potassium citrate. 3 figures. 25 references. (AA-M).

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Phosphorus Binders Source: Nephrology Exchange. 2(1): 7-12. April 1992. Contact: Available from Abbott Laboratories. Abbott Renal Care, Department R-10, Building AP-34, One Abbott Park Road, Abbott Park, IL 60064-3500. (800) 457-9472. Summary: This article explores the use of phosphorus binders that prevent or ameliorate the development of positive phosphorus balance. The authors note that although phosphorus-deficient diets can reduce intake to about 500 mg per day, they are generally unpalatable and not practical for long-term use. The ingestion of binders that impede phosphorus absorption offers a more practical and effective alternative. Topics include aluminum salts and the indications for aluminum salt phosphorus binders; calcium salts including calcium carbonate, calcium acetate, and calcium citrate; magnesium salts; and how each affects phosphorus binding; and the timing of phosphorus binders. 4 figures. 26 references.

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Ten Questions Commonly Asked by Physicians About Osteoporosis Source: Journal of Clinical Rheumatology. 2(1):33-40; February 1996. Summary: This journal article for health professionals answers 10 questions commonly asked by physicians about osteoporosis. Questions deal with the use of fluoride therapy to increase spinal bone mass, the prevention of bone loss in patients receiving chronic glucocorticosteroid therapy, the effectiveness of calcium supplements in the treatment of osteoporosis, options for preventing bone loss in early menopause if estrogen replacement is not possible, and the advantages and disadvantages of calcium carbonate versus calcium citrate. Questions also focus on the differences between osteoporosis and osteomalacia; the effectiveness of estrogen replacement therapy in treating osteoporosis after 65 years of age; the management of an elderly patient with severe, established osteoporosis; noninvasive radiographic techniques for assessing bone density; and the management of vertebral compression fractures. 26 references and 2 tables.

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Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management Source: American Family Physician. 59(6): 1547-1548,1550-1556. March 15, 1999. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the epidemiology, diagnosis, and management of vulvodynia and vulvar vestibulitis. Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction, and psychologic distress. Vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. Vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential vulvodynia, and vulvar dermatoses. Evaluation should include a thorough history and physical examination, as well as cultures for bacteria and fungus, potassium hydroxide microscopic examination, and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery, or laser therapy.

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Since vulvodynia is often a chronic condition, regular medical followup and referral to a support group are helpful for most patients. The article includes two case reports that illustrate the diagnostic and management challenges presented by vulvodynia. 8 figures, 2 tables, and 29 references. (AA-M).

Federally Funded Research on Calcium Citrate The U.S. Government supports a variety of research studies relating to calcium citrate. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to calcium citrate. 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 calcium citrate. The following is typical of the type of information found when searching the CRISP database for calcium citrate: •

Project Title: CALCIUM CITRATE AND PROPENSITY FOR CRYSTALLIZATION OF CALCIUM SALTS Principal Investigator & Institution: Sakhaee, Khashayar; Professor; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: Aims are: 1) to test the hypothesis that the rise in urinary calcium and in the propensity for the crystallization of calcium salts following calcium supplementation is transient, owing to the "intestinal adaptation process". and 2) that calcium citrate confers protection against calcium stone formation due to its persistent citraturic response. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF BONE LOSS IN EARLY POSTMENOPAUSAL WOMEN WITH CALCIUM Principal Investigator & Institution: Pak, Charles Yc.; Professor of Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: The hypothesis is that Calcium Citrate will be more effective than Calcium Carbonate in preventing spinal bone loss in early postmenopausal women because of greater bioavilability and alkali load. Bone density will be measured in lumbar vertebrae, proximal femur and radius every six months for four years during treatment with Calcium Citrate or Placebo.

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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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Calcium Citrate

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

Project Title: TREATMENT OF SENILE OSTEOPOROSIS Principal Investigator & Institution: Rubin, Craig D.; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002 Summary: The purpose of this study is to investigate the efficacy of supplemental calcium in the form of calcium citrate, and fluoride in the form of slow-release sodium fluoride in augmenting trabecular bone mass in women over the age of 65 years while preserving cortical bone. Major outcome measures include bone density, fracture rate, functional status, and adverse effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with calcium citrate, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “calcium citrate” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for calcium citrate (hyperlinks lead to article summaries): •

Acute biochemical variations induced by calcium citrate and calcium carbonate in Type 2 diabetic patients: impaired calcium absorption in Type 2 diabetic patients with prolonged gastric emptying time. Author(s): Song YM, Sheu WH, Lee WJ. Source: Journal of Diabetes and Its Complications. 2001 March-April; 15(2): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11274906

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Aluminum and lead absorption from dietary sources in women ingesting calcium citrate. Author(s): Nolan CR, DeGoes JJ, Alfrey AC. Source: Southern Medical Journal. 1994 September; 87(9): 894-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8091252

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Calcium absorption from apple and orange juice fortified with calcium citrate malate (CCM). Author(s): Andon MB, Peacock M, Kanerva RL, De Castro JA. Source: Journal of the American College of Nutrition. 1996 June; 15(3): 313-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8935449

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Calcium bioavailability from calcium carbonate and calcium citrate. Author(s): Nicar MJ, Pak CY. Source: The Journal of Clinical Endocrinology and Metabolism. 1985 August; 61(2): 3913. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4008614

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Calcium citrate for vulvar vestibulitis. A case report. Author(s): Solomons CC, Melmed MH, Heitler SM. Source: J Reprod Med. 1991 December; 36(12): 879-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1816400

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Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Author(s): Coburn JW, Mischel MG, Goodman WG, Salusky IB. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1991 June; 17(6): 708-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2042654

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Calcium citrate without aluminum antacids does not cause aluminum retention in patients with functioning kidneys. Author(s): Sakhaee K, Wabner CL, Zerwekh JE, Copley JB, Pak L, Poindexter JR, Pak CY. Source: Bone Miner. 1993 January; 20(1): 87-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8453325

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Calcium citrate, a nonaluminum-containing phosphate-binding agent for treatment of CRF. Author(s): Cushner HM, Copley JB, Lindberg JS, Foulks CJ. Source: Kidney International. 1988 January; 33(1): 95-9. Erratum In: Kidney Int 1988 May; 33(5): 1047. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3280855

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Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. Author(s): Harvey JA, Zobitz MM, Pak CY. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 1988 June; 3(3): 253-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3213620

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Effect of estrogen treatment and vitamin D status on differing bioavailabilities of calcium carbonate and calcium citrate. Author(s): Heller HJ, Poindexter JR, Adams-Huet B. Source: Journal of Clinical Pharmacology. 2002 November; 42(11): 1251-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12412824

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Enhanced calcium bioavailability from a solubilized form of calcium citrate. Author(s): Pak CY, Harvey JA, Hsu MC. Source: The Journal of Clinical Endocrinology and Metabolism. 1987 October; 65(4): 8015. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3654922

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Fluoride bioavailability from immediate-release sodium fluoride with calcium carbonate compared with slow-release sodium fluoride with calcium citrate. Author(s): Sakhaee K, Pak CY. Source: Bone Miner. 1991 August; 14(2): 131-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1912761

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Fluoride bioavailability from slow-release sodium fluoride given with calcium citrate. Author(s): Pak CY, Sakhaee K, Parcel C, Poindexter J, Adams B, Bahar A, Beckley R. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 1990 August; 5(8): 857-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2239370

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Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Author(s): Nolan CR, Califano JR, Butzin CA. Source: Kidney International. 1990 November; 38(5): 937-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2266679

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Management of hyperphosphatemia with calcium citrate in hemodialysis patients. Author(s): Saupe J, Belmega G, Krause R, Bennhold I. Source: Nephron. 1989; 52(1): 93-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2710274

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Measurement of intrinsic bone quality in vivo by reflection ultrasound: correction of impaired quality with slow-release sodium fluoride and calcium citrate. Author(s): Antich PP, Pak CY, Gonzales J, Anderson J, Sakhaee K, Rubin C. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 1993 March; 8(3): 301-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8456586

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Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Author(s): Sakhaee K, Bhuket T, Adams-Huet B, Rao DS. Source: American Journal of Therapeutics. 1999 November; 6(6): 313-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11329115

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Modification by food of the calcium absorbability and physicochemical effects of calcium citrate. Author(s): Wabner CL, Pak CY. Source: Journal of the American College of Nutrition. 1992 October; 11(5): 548-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1452953

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Superior calcium absorption from calcium citrate than calcium carbonate using external forearm counting. Author(s): Harvey JA, Kenny P, Poindexter J, Pak CY. Source: Journal of the American College of Nutrition. 1990 December; 9(6): 583-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2273192

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The effect of calcium carbonate and calcium citrate on the absorption of zinc in healthy female subjects. Author(s): Argiratos V, Samman S. Source: European Journal of Clinical Nutrition. 1994 March; 48(3): 198-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8194505

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The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized placebo-controlled study. Author(s): Ruml LA, Sakhaee K, Peterson R, Adams-Huet B, Pak CY. Source: American Journal of Therapeutics. 1999 November; 6(6): 303-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11329114

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The effect of intermittent slow-release sodium fluoride and continuous calcium citrate therapy on calcitropic hormones, biochemical markers of bone metabolism, and blood chemistry in postmenopausal osteoporosis. Author(s): Zerwekh JE, Padalino P, Pak CY. Source: Calcified Tissue International. 1997 October; 61(4): 272-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9312196

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The lack of influence of long-term potassium citrate and calcium citrate treatment in total body aluminum burden in patients with functioning kidneys. Author(s): Sakhaee K, Ruml L, Padalino P, Haynes S, Pak CY. Source: Journal of the American College of Nutrition. 1996 February; 15(1): 102-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8632109

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CHAPTER 2. NUTRITION AND CALCIUM CITRATE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and calcium citrate.

Finding Nutrition Studies on Calcium Citrate The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “calcium citrate” (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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Calcium Citrate

The following is a typical result when searching for recently indexed consumer information on calcium citrate: •

Is calcium citrate better than other calcium supplements? Source: Anonymous Johns-Hopkins-Med-Lett-Health-After-50. 2000 June; 12(4): 8 10421882

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

Comparative absorption of calcium sources and calcium citrate malate for the prevention of osteoporosis. Source: Patrick, L Altern-Med-Revolume 1999 April; 4(2): 74-85 1089-5159

•

In vitro characterization of poly(ethylene) glycol calcium citrate microspheres as a delivery system for the study of reparative dentinogenesis. Author(s): Department of Oral Rehabilitation, University of Otago, Dunedin, New Zealand. Source: Hunter, A R Kirk, E E Robinson, D H Kardos, T B Endod-Dent-Traumatol. 1998 August; 14(4): 159-62 0109-2502

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

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

•

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

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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/

Nutrition

13

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/

•

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

•

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

The following is a specific Web list relating to calcium citrate; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin D Source: Prima Communications, Inc.www.personalhealthzone.com

•

Minerals Calcium Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: Prima Communications, Inc.www.personalhealthzone.com Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Calcium/Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,937,00.html Calcium: Which Form Is Best? Source: Healthnotes, Inc.; www.healthnotes.com

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Calcium Citrate

Zinc Source: Healthnotes, Inc.; www.healthnotes.com Zinc Source: Prima Communications, Inc.www.personalhealthzone.com

15

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

A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. Author(s): Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. Source: The New England Journal of Medicine. 1990 September 27; 323(13): 878-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2203964

•

Absorbability and cost effectiveness in calcium supplementation. Author(s): Heaney RP, Dowell SD, Bierman J, Hale CA, Bendich A. Source: Journal of the American College of Nutrition. 2001 June; 20(3): 239-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11444420

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•

Acute effects of calcium sodium citrate supplementation of a test meal on mineral homeostasis, oxalate, and calcium oxalate crystallization in the urine of healthy humans--preliminary results in patients with idiopathic calcium urolithiasis. Author(s): Herrmann U, Schwille PO, Schmiedl A, Fan J, Manoharan M. Source: Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 1999 June; 53(5-6): 264-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10424248

•

Acute oral calcium-sodium citrate load in healthy males. Effects on acid-base and mineral metabolism, oxalate and other risk factors of stone formation in urine. Author(s): Schwille PO, Schmiedl A, Herrmann U, Schwille R, Fink E, Manoharan M. Source: Methods Find Exp Clin Pharmacol. 1997 July-August; 19(6): 417-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9385591

•

An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium. Author(s): Bo-Linn GW, Davis GR, Buddrus DJ, Morawski SG, Santa Ana C, Fordtran JS. Source: The Journal of Clinical Investigation. 1984 March; 73(3): 640-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6707197

•

Calcium citrate: reduced propensity for the crystallization of calcium oxalate in urine resulting from induced hypercalciuria of calcium supplementation. Author(s): Harvey JA, Zobitz MM, Pak CY. Source: The Journal of Clinical Endocrinology and Metabolism. 1985 December; 61(6): 1223-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4055988

•

Calcium supplementation and bone mineral density in adolescent girls. Author(s): Lloyd T, Andon MB, Rollings N, Martel JK, Landis JR, Demers LM, Eggli DF, Kieselhorst K, Kulin HE. Source: Jama : the Journal of the American Medical Association. 1993 August 18; 270(7): 841-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8340983

•

Calcium supplementation and increases in bone mineral density in children. Author(s): Johnston CC Jr, Miller JZ, Slemenda CW, Reister TK, Hui S, Christian JC, Peacock M. Source: The New England Journal of Medicine. 1992 July 9; 327(2): 82-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1603140

•

Calcium supplementation: effect on iron absorption. Author(s): Cook JD, Dassenko SA, Whittaker P.

Alternative Medicine 17

Source: The American Journal of Clinical Nutrition. 1991 January; 53(1): 106-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1984334 •

Comparative absorption of calcium sources and calcium citrate malate for the prevention of osteoporosis. Author(s): Patrick L. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 1999 April; 4(2): 74-85. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10231607

•

Comparison of erosion of dental enamel by four drinks using an intra-oral applicance. Author(s): Rugg-Gunn AJ, Maguire A, Gordon PH, McCabe JF, Stephenson G. Source: Caries Research. 1998; 32(5): 337-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9701658

•

Daidzin suppresses ethanol consumption by Syrian golden hamsters without blocking acetaldehyde metabolism. Author(s): Keung WM, Lazo O, Kunze L, Vallee BL. Source: Proceedings of the National Academy of Sciences of the United States of America. 1995 September 12; 92(19): 8990-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7568058

•

Effect of calcium citrate supplementation on urinary calcium oxalate saturation in female stone formers: implications for prevention of osteoporosis. Author(s): Levine BS, Rodman JS, Wienerman S, Bockman RS, Lane JM, Chapman DS. Source: The American Journal of Clinical Nutrition. 1994 October; 60(4): 592-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8092096

•

Effect of calcium supplementation on blood pressure in children. Author(s): Gillman MW, Hood MY, Moore LL, Nguyen US, Singer MR, Andon MB. Source: The Journal of Pediatrics. 1995 August; 127(2): 186-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7636641

•

Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Author(s): Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G. Source: Annals of Internal Medicine. 1991 October 1; 115(7): 505-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1883119

•

Effects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial.

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Author(s): Reid IR, Mason B, Horne A, Ames R, Clearwater J, Bava U, Orr-Walker B, Wu F, Evans MC, Gamble GD. Source: The American Journal of Medicine. 2002 April 1; 112(5): 343-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11904107 •

Effects of calcium supplementation on serum lipid levels in postmenopausal women. Author(s): Heaney RP, Recker RR, Lappe JM. Source: The American Journal of Medicine. 2003 May; 114(7): 620-1; Author Reply 621. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12753892

•

Effects of divalent cations on the interaction of platelets with tumor cells: aggregation and perfusion studies with two homologous human systems. Author(s): Bastida E, Escolar G, Ordinas A, Giardina SL, Jamieson GA. Source: The Journal of Laboratory and Clinical Medicine. 1985 July; 106(1): 68-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4009024

•

Experimentally induced in vivo increase in size of calcium citrate crystals in praying mantids. Author(s): Kenchington W. Source: Journal of Insect Physiology. 1974 October; 20(10): 2043-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4423818

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Hyperphosphatemia: its consequences and treatment in patients with chronic renal disease. Author(s): Delmez JA, Slatopolsky E. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1992 April; 19(4): 303-17. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1562018

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Inhibitory effect of different anticoagulants on gamma-glutamyl transpeptidase activity. Author(s): Franco CF, Castro-e-Silva Junior O, Vieira IR, Souza ME, Picinato MA, Ceneviva R. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 1990; 23(9): 801-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1983192

•

Iron status, menarche, and calcium supplementation in adolescent girls. Author(s): Ilich-Ernst JZ, McKenna AA, Badenhop NE, Clairmont AC, Andon MB, Nahhas RW, Goel P, Matkovic V.


Source: The American Journal of Clinical Nutrition. 1998 October; 68(4): 880-7. Erratum In: Am J Clin Nutr 1999 March; 69(3): 577. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9771866 •

Lack of skeletal lead accumulation during calcium citrate supplementation. Author(s): Zerwekh JE, Pak CY. Source: Clinical Chemistry. 1998 February; 44(2): 353-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9474040

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Limited risk of kidney stone formation during long-term calcium citrate supplementation in nonstone forming subjects. Author(s): Sakhaee K, Baker S, Zerwekh J, Poindexter J, Garcia-Hernandez PA, Pak CY. Source: The Journal of Urology. 1994 August; 152(2 Pt 1): 324-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8015062

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Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. Author(s): Riggs BL, O'Fallon WM, Muhs J, O'Connor MK, Kumar R, Melton LJ 3rd. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 1998 February; 13(2): 168-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9495509

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Risk of calcium oxalate nephrolithiasis in postmenopausal women supplemented with calcium or combined calcium and estrogen. Author(s): Domrongkitchaiporn S, Ongphiphadhanakul B, Stitchantrakul W, Chansirikarn S, Puavilai G, Rajatanavin R. Source: Maturitas. 2002 February 26; 41(2): 149-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11836046

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Selenium intakes, absorption, retention, and status in adolescent girls. Author(s): Holben DH, Smith AM, Ilich JZ, Landoll JD, Holcomb JP, Matkovic V. Source: Journal of the American Dietetic Association. 2002 August; 102(8): 1082-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12171452

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Supplementation trials with calcium citrate malate: evidence in favor of increasing the calcium RDA during childhood and adolescence. Author(s): Andon MB, Lloyd T, Matkovic V. Source: The Journal of Nutrition. 1994 August; 124(8 Suppl): 1412S-1417S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8064394

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The effect of calcium supplementation and Tanner stage on bone density, content and area in teenage women.

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Author(s): Lloyd T, Martel JK, Rollings N, Andon MB, Kulin H, Demers LM, Eggli DF, Kieselhorst K, Chinchilli VM. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 1996; 6(4): 276-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8883115 •

Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. Author(s): Metts JF. Source: American Family Physician. 1999 March 15; 59(6): 1547-56, 1561-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10193596

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/

•


•

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/

•

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

•

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

•

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

The following is a specific Web list relating to calcium citrate; 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 Bladder Infection Alternative names: Urinary Tract Infection [UTI] Source: Prima Communications, Inc.www.personalhealthzone.com


Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Kidney Stones Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Healthnotes, Inc.; www.healthnotes.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Prima Communications, Inc.www.personalhealthzone.com •

Herbs and Supplements Aluminum Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Antacids Source: Prima Communications, Inc.www.personalhealthzone.com Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Uva Ursi Source: Prima Communications, Inc.www.personalhealthzone.com

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 CALCIUM CITRATE 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.5 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 “calcium citrate” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on calcium citrate, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Calcium Citrate By performing a patent search focusing on calcium citrate, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

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

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Calcium Citrate

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

Aqueous calcium citrate compositions Inventor(s): Saleeb; Fouad Z. (Pleasantville, NY), Vidal; Susan M. (Patterson, NY) Assignee(s): Kraft General Foods, Inc. (Northfield, IL) Patent Number: 5,219,602 Date filed: December 20, 1991 Abstract: An aqueous dispersion containing a finely divided reaction product of a calcium compound with citric acid having a mole ratio of calcium to citric acid from 2.5:2 to 2.95:2 is provided to be used for opacifying and whitening aqueous food compositions. Excerpt(s): This invention relates to aqueous compositions comprising certain calcium citrate salts and the use thereof, particularly in the food industry. Commonly assigned U.S. patent application Ser. No. 07/704,500 filed May 23, 1991, now U.S. Pat. No. 5,149,552 issued Sep. 22, 1992 which describes certain calcium citrate salt crystals. The dietary importance of low-fat, low-calorie, no cholesterol foods is well-documented in not only the scientific literature but also in the lay press. Considerable research effort has been, and is now being, expended to meet the requirements of new food technology. Thus, low fat food products such as cheeses, mayonnaise, pudding, pastries, salad dressings, margarines and the like have been developed based on non-fat substitutions in whole or in part for the fat content of classical foods. Such products necessitate new food additives and constituents of the new dietary food compositions. These new additives and constituents are mainly designed to improve appearance, color, mouthfeel, and induce other properties to assure public acceptability of the new dietary compositions. To be successful, such additives and constituents should be food acceptable and compatible with the compositions in which they are employed. For example, titanium dioxide has been used as a whitener in low fat compositions and is found to be compatible in these compositions. However, the food-acceptability of titanium dioxide has been challenged and is rejected in many countries, especially in Europe. Web site: http://www.delphion.com/details?pn=US05219602__

•

Baked goods, doughs or batters, dry mixes and methods for producing thereof Inventor(s): delValle; Frank (Croton-on-Hudson, NY), Gbogi; Emanuel O. (Tarrytown, NY), Saleeb; Fouad Z. (Pleasantville, NY) Assignee(s): Kraft General Foods, Inc. (Northfield, IL) Patent Number: 5,260,082 Date filed: September 16, 1992 Abstract: Improved baked goods, doughs or batters, dry mixes and methods for producing same are provided by the addition of a special calcium citrate reaction product to the flour-containing baking ingredients. Excerpt(s): The present invention relates to improved baked goods and to methods for producing same. More particularly, the invention relates to improved shelf-stable baked

Patents 25

or fried bakery products and the doughs used in making these products. Baked or fried bakery goods which incorporate the teachings of this invention have been found to have improved texture, mouthfeel, softness, moistness, moisture retention among other highly desirable properties. The products of this invention further relate to a shelfstable, refrigerated or freezer baked product which when reheated in a microwave oven will retain its palatability. Problems have arisen with the use of microwave energy for heating traditional yeast-raised food products such as bread and roll products. Traditional bread and roll products become impalatable after short exposures to microwave energy. The term palatable or palatability refers to the eating quality of food products. Palatable food products are agreeable to the taste and possess an appetizing appearance and texture. Upon exposure to microwave energy, the crust of traditional bread and roll products becomes extremely tough and/or soggy as water present within the baked good migrates to the surface crust but does not evaporate off. The crust of such microwave exposed products may become so tough that it is difficult to tear such products. The bread product itself may become soggy or develop hard lumpy portions. The crumb of the products becomes rubbery and gummy and is difficult to chew. Consequently, traditional bread and roll products, upon exposure to microwave energy, are not palatable. Web site: http://www.delphion.com/details?pn=US05260082__ •

Binders for foundry cores and moulds Inventor(s): Morley; John G. (Kings Coughton, near Alcester, GB2) Assignee(s): BCIRA (Birmingham, GB2) Patent Number: 4,588,013 Date filed: March 29, 1985 Abstract: A binder for a foundry core or mould consists of an alkali metal salt of a polybasic organic acid or of a polymerized monobasic organic acid, for example sodium polyacrylate, an alkaline earth metal hydroxide such as calcium hydroxide, one or more polyvalent metal oxides, preferably magnesium oxide, and calcium citrate, together with water. The mixture may also include another polyvalent metal oxide, for example zinc oxide. The inclusion of calcium citrate in the binder composition, particularly in the presence of magnesium oxide, has been found to reduce the problem of `softening back` in which the strength of the core or mould interior deteriorates over storage periods of a few days due to the continued absorption of carbon dioxide from the atmosphere in damp conditions. Excerpt(s): Various processes are at present in use for binding together the grains of refractory material (generally sand) used to form foundry cores and, less often, moulds. In our British patent application No. 8228716, GB publication No. 2 112 003, we describe a process in which a binder comprising an alkali metal salt of a polybasic organic acid or of a polymerised monobasic organic acid and an alkaline earth metal hydroxide is hardened by passing an acid gas through the refractory mixture, the preferred materials being sodium polyacrylate, calcium hydroxide and carbon dioxide respectively. It has been found that the storage strengths of cores produced from mixtures described in GB 2 112 003 have been good provided that the cores have been stored in conditions in which the relative humidity did not exceed about 70 percent. At higher humidities relatively large cores of about 10 kg weight and above have shown a `softening back` problem, in which the strength of the core interior has deteriorated over two or three day storage periods to such an extent that the interior sand became soft and damp. This

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can cause the cores to fracture in thin sections, or in areas of high stress during transport of the cores or when laying the cores in the mould. Web site: http://www.delphion.com/details?pn=US04588013__ •

Calcium and trace mineral supplements Inventor(s): Saltman; Paul D. (La Jolla, CA), Smith; Kenneth T. (Cincinnati, OH) Assignee(s): Regents of the University of California (Oakland, CA), The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,151,274 Date filed: August 6, 1990 Abstract: Nutritional mineral supplements comprising calcium citrate malate and salts of manganese, copper and zinc are disclosed. These supplements, which provide at least 25% RDA of the minerals, and used in addition to the normal diet. These supplements are useful for increasing bone growth and for treating age-related bone loss in humans and animals. Excerpt(s): The present invention relates to nutritional improvements in calcium supplements containing trace minerals, in particular copper, manganese and zinc. These supplements are useful for increasing bone growth and treating age-related bone loss. They can be used in conjunction with foods and beverages or taken as an oral solid or liquid supplement. The invention also relates to a method of building bone or treating bone loss in osteoporosis patients and post-menopausal women. Vitamin and mineral supplements for human and veterinary use are commonplace. Some diets, heavy physical exercise and disease conditions may require the intake of considerable quantities of minerals apart from those generally obtained through what otherwise would be considered a normal diet. Calcium and trace mineral supplementation is important primarily for those who have inadequate diets, including growing children. Older adults have an additional need for calcium to help prevent the bone loss which occurs as a normal consequence of the aging process. In particular, postmenopausal women need additional calcium due to hormonal changes which can accelerate the bone loss rate leading to a further diminishment in bone mass. The trace minerals which affect bone growth are copper, zinc and manganese. Supplementation of the diet with these minerals along with a highly bioavailable source of calcium is highly desirable. Commercially available mineral supplements are useful in many circumstances where increased mineral intake is desirable. Most of these multi-vitamin and multi-mineral tablets are low in calcium, requiring separate supplementation with calcium sources. In addition, not all calcium sources are equal in terms of bioavailability and absorption. It would be more convenient if all of the minerals could be administered conjointly in a convenient and/or pleasant tasting form which would not require extra attention, planning and implementation by the user. This could be done in the form of foods and beverages as well as in the form of tablets. Web site: http://www.delphion.com/details?pn=US05151274__

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Calcium citrate-vegetable oil compositions Inventor(s): Cante; Charles J. (Pleasantville, NY), Gbogi; Emmanuel O. (Tarrytown, NY), Saleeb; Fouad Z. (Pleasantville, NY) Assignee(s): Kraft General Foods, Inc. (Northfield, IL) Patent Number: 5,194,270 Date filed: December 20, 1991 Abstract: A vegetable oil-based composition containing finely divided special type of calcium citrate salt compositions and processes of making are provided to produce semi-solid to solid vegetable oil compositions without the use of hydrogenation. Excerpt(s): This invention relates to semi-solid to solid, normally liquid vegetable oil compositions and the use thereof, particularly in the food industry. Commonly assigned U.S. patent application Ser. No. 07/704,500, filed May 23, 1991, which describes certain calcium citrate salt crystals. Vegetable oils are most desirable natural forms of lipids to be used for diet purpose The role of lipids, i.e. fats, which are saturated or comprise trans unsaturated fatty acid glycerides in blood circulatory problems is well known. The use of vegetable oils which are comprised of cis-unsaturated fatty acid triglyceride in lieu of the aforesaid saturated fats or trans-unsaturated fatty acid triglycerides has been highly recommended to avoid the blood circulatory problems of the latter fats. Web site: http://www.delphion.com/details?pn=US05194270__

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Calcium fortified dressing salad product Inventor(s): Burkes; Alice L. (Cincinnati, OH), Fox; Mary M. (Fairfield, OH), Luhrsen; Kenneth R. (Aurora, IN) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,215,769 Date filed: August 13, 1992 Abstract: This invention relates to sauces and salad dressings containing a soluble calcium source comprising specific molar ratios of calcium, citrate and malate or calcium acetate. The calcium composition is more soluble in these products than calcium citrate or calcium carbonate. The calcium citrate malate consists of a metastable complex salt. A calcium fortified vinegar is also disclosed. Excerpt(s): This invention relates to sauces and salad dressings containing a soluble calcium source comprising specific molar ratios of calcium, citrate and malate or calcium acetate. The calcium citrate malate composition is more soluble than calcium citrate or calcium carbonate, and consists of a metastable complex salt. Calcium is a mineral that is important for building bones and teeth. One of the problems with supplementation of the diet with calcium is that all sources of calcium are not equally soluble or bioavailable. In addition, some calcium sources are not as pure as other sources. For example, calcium carbonate derived from bone meal, oyster shell, or other biological origins contains trace amounts of lead and other minerals. Some calcium carbonates also contain silica. Therefore, it is necessary to take additional amounts of these materials to achieve the same calcium level as those taken from synthetic sources which are essentially pure calcium carbonate. Calcium citrate is poorly soluble in water; calcium malate is more soluble. Calcium hydroxide is somewhere in between these salts. The hydroxide absorbs carbon dioxide from the air readily forming calcium carbonate.

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Calcium salts readily hydrate even when stored in dry cool places. Therefore, the amount of calcium being delivered by any pill or preparation may be even less than expected because of the large amount of water absorbed by the salts. Web site: http://www.delphion.com/details?pn=US05215769__ •

Calcium supplements Inventor(s): Jacobs; Stephen A. (Fairfield, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,314,919 Date filed: February 6, 1991 Abstract: A calcium citrate malate complex or mixture having a molar composition of calcium:citrate:malate of about 6:2:3. The calcium citrate malate is preferably administered in an oral dosage form, containing pharmaceutically-acceptable carriers and excipients. Excerpt(s): This invention relates to a novel material and composition useful as a calcium supplement for humans and other animals. In particular, this invention relates to specific calcium citrate malate materials and dosage forms containing such materials. Calcium is the fifth most abundant element in the human body. It plays an important role in many physiological processes, including nerve and muscle functions. Not surprisingly, nutritional and metabolic deficiencies of calcium can have broad-ranging adverse effects. Since about 90% of the body's calcium is found in bone tissues, many of these adverse effects are manifested through deficiencies in the structure, function and integrity of the skeletal system. The most common metabolic bone disorder is osteoporosis. Osteoporosis can be generally defined as the reduction in the quantity of bone, or the atrophy of skeletal tissue. In general, there are two types of osteoporosis: primary and secondary. "Secondary osteoporosis" is the result of an identifiable disease process or agent. However, approximately 90% of all osteoporosis cases is idiopathic "primary osteoporosis". Such primary osteoporosis includes postmenopausal osteoporosis, age-associated osteoporosis (affecting a majority of individuals over the age of 70 to 80), and idiopathic osteoporosis affecting middle-aged and younger men and women. Web site: http://www.delphion.com/details?pn=US05314919__

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Chemical removal of dental plaque Inventor(s): Sayles; David C. (Huntsville, AL), Wilkinson; Edward L. (New Hope, AL) Assignee(s): The United States of America as represented by the Secretary of the Army (Washington, DC) Patent Number: 4,819,675 Date filed: May 5, 1988 Abstract: A method and a product employed in the method for the mechanical and cheml removal of dental plaques are disclosed. The method comprises providing cotton filaments of a size suitable for passing between teeth as a dental floss, chemically impregnating the cotton filaments by soaking in a saturated solution of potassium hydrogen tartrate and potassium hydrogen citrate, subsequently drying the chemically

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impregnated cotton fibers, and passing the dried chemically impregnated cotton filaments in the form of a dental floss between teeth and over the surfaces of the teeth containing plaque compositions including a calcium phosphate to thereby convert the calcium phosphate to the more soluble compounds calcium citrate and calcium tartrate which go into solution and the plaque is, thus, removed from the surfaces of the teeth. The method can alternately include the wetting agent polyoxyethylated sorbitan monooleate to enhance the penetration of the impregnated chemicals through mucin for reaction with calcium phosphate. The product prepared as described hereinabove can also be coated with paraffin wax after the drying step is completed and prior to using the product as a chemically impregnated dental floss. Excerpt(s): Plaque is a localized abnormal patch on a body part or surface. Plaque which tightly binds to a tooth's surface in the form of a deposit is the subject matter to which the present invention relates. The source of this plaque is saliva which is a mixed secretion, produced mainly by three pairs of glands, the submaxillary, sublingual and parotid and to a lesser extent by the mucous membrane and the buccal glands of the mouth, throat and esophagus. It is a viscous, frothy, slightly opalescent fluid containing many substances. The salivary glands possess two kinds of cells: the serous or albuminous which secretes a fluid containing calcium phosphate, protein and enzyme; and the mucous cells which secrete a ropy fluid containing the glycoprotein mucin. A mixed secretion is obtained from the submaxillary gland which has both serous and mucous cells. The sublingual glands are chiefly mucous, and the parotid glands are chiefly serous. On the basis of analysis by various investigators, the water content of human mixed saliva may be set at approximately 99.4 percent. The amount of total solids is 0.6 percent, about one-third is composed of inorganic constituents and the remainder of organic substances, including mucin, enzymes and epithelial cell debris. The pH of saliva (-log [H+]) varies from 5.75 to 7.05. The reaction of saliva, however, is usually slightly acidic, and the salivary pH falls just before and remains low just after meals. Between meals, the reaction of saliva approaches neutrality. Web site: http://www.delphion.com/details?pn=US04819675__ •

Chewable, non-gritty calcium citrate tablet Inventor(s): McNamee; Adrian G. (Scarborough, CA), Scheurer; Heinrich P. (Scarborough, CA) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 4,882,161 Date filed: December 31, 1987 Abstract: A non-gritty chewable calcium tablet comprising a granulation having a bulk density of about 0.3 g/ml to about 1.5 g/ml, said granulation comprising micronized calcium citrate, a sweetener and a lubricant. The calcium particle size is in the range of about 0.1 micronmeters to about 10 micronmeters. Excerpt(s): This invention concerns a non-gritty, chewable calcium tablet which has improved palatability and calcium bioavailability due to the use of a granulation of micronized citrate, sweetener and lubricant. More specifically, the granulation has a specified bulk density and micronized calcium citrate particle size range which are critical to the formation of a non-gritty chewable tablet having readily available calcium. The use of calcium citrate is well known as a source of calcium in nutrient supplements and the like. Calcium citrate is disclosed in the literature as actually being more readily

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bioavailable than other more commonly used calcium salts such as calcium carbonate and calcium phosphate. Calcium has been recognized recently as a potential means of minimizing osteoporotic development, particularly in post menopausal women and aging people of both sexes. Additionally, the citrate form is reported as raising urinary citrate, which may retard the formation of calcium kidney stones, a concern for those ingesting large amounts of calcium on a regular basis. The disadvantage of forming a chewable tablet with calcium salts is the objectionable grittiness and mouth feel which result in an unpalatable and commercially unacceptable product. Since the intake of calcium is particularly important to certain classes of people, such as postmenopausal women and the elderly, it is critical that a product be available which encourages a high compliance to the prescribed daily regimen to insure adequate intake. Tablets are commercially available using calcium carbonate as the calcium source, but as previously discussed, calcium in this form is not believed to be as bioavailable as calcium citrate. Calcium citrate, on the other hand, is commercially available only in its crystalline form in a size range of about 60 to 100 mesh (U.S. standard), equivalent to about 250 to 150 micrometers. Compressed tablets formed from calcium citrate in these particle ranges result in tablets which are extremely gritty and unpalatable. Such tablets would not be considered commercially acceptable to patients for whom compliance may be a concern. Web site: http://www.delphion.com/details?pn=US04882161__ •

Dietary food enhancement agent Inventor(s): Bangs; William E. (Philadelphia, PA), Khoo; Chor San Heng (Mt. Laurel, NJ), Ko; Sandy (Abington, PA) Assignee(s): Campbell Soup Company (Camden, NJ) Patent Number: 6,039,978 Date filed: September 20, 1996 Abstract: The invention is a dietary food enhancement agent for fortifying food products. The agent includes a premixed combination of Vitamin A, Vitamin B.sub.1, Vitamin B.sub.2, Vitamin B.sub.6, Vitamin B.sub.12, Vitamin C, Vitamin D, Vitamin E, Vitamin K, Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Pantothenic Acid, Phosphorus, and Zinc. Further, calcium may be supplied by a combination of calcium citrate and dicalcium phosphate, the phosphorus is supplied by a combination of dicalcium phosphate and magnesium phosphate, and the magnesium is supplied by magnesium phosphate. Excerpt(s): This invention relates generally to therapeutic systems and methods for dietary health management, i.e., the prevention, treatment, or reduction of risk factors associated with diet-responsive conditions, or a combination thereof In particular, it relates to systems providing a choice of prepackaged, easy to prepare, and good tasting, therapeutic meals which are intended to improve the health and quality of life of patients utilizing the system. Further, it relates to the fortification of meals and food products for use with such a system. As confirmed by clinical trials, the systems and methods disclosed herein achieve improvements in quantifiable indicators of dietresponsive conditions, improved quality of life, and a high degree of compliance. People have become increasingly aware of the importance of a proper diet for health maintenance and disease prevention and treatment. Unfortunately, because numerous different and often conflicting dietary guidelines are presented in such complex manners, it is often very difficult for a person attempting to follow a diet for health and disease management (hereinafter a "patient") to understand and fully and effectively

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implement a healthy diet. For example, a diet which maximizes health and disease management concerns might control the intake of simple sugars, cholesterol, and different quantities and types of fat, as well as calories, while also attempting to optimize levels of macro- and micronutrients, e.g., protein, carbohydrates, and fat, and vitamins and minerals, and to provide adequate dietary fiber. As suggested above, however, the problem of planning and maintaining a healthful diet goes beyond the usual health concerns and exists with respect to special diet situations, including those associated with diet-responsive conditions, such as cardiovascular disease (hypertension and hyperlipidemia), diabetes and cancer. Diet planning assistance available to patients has been of limited value and often fails to satisfy long term compliance. Much additional planning has been left in the hands of patients who usually lack sufficient knowledge in the field of nutrition to fully and properly implement an adequate diet plan as part of a system or method for health management. More specifically, prior approaches to the planning and maintenance of a patient's diet have supplied the patient with general food and beverage categories to be consumed or avoided: for example, meat, eggs, and fish; fruits and vegetables; breads and cereals; and dairy products. Such approaches generally fail to achieve their desired goal, however, because patients do not consume general food and beverage categories; instead, they consume complex meals composed of specific foods and beverages. Even within these broad categories, specific foods and beverages are so diverse that it is often difficult for patients to convert the broad categories into meals, i.e., to plan actual diets, while still maintaining adequate consumption of protein, carbohydrates, fat, sugars, cholesterol, fiber and other macro- and micronutrients meeting the dietary guidelines. Web site: http://www.delphion.com/details?pn=US06039978__ •

Dried fruits and cereal combinations thereof Inventor(s): Kearns; Joyce M. (New City, NY), Saleeb; Fouad Z. (Pleasantville, NY) Assignee(s): Kraft General Foods, Inc. (Northfield, IL) Patent Number: 5,223,287 Date filed: August 25, 1992 Abstract: Improved dried fruits having improved handling and physical properties are provided by coating the fruits with a finely divided specially prepared calcium citrate reaction product. Also included is the combination of these improved dried fruits with dry cereals. Excerpt(s): This invention relates to improved dried fruits and particularly to new dried fruit products having improved properties initially and upon storage. Additionally, the invention includes the combination of these dried fruits with dry cereals. There is a long history of the desirability of and necessity for dried fruit products. Many of these products are simply dried under naturally occurring sunny conditions, such as raisins and other fruits are dried under controlled industrial conditions to protect the color, flavor and texture of the products. The known commercial processes leave much to be desired in terms of handling, processing and the ability of the products so dried to remain desirably soft and natural looking over extended periods of time with minimal changes in color and flavor. Several techniques are known to obtain dried fruits having highly desirable softness properties. One such technique is the infusion of dried fruits with sugar. U.S. Pat. No. 4,350,711 entitled "Methods of Infusing Fruits" issued Sep. 21, 1982 describes methods for incorporating sugar solids such as fructose to provide a soft and edible consistency even at freezing temperatures. U.S. Pat. No. 4,364,968 entitled

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"Process for Preparing a Dried Grape Product" describes a dehydration technique wherein grapes are immersed in an aqueous hydrophillic carbohydrate solution such as fructose, glycerol, corn syrup and the like having a concentration effective to provide significant osmotic withdrawal of water, removing the excess solution and drying to develop a natural raisin-like flavor. Although these dried fruit products as described provide satisfactory products, there is a significant disadvantage in the handling of these products because on storage these products tend to clump and on standing can further dehydrate losing softness properties as well as flavor properties. Web site: http://www.delphion.com/details?pn=US05223287__ •

Frozen surimi product and process for preparing Inventor(s): Ebisu; Takashi (Shizuoka, JP), Hatayama; Shizuo (Kanagawa, JP), Naito; Mayuko (Shizuoka, JP), Okubo; Takeshi (Tokyo, JP), Yamamoto; Yasuhiro (Shizuoka, JP) Assignee(s): Towa Chemical Industry Co., Ltd. (Tokyo, JP) Patent Number: 5,028,444 Date filed: November 22, 1989 Abstract: The present invention relates to quality-improving agents for Frozen SURIMI which is used as a raw material of fish pastes, and also relates to a process for preparing Frozen SURIMI which comprises using such quality-improving agents. The qualityimproving agents for addition to Frozen SURIMI comprise, as an effective ingredient, a mixture of sodium bicarbonate, calcium citrate and calcium lactate. Excerpt(s): This invention relates to quality-improving agents for Frozen SURIMI (ground frozen fish) useful as a raw material for fish pastes such as KAMABOKO (fish jelly) and a process for preparing Frozen SURIMI using the same. Items considered to be extremely important among items for quality evaluation of fish pastes such as KAMABOKO are whiteness and elasticity. In preparation of fish pastes excellent in such whiteness and elasticity, it is the quality of Frozen SURIMI that has the most influence on these quality evaluating items, and it is freshness of the fish that has the most influence on the quality. Web site: http://www.delphion.com/details?pn=US05028444__

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Method of preparing fruit juice beverages and juice concentrates nutritionally supplemented with calcium Inventor(s): Heckert; David C. (Oxford, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 4,919,963 Date filed: December 11, 1987 Abstract: The method for preparing these beverages and concentrates involves forming a premix solution containing highly soluble calcium citrate and malate species which is then combined with concentrated fruit juice, plus other fruit juice materials. This method provides beverages and concentrates which contain substantial levels of solubilized calcium without generating cooked/browned off-flavors and without including undesirable species such as chloride ions.

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Excerpt(s): This application relates to fruit juice beverages and juice concentrates which are nutritionally supplemented with significant levels of calcium. This application further relates to a method for preparing these beverages and concentrates. Dietary calcium inadequacy may be a contributing cause to osteoporosis, at least for some populations. For example, a positive correlation between calcium intake and bone mass has been found across many age groups. It has also been suggested that the level of calcium intake early in life directly influences the peak bone mass achieved at skeletal maturity. During the period of late teenage to young adulthood, it has been found that a significant reduction in dietary calcium intake typically occurs. This is especially true of the female population where reduced dietary calcium intake usually happens much earlier in life compared to their male counterparts. Accordingly, females, as a class, are especially susceptible to a prolonged calcium deficit over their life span. This calcium deficit may be one reason for the greater incidence of osteoporosis in postmenopausal women. Web site: http://www.delphion.com/details?pn=US04919963__ •

Method of preventing tooth enamel erosion utilizing an acidic beverage containing calcium Inventor(s): Andon; Mark B. (Fairfield, OH), Kanerva; Robert L. (Cincinnati, OH), Rotruck; John T. (Oxford, OH), Smith; Kenneth T. (Cincinnati, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,108,761 Date filed: October 1, 1990 Abstract: Acidic beverages, e.g. juices and carbonated beverages containing calcium citrate malate are disclosed. These beverages inhibit the erosion of tooth enamel that normally occurs during consumption of acidic beverages. A nutritional regimen of administering an acid beverage (pH below 5.5) containing from 35 mg to 270 mg calcium per 6 ounce (180 ml) serving (0.02% to 0.15% w/v of calcium) in the form of calcium citrate malate, for preventing tooth enamel erosion is disclosed. This beverage comprises water, sweetener and flavor or juice. Excerpt(s): The present invention relates to nutritional and healthful improvements in acidic beverages. When these beverages are supplemented with calcium and specific molar ratios of malic and citric acids, the beverages inhibit the erosion of tooth enamel caused by contact with the acid. Commonly preferred sources of vitamin C include orange Juice and other citrus products, in particular, lemons. However, it has been recognized for a long time that these juices, due to their high acid content, can erode or etch the tooth enamel. Citrus juices are not alone in this effect. Nectars, fruit punches, carbonated soft drinks, including colas and other fruit flavored drinks also have this effect on tooth enamel. In fact, any beverage with a pH of less than 5.5 has this effect. These beverages, aside from their sugar content, are becoming increasingly popular among all ages of consumers and are replacing coffee and tea as the most popular beverage products. There has been a desire, especially on the part of dentists to lessen the intake of these acid beverages which can cause this erosion. Web site: http://www.delphion.com/details?pn=US05108761__

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Osteoporosis inhibition by dietary calcium supplementation Inventor(s): Pak; Charles Y. C. (Dallas, TX) Assignee(s): Board of Regents, U T Systems (Austin, TX) Patent Number: 4,772,467 Date filed: December 11, 1985 Abstract: A process for dietary calcium supplementation. Oral dosage of a composition comprising calcium citrate is utilized to provide an efficiently absorbable chemical form of calcium, while raising urinary level of citrate. Because of improved absorption of calcium, osteoporosis development is precluded. Since citrate retards precipitation of stone-forming calcium stones, the risk of calcium nephrolithiasis (resulting from calcium supplementation) is reduced. Excerpt(s): The mineral calcium is an important human dietary component. Calcium is required for adequate bone formation and maintenance, as well as for diverse metabolic functions. These diverse metabolic functions of calcium are incompletely understood but likely to involve, at least in part, the alteration and functional control of proteins such as enzymes, and of hormones that regulate bone metabolism. An assurance of adequate dietary calcium intake is thus important for normal development, metabolism and maintenance. Dietary calcium intake alone however is insufficient to assure that adequate calcium levels are available for required body functions. Dietary calcium must be absorbed from the digestive tract before it may be utilized. The efficiency of calcium absorption is determined by several factors, including the physiological status of the patient and the particular chemical form of ingested calcium. However, a part of the absorbed calcium is eliminated in urine, which poses a problem for certain subjects who are prone to the formation of calcium-containing kidney stones (calcium nephrolithiasis). Thus, the amount of calcium intake and efficiency of calcium absorption could influence two clinical conditions, osteoporosis and calcium nephrolithiasis. Web site: http://www.delphion.com/details?pn=US04772467__

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Psyllium drink mix compositions Inventor(s): Daggy; Bruce P. (Mason, OH), Hord; Lee A. (Mason, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,356,618 Date filed: May 14, 1993 Abstract: Psyllium husk-containing drink mix compositions comprising calcium citrate malate. Excerpt(s): The present invention relates to psyllium husk-containing drink mix compositions comprising the salt calcium citrate realate. This salt provides the benefit of reducing the gellation rate of the psyllium husk when dispersed in an aqueous solution. Products containing psyllium seed husk are known (for example, Metamucil.RTM., sold by The Procter & Gamble Company). Such products are useful for the benefit of normalizing bowel function and laxation. In addition, recent research has demonstrated the effectiveness of psyllium seed husk fiber in reducing human serum cholesterol levels and in controlling blood glucose levels in diabetics. Psyllium seed husk contains natural mucillage. It forms a gellatinous mass on contact with water, and it exhibits poor

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dispersibility and mixability in water. Dispersibility and mixability of psyllium husk in aqueous solutions have been shown to be improved by utilizing higher levels of sugar, and by coating the husk with materials such as maltodextrin. Web site: http://www.delphion.com/details?pn=US05356618__ •

Skin care compositions Inventor(s): Henderson; Esther G. (11641 Harrells Ferry Rd., Apt. D, Baton Rouge, LA 70816) Assignee(s): none reported Patent Number: 5,296,476 Date filed: April 30, 1991 Excerpt(s): The present invention relates to a topical skin care formulation comprised of micronized calcium citrate and salicylic acid. This composition provides a method for treating acne as well as providing for a variety of skin beautification products which are especially applicable to sensitive skin. Skin care formulations have been previously formulated utilizing a great variety of components including salicylic acid. For example, U.S. Pat. Nos. 3,265,571, 4,318,907, 2,942,008 and 3,236,730 all disclose formulations which incorporate salicylic acid in their acne treating compositions calcium citrate is also found in a variety of products and is included in the "Generally Regarded as Safe" (GRAS) classification by U.S. Food and Drug Administration. It has been utilized as a source of calcium for humans rather than as an active ingredient in medications. An exception to its use as a medicament is U.S. Pat. No. 2,719,811 which discloses the use of a variety of water soluble metal complexes including calcium citrate which is used as a stimulating agent for cellular respiration. The applicant of the instant formulation holds U.S. Pat. No. 4,393,045, which is a process in which the lining of mollusk shells were admixed with the extrudate of citric acid and was found to be effective in the treatment of skin care symptoms such as acne. After the issuance of the above patent, applicant found that it would be advantageous to include a keratolytic agent such as salicylic acid in the composition. The inventor found that by combining the calcium citrate with salicylic acid in the manner shown herein, that the results effected by each ingredient alone, were enhanced, not only as to effectiveness but also as the variety of application for skin care and topical analgesic products. Web site: http://www.delphion.com/details?pn=US05296476__

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Sweetener supplement fortified with a concentrated bioavailable calcium source and process of making Inventor(s): Burkes; Alice L. (Cincinnati, OH), Fox; Mary M. (Fairfield, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,445,837 Date filed: January 21, 1994 Abstract: A sweetener supplement compositions which provides a bioavailable source of calcium and are stable from calcium salt precipitation for at least about four hours at temperatures of at least about 85.degree. F. (29.degree. C.). The compositions comprise:a) from about 0.6% to about 7%, by weight, soluble calcium;b) from about 2%

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to about 47%, by weight, of an edible acid component comprising a mixture of citric acid and malic acid wherein the ratio of citric equivalents and malic equivalents to calcium equivalents is from about 1.5:1 to about 2:1 and the ratio of citric equivalents to malic equivalents is from about 3:97 to about 93:7;c) from about 5% to about 80%, on a dry weight basis, sugar, wherein preferably at least about 15% of said sugar is fructose, on a dry weight basis; andd) from about 5% to about 92%, by weight, water.The present invention also relates to methods of making said sweetener supplements, foods and beverages containing them and to methods of enhancing the solubility and bioavailability of calcium citrate malate. Excerpt(s): The present invention relates to sweetener supplements which are nutritionally supplemented with significant levels of concentrated calcium citrate malate and to methods for making said supplements. The supplements are for use in foods, beverages and pharmaceuticals. When a member of the general public is asked to define "sugar", a typical given description is "a sweet tasting granular substance". In the nutritional art "sugar" typically refers to a carbohydrate such as glucose, sucrose, maltose, fructose, sugar alcohols, low molecular weight dextrins and related carbohydrates. In the art, the broader term "sweeteners" includes both sugar and artificial sweeteners such as Aspartame.RTM. saccharin, and the like. Fructose is the sweetest of the common sugars and is commonly used in foods and beverages in such forms as high fructose corn syrup or invert syrup. Due to its high hygroscopicity, powdered or crystalline fructose is very expensive and hard to make. Crystalline fructose is very hygroscopic and will begin to absorb moisture at 60% relative humidity. To prevent water absorption and to avoid difficulties in processing and packaging, crystalline fructose's recommended storage conditions are 77.degree. F. (25.degree. C.) or lower, and 50% or less relative humidity. Due to hygroscopicity and storage requirements of crystalline fructose, fructose in the form of syrups comprising about 77% solids and 23% water, wherein 42% to 99% of the solids are fructose, are used in making many food and beverage products. Liquid sweeteners such as Domino's liquid brown sugar, Karo light corn syrup, and Pillsbury Sweet 10 are often purchased by the consumer because of their ease of usage and dissolvability. Manufacturers of food and beverage products purchase large quantities of liquid sweeteners such as high fructose corn syrup, NETO.RTM., and liquid sucrose to reduce preparation time. Web site: http://www.delphion.com/details?pn=US05445837__ •

Ultradense and more soluble and bioavailable preparations of calcium citrate Inventor(s): Alexandrides; George (San Antonio, TX), Pak; Charles Y. C. (Dallas, TX), Walsdorf; Neill B. (San Antonio, TX) Assignee(s): Board of Regents, University of Texas System (Austin, TX), Mission Pharmacal (San Antonio, TX) Patent Number: 4,814,177 Date filed: August 13, 1986 Abstract: A calcium citrate composition having a bulk density greater than about 1.1 g/cc. Citric acid and a calcium compound are mixed to produce a mixture having a calcium compound/citric acid molar ratio of about 1.5. A hydrated mixture percent is produced by agitatively adding water to the mixture, although when desired the calcium compound, citric acid and water mayBACKGROUND OF THE INVENTIONA portion of the development of the present invention was supported by Grant No. P01AM 20543 from the United States Government, National Institutes of Health.

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Excerpt(s): The mineral calcium is an important human dietary component. Calcium is required for adequate bone formation and maintenance, as well as for diverse metabolic functions. These diverse metabolic functions of calcium are incompletely understood but likely to involve, at least in part, the alteration and functional control of proteins such as enzymes. An assurance of adequate dietary calcium intake is thus important for normal development, metabolism and maintenance. Dietary calcium intake alone however is insufficient to assure that adequate calcium levels are available for required body functions. Dietary calcium must be absorbed from the digestive tract before it may be utilized. Furthermore, the urinary excretion of absorbed calcium must be considered, particularly for individuals who may be subject to the formation of calcium-containing kidney stones. The intestinal absorption of calcium is enhanced by vitamin D and may also be affected by the particular chemical form of ingested calcium. Web site: http://www.delphion.com/details?pn=US04814177__

Patent Applications on Calcium Citrate As of December 2000, U.S. patent applications are open to public viewing.6 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 calcium citrate: •

Method of administering calcium citrate Inventor(s): Reid, Ian R.; (Auckland, NZ) Correspondence: Fulbright & Jaworski, Llp; 1301 Mckinney; Suite 5100; Houston; TX; 77010-3095; US Patent Application Number: 20020128320 Date filed: December 10, 2001 Abstract: The present invention describes a method of increasing the high-density lipoprotein level in plasma by administering to a postmenopausal woman a pharmaceutical formulation comprised of calcium citrate. The invention also provides for a pharmaceutical composition and a dietary supplement thereof. Excerpt(s): The invention is related to the field of medicine and physiology and pertains to the administration of calcium citrate to improve serum lipid levels in a postmenopausal woman. Calcium forms hydroxyapatite, the major mineral constituent of bone, and is an essential element in many biological processes, including mediating some hormonal signals, triggering muscle contraction, transmitting nerve impulses and blood clotting. As a consequence, calcium is vital to normal bone formation and maintenance of bone density. Long-term dietary calcium insufficiency almost always results in net loss of calcium from the bones. The U.S. recommended daily allowance (RDA) for calcium is 800 mg/day, with an additional 400 mg advisable for pregnant and lactating women. A large proportion of the over-60 population consumes less than onehalf of the RDA for calcium. This is also the age group most at risk of developing osteoporosis, which is characterized by loss of the organic matrix as well as progressive demineralization of the bone. Calcium supplementation is widely recommended and used amongst postmenopausal women for prevention of osteoporosis (Genant et al.,

6

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

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1999), and consistent evidence from randomized controlled trials have demonstrated that calcium supplementation slows postmenopausal bone loss (Dawson-Hughes, et al., 1990; Reid et al., 1993). There is also some evidence that calcium supplementation prevents fractures in postmenopausal women (Chevalley et al., 1994; Reid et al., 1995; Recker et al., 1996). Other benefits from the use of calcium supplements have been suggested, including effects on colon cancer, blood pressure and serum lipids (BargerLux et al., 1994). The suggestion that calcium intakes impacts serum lipid concentrations has arisen from human and animal studies which indicate that calcium binds to fatty acids and bile acids in the gut, thereby interfering with their absorption (Govers et al., 1993; Denke et al., 1993; Mitchell et al., 1968). However, these suggestions are counterbalanced by studies showing no effect of calcium supplementation on circulating lipid concentrations (Mitchell et al., 1968; Bostick et al., 2000). As a result, the entire span of health benefits afforded by calcium supplementation has remained unrealized. There has been no long-term randomized controlled trial to address the many discrepancies, including no adequate studies in normal postmenopausal women, the group most commonly using calcium supplementation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

POTASSIUM CALCIUM CITRATE COMPOSITIONS AND METHODS THEREFOR Inventor(s): ALEXANDRIDES, GEORGE; (SAN ANTONIO, TX), PAK, CHARLES Y. C.; (DALLAS, TX), WALSDORF, NEILL B.; (SAN ANTONIO, TX) Correspondence: Akin, Gump, Strauss; Hauer & Feld, L.L.P.; 300 Convent Street,; Suite 1500; San Antonio; TX; 78205; US Patent Application Number: 20010003002 Date filed: July 19, 1999 Abstract: A composition useful as a dietary supplement for providing potassium, calcium, and citrate is presented, as well as processes for producing the composition, and methods for using the composition as a dietary supplement. Administration of the composition counters bone loss associated with aging or menopause by providing bioavailable calcium and, simultaneously, delivering alkali load. In addition, administration of the composition produces a substantial increase in urinary citrate, which counters kidney-stone formation. Excerpt(s): The present invention relates to a composition comprising high bulk density potassium calcium citrate as a single compound, wherein the molar ratio of potassium to calcium to citrate in the single compound is 1:1:1, or 4:1:2, respectively. The present invention also relates to processes for producing the composition in a solid form having a bulk density from about 0.8 g/cc to about 1.3 g/cc, as well as methods for using the composition as a dietary supplement, for example, to counter bone loss while avoiding kidney-stone formation. Mineral compositions are commonly taken as dietary aids, either as therapeutic preparations directed to a specific medical problem or as general nutritional supplements. Among useful dietary supplements are dosage units of calcium citrate, orally administered in solid or liquid form (U.S. Pat. Nos. 4,772,467, 4,814,177, and 4,851,221; each patent herein incorporated by reference). Oral administration of calcium citrate as a nutritional supplement both modestly increases levels of urinary citrate and provides bioavailable calcium. By modestly increasing levels of urinary citrate, administration of calcium citrate counters calcium nephrolithiasis (i.e., formation of calcium-containing kidney stones). Furthermore, calcium is more readily absorded when administered as calcium citrate than as calcium

Patents 39

carbonate, i.e., the administration of calcium citrate provides calcium that is more bioavailable. Improved absorption of calcium allows more effective treatment of calcium-deficiency conditions like osteoporosis. Osteoporosis--a condition in which an affected person's bones become increasingly porous, brittle, and subject to fracture, owing to loss of calcium and other mineral components--is common in older persons, particularly in postmenopausal women. Bone loss may also be associated with a variety of other conditions, including those brought on by long-term steroid therapy and certain endocrine disorders. If not countered, osteoporosis or bone loss may lead to fractures of the spine, hip, and long bones. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Reduction of heartburn episodes after ingestion of orange juice Inventor(s): Green, Nancy R.; (Bradenton, FL), Letourneau, Stephen A.; (Holmes Beach, FL), McArdle, Richard N.; (Bradenton, FL), McGill, Carla R.; (Sarasota, FL) Correspondence: Cook, Alex, Mcfarron, Manzo, Cummings & Mehler Ltd; Suite 2850; 200 West Adams Street; Chicago; IL; 60606; US Patent Application Number: 20020192309 Date filed: May 3, 2001 Abstract: Reducing heartburn episodes is achieved in individuals having an orange juice intolerance or food allergy. The orange juice product has a low titratable acidity which combines with a condition resulting after addition of a calcium source such as a calcium citrate source. Individuals prone to orange juice induced heartburn episodes experience a reduced incidence of these heartburn episodes. Excerpt(s): This invention relates to approaches for reducing heartburn episodes when an individual having an orange juice intolerance ingests orange juice according to the invention. The invention is achieved without any substantial negative impact on orange juice flavor or other important attributes. The heartburn reduction is achieved by orange juice which combines the features of being of a lower acid type while incorporating a calcium source such as in the form of a calcium citrate source. Numerous individuals have been known to experience negative effects upon ingesting different foods. A true food allergy occurs when the immune system of the individual overreacts to certain proteins in food. It is believed that hundreds of food ingredients can provoke an allergic reaction. Typical foods in this regard are nuts, peanuts, milk, eggs, fish, shellfish, soybeans and wheat. Foods such as these can lead to symptoms including nausea, hives, skin rash, nasal congestion, wheezing, and the like. However, most unpleasant reactions to food are caused not by allergies but by intolerances, which tend to be less severe than true food allergies. Typical in this regard are lactose intolerance, sulfite intolerance and intolerance to monosodium glutamate, red wine, chocolate and food coloring agents. Another intolerance of some frequency is manifested by gastral distress and/or digestive difficulties which certain individuals experience shortly after ingesting orange juice products. In some circles, it is generally assumed that the relatively high acidity of orange juice products is a primary contributor to these negative or unpleasant experiences with orange juice products for a small percentage of the population. For example, Kligerman et al U.S. Pat. No. 5,665,415 and No. 5,869,119, incorporated hereinto by reference, suggest that acidic foods or beverages such as coffee and other beverages can be combined with calcium glycerophosphate so as to raise the pH of the food or beverage by at least 0.5 pH units, such as to a pH of greater than 5.4, which typically is pH higher than desirable for superior tasting orange juice. This pH

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adjustment is said to reduce the tendency of the food or beverage to cause heartburn and other esophageal and/or gastrointestinal distress. This approach generally follows the conventional wisdom that ingesting antacids treats heartburn by helping to neutralize stomach acid. This approach suggests, in general, raising the pH of the food or beverage to well above 5. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Vitamin formulation for enhancing bone strength Inventor(s): Lovett, William E.; (Naples, FL) Correspondence: Dykema Gossett Pllc; Franklin Square, Third Floor West; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20030190369 Date filed: April 9, 2003 Abstract: The present invention provides a method and composition for dietary vitamin supplementation utilizing a form and dosage of vitamins and minerals for enhanced calcium absorption. The method includes the steps of providing a pharmaceutically acceptable composition including calcium citrate, and supplementing the daily dietary regimen of a subject with calcium citrate within the range of approximately 100 mg calcium to approximately 2000 mg calcium, and preferably 1000 mg calcium. The chewable form of the supplement provided herein facilitates absorption of calcium in the teeth and bones of a subject, for enhanced physiological and psychological benefits. The supplement is especially beneficial for subjects experiencing osteoporosis, arthritis, demineralization of teeth and bones, bodily pain and lack of energy, as well as for the prevention of these ailments. Excerpt(s): This application claims benefit of priority of Provisional Application Serial No. 60/370,733, filed Apr. 9, 2002. The invention relates generally to dietary supplementation, and, more particularly to a novel method and composition for dietary vitamin supplementation utilizing a form and dosage of vitamins and minerals for enhanced calcium absorption. Vitamins and minerals are essential to life and vital for many functions such as the breaking down of digested food and for providing energy for each cell in the body. Many vitamins cannot be stored and therefore must be replenished on a daily basis. Minerals, which are primarily stored in bone and muscle tissue, likewise must be replenished daily. Replenishing vitamins and minerals appropriately can be a complex task and research has shown that there must be a balance of vitamins and minerals taken daily for optimal absorption. One key factor in determining a vitamin composition relates to the interaction of different vitamins and minerals. For example, a large dose of one "B" vitamin may cause a deficiency in another "B" vitamin. The same is true for minerals, which must also be taken in correct amounts and combinations to produce the synergistic effect of increasing the positive effect of each one alone. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 41

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

43

CHAPTER 5. BOOKS ON CALCIUM CITRATE Overview This chapter provides bibliographic book references relating to calcium citrate. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on calcium citrate include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

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

Electrolytes and Replacement Solutions Source: in Moreau, D., ed. Nursing96 Drug Handbook. Springhouse, PA: Nursing96 Books. Springhouse Corporation. 1996. p. 823-836. Contact: Available from Springhouse Publishing. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477. (800) 331-3170 or (215) 646-4670 or (215) 646-4671. Fax (215) 6468716. PRICE: $29.95. ISBN: 087434817X. ISSN: 0273320X. Summary: This chapter on electrolytes and replacement solutions is from a nursing handbook on pharmaceuticals; the handbook focuses on the clinical aspects of drug therapy. The chapter begins with an alphabetically arranged list of the generic names of drugs described in the chapter, followed by an alphabetized list of its brand names and a list of selected combination products in which these drugs are found. Specific information on each drug is arranged under the following headings: How Supplied, Action, Onset, Peak, Duration, Indications and Dosage, Adverse Reactions, Interactions,

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Contraindications, and Nursing Considerations. Drugs covered are calcium acetate, calcium carbonate, calcium chloride, calcium citrate, calcium glubionate, calcium gluceptate, calcium gluconate, calcium lactate, calcium phosphate, dextran, hetastarch, magnesium chloride, magnesium sulfate, potassium acetate, potassium bicarbonate, potassium chloride, potassium gluconate, Ringer's inject, and sodium chloride. •

Medications Source: in Rodman, J.S.; Seidman, C.; Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 178-184. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: Throughout medical history, people have taken a wild assortment of remedies to cure real and imagined ailments. This chapter on medications for kidney stones is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors describe the modern medications that are used to treat various kidney stone problems. The authors stress that four out of five people who present with stone problems can be managed without any medications. Medication is more likely to be prescribed for people with multiple stone episodes, difficulty in passing stones, or prior urological intervention, such as surgery or ESWL (extracorporeal shock wave lithotripsy) treatment. The authors discuss alkaline potassium salts (including potassium citrate and potassium bicarbonate), alkaline sodium salts (sodium bicarbonate), thiazide diuretics, allopurinol (which reduces the production of uric acid), triamterene, amiloride, pyridozine, magnesium oxide and other magnesium salts, thiola and penicillamine (used to treat cystinuria), acetohydroxamic acid, antibiotics and urinary antiseptics, calcium citrate and other calcium preparations, phosphates, cellulose phosphate, and aluminum hydroxide.

45

APPENDICES

47

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

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/

7

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 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:9 •

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

8

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). 9 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 Gateway10 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.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “calcium citrate” (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 239 0 885 0 13 1137

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 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.14 Simply search by “calcium citrate” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

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

11

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). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

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

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

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Coffee Break: Tutorials for Biologists15 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.16 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.17 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/.

15 Adapted 16

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. 17 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.

53

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 calcium citrate 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 calcium citrate. 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 calcium citrate. 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 “calcium citrate”:

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Child Nutrition http://www.nlm.nih.gov/medlineplus/childnutrition.html Dietary Supplements http://www.nlm.nih.gov/medlineplus/dietarysupplements.html Osteoporosis http://www.nlm.nih.gov/medlineplus/osteoporosis.html Vitamins and Minerals http://www.nlm.nih.gov/medlineplus/vitaminsandminerals.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on calcium citrate. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

FAN Flashbacks: Milk Source: Fairfax, VA: Food Allergy and Anaphylaxis Network (FAAN). 1996. 11 p. Contact: Available from Food Allergy and Anaphylaxis Network (FAAN). 10400 Eaton Place, Suite 107, Fairfax, VA 22030. (800) 929-4040 or (703) 691-3179. Fax (703) 691-2713. E-mail: [email protected]. Web site: http://www.foodallergy.org/. Price: $2.00 each. Summary: This brochure reprints relevant information on specific topics from previous issues of Food Allergy News, the newsletter of the Food Allergy and Anaphylaxis Network. This brochure focuses on milk allergy, particularly in children. Articles are reprinted on topics including altering a child's diet to accommodate a milk allergy; protein hydrolysate formulas to substitute for cow milk or soy formulas; determining the need for vitamin or other supplements; calcium compounds, including calcium citrate, calcium carbonate, and calcium gluconate; kosher foods and allergies, including understanding kosher rules and markings; new products, including Simplesse, and Vitamite nondairy beverage; consumer guidelines for specific brand name products; calcium-fortified products; milk-free products; the different types of chocolate products, including cocoa powder, cocoa butter, chocolate liquor, baking chocolate, milk chocolate, semisweet and sweet chocolates, and unsweetened chocolate; finding desserts and dessert substitutes for children who are allergic to milk; goat milk as a substitute for cow milk; and kosher processing and food allergies. The brochure includes the address, telephone numbers, and email addresses for the Food Allergy and Anaphylaxis

Patient Resources

55

Network, a national nonprofit organization established to help families living with food allergies and to increase public awareness about food allergies and anaphylaxis. (AAM). 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 calcium citrate. 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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to calcium citrate. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with calcium citrate. 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 calcium citrate. 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.

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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 “calcium citrate” (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 “calcium citrate”. 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 “calcium citrate” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “calcium citrate” (or a synonym) into the search box, and click “Submit Query.”

57

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.18

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

18

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)19: •

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/

19

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

Finding Medical Libraries

59

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Medical Libraries

61

•

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

63

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

65

CALCIUM CITRATE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Acetaldehyde: A colorless, flammable liquid used in the manufacture of acetic acid, perfumes, and flavors. It is also an intermediate in the metabolism of alcohol. It has a general narcotic action and also causes irritation of mucous membranes. Large doses may cause death from respiratory paralysis. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

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Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Aluminum Hydroxide: Hydrated aluminum. A compound with many biomedical applications: as a gastric antacid, an antiperspirant, in dentifrices, as an emulsifier, as an adjuvant in bacterins and vaccines, in water purification, etc. [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] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH]

Dictionary 67

Antidote: A remedy for counteracting a poison. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-Infective Agents: Substances that prevent infectious agents or organisms from spreading or kill infectious agents in order to prevent the spread of infection. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antioxidants: Naturally occurring or synthetic substances that inhibit or retard the oxidation of a substance to which it is added. They counteract the harmful and damaging effects of oxidation in animal tissues. [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] 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] Astringent: Causing contraction, usually locally after topical application. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [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] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH]

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Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Bioavailable: The ability of a drug or other substance to be absorbed and used by the body. Orally bioavailable means that a drug or other substance that is taken by mouth can be absorbed and used by the body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] 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 Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] 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

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functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calcium Chloride: A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning. [NIH] Calcium Citrate Malate: It transmits extracellular signals within cells. [NIH] Calcium Compounds: Inorganic compounds that contain calcium as an integral part of the molecule. [NIH] Calcium Gluconate: The calcium salt of gluconic acid. The compound has a variety of uses, including its use as a calcium replenisher in hypocalcemic states. [NIH] Calcium Hydroxide: Ca(OH)2. A white powder that has many therapeutic uses. Because of its ability to stimulate mineralization, it is found in many dental formulations. [NIH] Calcium Oxalate: The calcium salt of oxalic acid, occurring in the urine as crystals and in certain calculi. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carbonated Beverages: Drinkable liquids combined with or impregnated with carbon dioxide. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH]

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Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell 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] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] 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] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [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

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C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Consciousness: Sense of awareness of self and of the environment. [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 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 heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried

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by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] 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]

Cystinuria: An inherited abnormality of renal tubular transport of dibasic amino acids leading to massive urinary excretion of cystine, lysine, arginine, and ornithine. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental Plaque: A film that attaches to teeth, often causing dental caries and gingivitis. It is composed of mucins, secreted from salivary glands, and microorganisms. [NIH] Dentifrices: Any preparations used for cleansing teeth; they usually contain an abrasive, detergent, binder and flavoring agent and may exist in the form of liquid, paste or powder; may also contain medicaments and caries preventives. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH]

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Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] 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] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [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] Diuretic: A drug that increases the production of urine. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] 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] Elasticity: Resistance and recovery from distortion of shape. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in

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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] Emollient: Softening or soothing; called also malactic. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] Expectorant: 1. Promoting the ejection, by spitting, of mucus or other fluids from the lungs and trachea. 2. An agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives). [EU]

Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root.

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Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [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] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Food Additives: Substances which are of little or no nutritive value, but are used in the processing or storage of foods or animal feed, especially in the developed countries; includes antioxidants, food preservatives, food coloring agents, flavoring agents, anti-infective agents (both plain and local), vehicles, excipients and other similarly used substances. Many of the same substances are pharmaceutic aids when added to pharmaceuticals rather than to foods. [NIH]

Food Coloring Agents: Natural or synthetic dyes used as coloring agents in processed foods. [NIH] Food Preservatives: Substances capable of inhibiting, retarding or arresting the process of fermentation, acidification or other deterioration of foods. [NIH] Food Technology: The application of knowledge to the food industry. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH]

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Gastric Emptying: The evacuation of food from the stomach into the duodenum. [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]

Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] 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] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [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] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [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] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hetastarch: A derivative of starch used as a plasma substitute in the treatment of hemorrhage. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] 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, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1

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isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypercalciuria: Abnormally large amounts of calcium in the urine. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [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] Infant, Newborn: An infant during the first month after birth. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] 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] Keratolytic: An agent that promotes keratolysis. [EU] Kidney stone: A stone that develops from crystals that form in urine and build up on the

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inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Magnesium Chloride: Magnesium chloride. An inorganic compound consisting of one magnesium and two chloride ions. The compound is used in medicine as a source of magnesium ions, which are essential for many cellular activities. It has also been used as a cathartic and in alloys. [NIH] Magnesium Hydroxide: Magnesium hydroxide (Mg(OH)2). An inorganic compound that occurs in nature as the mineral brucite. It acts as an antacid with cathartic effects. [NIH] Magnesium Oxide: Magnesium oxide (MgO). An inorganic compound that occurs in nature as the mineral periclase. In aqueous media combines quickly with water to form magnesium hydroxide. It is used as an antacid and mild laxative and has many nonmedicinal uses. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mannans: Polysaccharides consisting of mannose units. [NIH]

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Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menarche: The establishment or beginning of the menstrual function. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] 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] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle

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fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Nephrolithiasis: Kidney stones. [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] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutritive Value: An indication of the contribution of a food to the nutrient content of the diet. This value depends on the quantity of a food which is digested and absorbed and the amounts of the essential nutrients (protein, fat, carbohydrate, minerals, vitamins) which it contains. This value can be affected by soil and growing conditions, handling and storage, and processing. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opalescent: Showing a milky iridescence, like an opal. [EU] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU]

Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Oxalate: A chemical that combines with calcium in urine to form the most common type of

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kidney stone (calcium oxalate stone). [NIH] Oxalic Acid: A strong dicarboxylic acid occurring in many plants and vegetables. It is produced in the body by metabolism of glyoxylic acid or ascorbic acid. It is not metabolized but excreted in the urine. It is used as an analytical reagent and general reducing agent. [NIH] Oxides: Binary compounds of oxygen containing the anion O(2-). The anion combines with metals to form alkaline oxides and non-metals to form acidic oxides. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [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] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that

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of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmaceutic Aids: Substances which are of little or no therapeutic value, but are necessary in the manufacture, compounding, storage, etc., of pharmaceutical preparations or drug dosage forms. They include solvents, diluting agents, and suspending agents, and emulsifying agents. Also, antioxidants; preservatives, pharmaceutical; dyes (coloring agents); flavoring agents; vehicles; excipients; ointment bases. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phosphates: Inorganic salts of phosphoric acid. [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] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [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]

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

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation

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of, or exposure to a deleterious agent. [NIH] Polyvalent: Having more than one valence. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Chloride: Potassium chloride. A white crystal or crystalline powder used as an electrolyte replenisher, in the treatment of hypokalemia, in buffer solutions, and in fertilizers and explosives. [NIH] Potassium Citrate: A powder that dissolves in water, which is administered orally, and is used as a diuretic, expectorant, systemic alkalizer, and electrolyte replenisher. [NIH] Potassium hydroxide: A toxic and highly corrosive chemical used to make soap, in bleaching, and as a paint remover. It is used in small amounts as a food additive and in the preparatrion of some drugs. [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] Precipitation: The act or process of precipitating. [EU] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH]

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Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] 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] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [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] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renal tubular: A defect in the kidneys that hinders their normal excretion of acids. Failure to excrete acids can lead to weak bones, kidney stones, and poor growth in children. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Paralysis: Complete or severe weakness of the muscles of respiration. This condition may be associated with motor neuron diseases; peripheral nerve disorders; neuromuscular junction diseases; spinal cord diseases; injury to the phrenic nerve; and other disorders. [NIH]

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Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saccharin: Flavoring agent and non-nutritive sweetener. [NIH] Salicylic: A tuberculosis drug. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] 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] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] 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]

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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] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Bicarbonate: A white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions. [NIH] Sodium Fluoride: A source of inorganic fluoride which is used topically to prevent dental caries. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] 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] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Steroid therapy: Treatment with corticosteroid drugs to reduce swelling, pain, and other symptoms of inflammation. [NIH]

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Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Sublingual: Located beneath the tongue. [EU] Submandibular: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH]

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Calcium Citrate

Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urolithiasis: Stones in the urinary system. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH]

Dictionary 89

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] 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] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Vulvovaginitis: Inflammation of the vulva and vagina, or of the vulvovaginal glands. [EU] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xanthine: An urinary calculus. [NIH] Xanthine Oxidase: An iron-molybdenum flavoprotein containing FAD that oxidizes hypoxanthine, some other purines and pterins, and aldehydes. Deficiency of the enzyme, an autosomal recessive trait, causes xanthinuria. EC 1.1.3.22. [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] Zinc Oxide: A mild astringent and topical protectant with some antiseptic action. It is also used in bandages, pastes, ointments, dental cements, and as a sunblock. [NIH]

91

INDEX A Acetaldehyde, 17, 65 Acne, 35, 65, 85 Actin, 65, 79, 80 Adaptation, 5, 65 Adenosine, 65, 82 Adjustment, 40, 65 Adjuvant, 65, 66 Adolescence, 19, 65 Adverse Effect, 6, 28, 65, 85 Affinity, 65, 86 Agar, 65, 82 Age Groups, 33, 66 Aged, 80 and Over, 66 Airway, 66, 89 Algorithms, 66, 68 Alimentary, 66, 73 Alkaline, 25, 44, 66, 68, 81, 87 Allopurinol, 44, 66 Alternative medicine, 66 Aluminum, 4, 6, 7, 8, 9, 21, 44, 66 Aluminum Hydroxide, 7, 21, 44, 66 Amino Acids, 66, 72, 81, 83 Analgesic, 35, 66 Anaphylaxis, 54, 66 Anatomical, 66, 74, 78 Anions, 66, 77 Anorexia, 66, 80 Antibiotics, 44, 66, 81 Antibody, 65, 66, 67, 70, 76 Anticoagulants, 18, 66 Antidote, 67, 69 Antifungal, 67, 75 Antigen, 65, 66, 67, 71, 76, 77 Anti-infective, 67, 75, 86 Anti-Infective Agents, 67, 75 Anti-inflammatory, 67, 72, 81 Antioxidants, 67, 75, 82 Antiseptic, 67, 89 Anus, 67, 70 Apolipoproteins, 67, 78 Aqueous, 24, 32, 34, 67, 78 Arginine, 67, 72, 80 Arterial, 67, 70, 77, 83, 87 Arteries, 67, 68, 71, 78 Artery, 67, 81 Astringent, 67, 89 Atrophy, 28, 67

B Bacteria, 4, 67, 68, 72, 79, 88 Bacterial Physiology, 65, 67 Bactericidal, 67, 74 Base, 16, 67, 74, 77 Bile, 38, 67, 68, 75, 78, 86 Bile Acids, 38, 67, 68, 86 Bile Acids and Salts, 67, 68 Biliary, 68, 69 Biliary Tract, 68, 69 Binding agent, 7, 68 Bioavailability, 7, 8, 9, 26, 29, 36, 68 Bioavailable, 26, 27, 30, 35, 36, 38, 68 Biochemical, 6, 9, 68 Biopsy, 4, 68, 81 Biotechnology, 6, 49, 68 Bladder, 20, 68, 71, 78, 84, 88 Blood Coagulation, 68, 69 Blood Glucose, 34, 68 Blood pressure, 17, 38, 68, 69, 77, 86 Blood vessel, 68, 69, 70, 77, 81, 87, 89 Body Fluids, 68, 73, 86 Bone Density, 4, 6, 9, 15, 19, 37, 68 Bowel, 34, 68, 77, 78, 87 Buccal, 29, 68 C Calcium, 3, 4, 5, 6, 7, 8, 9, 12, 13, 15, 16, 17, 18, 19, 20, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 44, 54, 68, 69, 71, 77, 80, 81, 87 Calcium Carbonate, 4, 5, 6, 7, 8, 9, 27, 30, 39, 44, 54, 69 Calcium Chloride, 44, 69 Calcium Citrate Malate, 7, 12, 17, 19, 26, 27, 28, 33, 34, 36, 69 Calcium Compounds, 54, 69 Calcium Gluconate, 44, 54, 69 Calcium Hydroxide, 25, 69 Calcium Oxalate, 16, 17, 19, 69, 81 Calculi, 3, 69 Candidiasis, 69, 75 Capsules, 69, 73 Carbohydrate, 32, 36, 69, 72, 76, 80 Carbon Dioxide, 25, 27, 69, 84 Carbonated Beverages, 33, 69 Carcinogenic, 69, 86 Cardiac, 69, 86 Cardiovascular, 31, 69

92

Calcium Citrate

Cardiovascular disease, 31, 69 Case report, 5, 7, 69 Catheter, 69, 78 Cathode, 70, 74 Cations, 18, 70, 77 Cell, 29, 40, 65, 67, 68, 70, 71, 73, 74, 75, 77, 78, 80, 82, 84 Cell Division, 67, 70, 82 Cell Respiration, 70, 84 Cerebrovascular, 69, 70 Chlorophyll, 70, 75 Cholesterol, 24, 31, 34, 67, 68, 70, 72, 78, 86 Cholesterol Esters, 70, 78 Chronic, 4, 18, 70, 71, 74 Chronic renal, 18, 70 Chylomicrons, 70, 78 CIS, 27, 70 Clinical trial, 5, 30, 49, 70, 71, 84 Cloning, 68, 70 Collapse, 66, 70 Colon, 38, 70, 78 Combination Therapy, 70, 74 Complement, 70, 71 Complementary and alternative medicine, 15, 21, 71 Complementary medicine, 15, 71 Compliance, 30, 71 Computational Biology, 49, 71 Concretion, 69, 71 Congestion, 39, 71 Consciousness, 66, 71, 83 Constriction, 71, 77, 89 Contraindications, ii, 44, 71 Controlled study, 9, 71 Coronary, 69, 71 Coronary heart disease, 69, 71 Cortex, 72, 83 Cortical, 6, 72 Corticosteroid, 72, 86 Crystallization, 3, 5, 16, 72 Cyclic, 4, 72 Cystine, 72 Cystinuria, 44, 72 D Dairy Products, 31, 72 Decubitus, 72, 86 Decubitus Ulcer, 72, 86 Dehydration, 32, 72 Dental Caries, 72, 86 Dental Plaque, 28, 72 Dentifrices, 66, 72 Dentists, 33, 72

Detergents, 73, 86 Deuterium, 73, 77 Developed Countries, 73, 75 Diagnostic procedure, 23, 73 Dialyzer, 73, 76 Diastolic, 73, 77 Dietary Fiber, 31, 73 Digestion, 66, 67, 68, 73, 77, 78, 87 Digestive tract, 34, 37, 73 Direct, iii, 73, 77, 84 Disinfectant, 73, 74 Distal, 73, 83 Diuretic, 69, 73, 83, 88 Dosage Forms, 28, 73, 82 Duct, 73, 85 Duodenum, 67, 73, 76, 87 Dyes, 73, 75, 82 E Efficacy, 6, 73 Elasticity, 32, 73 Electrolysis, 66, 70, 73 Electrolyte, 72, 73, 83, 86 Electrons, 67, 70, 73, 77 Emollient, 74, 76, 80 Enamel, 17, 33, 72, 74 Endocrine Glands, 74, 81 End-stage renal, 70, 74 Environmental Health, 48, 50, 74 Enzymatic, 69, 71, 72, 74 Enzyme, 29, 74, 89 Epithelial, 29, 74 Esophageal, 40, 74 Esophagus, 29, 73, 74, 76, 87 Estrogen, 4, 8, 19, 74 Estrogen Replacement Therapy, 4, 74 Ethanol, 17, 74 Evacuation, 74, 76, 78 Excipients, 28, 74, 75, 82 Expectorant, 74, 83 Expiration, 74, 84 Extracellular, 69, 74, 86, 87 Extracorporeal, 44, 74 F Facial, 74, 81 Facial Nerve, 74, 81 Family Planning, 49, 75 Fat, 24, 31, 68, 72, 75, 78, 80, 88 Fatty acids, 38, 75, 86 Femur, 5, 75 Fertilizers, 75, 83 Flatus, 75 Flavoring Agents, 75, 82

93

Fluconazole, 4, 75 Food Additives, 24, 75 Food Coloring Agents, 39, 75 Food Preservatives, 75 Food Technology, 24, 75 Forearm, 9, 68, 75 Fructose, 31, 36, 75 Fungus, 4, 69, 75 G Gallbladder, 68, 75, 78 Gas, 25, 69, 75, 76 Gastric, 6, 16, 66, 73, 75, 76 Gastric Acid, 16, 75 Gastric Emptying, 6, 76 Gastrointestinal, 3, 40, 74, 76, 87 Gastrointestinal tract, 74, 76 Gene, 68, 76 Gingivitis, 72, 76 Gland, 29, 72, 76, 81, 85, 87 Glucose, 36, 68, 76, 85 Glutamate, 39, 76 Glycerol, 32, 76, 82 Glycoprotein, 29, 76 Goats, 72, 76 Gonadal, 76, 86 Governing Board, 76, 83 H Heart attack, 69, 76 Heartburn, 39, 76 Hemodialysis, 8, 69, 73, 76 Hemorrhage, 76, 87 Hetastarch, 44, 76 Histology, 76, 81 Homeostasis, 16, 76 Homologous, 18, 76 Hormonal, 26, 37, 67, 72, 74, 76 Hormone, 72, 74, 76, 83, 87 Hydrogen, 28, 67, 69, 73, 76, 77, 79, 81, 83 Hydrogenation, 27, 77 Hydrophobic, 73, 77, 78 Hygienic, 77, 86 Hypercalciuria, 16, 77 Hyperlipidemia, 31, 77 Hypersensitivity, 66, 77 Hypertension, 31, 69, 77 I Idiopathic, 16, 28, 77 Immune system, 39, 77 In vitro, 12, 77 In vivo, 8, 18, 77 Infant, Newborn, 66, 77 Inflammation, 65, 67, 76, 77, 79, 82, 86, 89

Infusion, 31, 77 Ingestion, 4, 39, 77, 82, 87 Inorganic, 29, 69, 77, 78, 82, 86 Intermittent, 9, 77 Intestinal, 5, 8, 37, 77 Intestine, 68, 73, 76, 77, 78 Intoxication, 77, 89 Intracellular, 77, 83 Intravenous, 77 Intrinsic, 8, 65, 77 Ions, 32, 67, 73, 76, 77, 78, 79 Ischemia, 67, 72, 77 K Kb, 48, 77 Keratolytic, 35, 72, 77 Kidney stone, 19, 30, 34, 37, 38, 44, 77, 80, 81, 84, 88 L Large Intestine, 73, 77, 78, 84 Laser therapy, 4, 78 Laxative, 65, 78 Lipid, 17, 18, 37, 67, 76, 78, 88 Lipoprotein, 37, 78 Liquor, 54, 78 Lithotripsy, 44, 78 Liver, 67, 68, 75, 78 Localized, 29, 72, 78, 82, 88 Low-density lipoprotein, 78 Lumbar, 5, 78 Lymph, 78, 87 Lymphoid, 78 Lysine, 72, 78 M Magnesium Chloride, 44, 78 Magnesium Hydroxide, 78 Magnesium Oxide, 25, 44, 78 Malnutrition, 67, 78 Mannans, 75, 78 Meat, 31, 79 Medicament, 35, 79 MEDLINE, 49, 79 Membrane, 29, 71, 73, 79, 80, 82 Menarche, 18, 79 Meningitis, 75, 79 Menopause, 4, 21, 38, 79, 83 Menstruation, 79 Microbiology, 65, 79 Micronutrients, 31, 79 Microorganism, 79, 89 Microspheres, 12, 79 Milliliter, 68, 79 Mineralization, 69, 79, 80

94

Calcium Citrate

Modification, 9, 79, 84 Molecular, 36, 49, 51, 68, 71, 79, 88 Molecular Structure, 79, 88 Molecule, 67, 69, 71, 79, 84 Morphological, 75, 79 Motion Sickness, 79, 80 Mucins, 72, 79, 85 Muscle Contraction, 37, 79 Myosin, 79 N Narcotic, 65, 80 Nausea, 39, 73, 80 NCI, 1, 47, 70, 80 Nephrolithiasis, 3, 19, 34, 38, 80 Neurotransmitter, 65, 76, 80, 87 Nucleus, 72, 73, 80, 83 Nutritive Value, 75, 80 O Ointments, 73, 80, 81, 86, 89 Opalescent, 29, 80 Ornithine, 72, 80 Osmosis, 80 Osmotic, 32, 80 Osteomalacia, 4, 80 Osteoporosis, 4, 9, 12, 17, 20, 21, 26, 28, 33, 34, 37, 39, 40, 54, 74, 80 Oxalate, 16, 80 Oxalic Acid, 69, 81 Oxides, 25, 81 Oxygen Consumption, 81, 84 P Paraffin, 29, 81 Parathyroid, 19, 81, 87 Parathyroid Glands, 81 Parathyroid hormone, 19, 81 Parotid, 29, 81 Particle, 29, 81 Patch, 29, 81 Pathologic, 68, 71, 77, 81 Patient Education, 54, 58, 60, 63, 81 Pelvis, 78, 81 Penicillamine, 44, 81 Penicillin, 81, 88 Peptide, 81, 83 Percutaneous, 78, 81 Perfusion, 18, 81 Petroleum, 81 PH, 17, 68, 81 Pharmaceutic Aids, 75, 82 Pharmaceutical Solutions, 73, 82 Pharmacologic, 82, 88 Phosphates, 44, 82

Phospholipids, 75, 78, 82 Phosphorus, 4, 30, 68, 81, 82 Physical Examination, 4, 82 Physical Therapy, 4, 82 Physicochemical, 9, 82 Physiologic, 79, 82, 84 Physiology, 18, 37, 82 Plants, 69, 76, 81, 82, 85 Plaque, 29, 82 Plasma, 37, 70, 76, 82 Platelets, 18, 82, 87 Pneumonia, 71, 82 Poisoning, 69, 77, 80, 82 Polyvalent, 25, 83 Postmenopausal, 5, 9, 15, 17, 18, 19, 26, 28, 30, 33, 37, 39, 74, 80, 83 Potassium, 3, 4, 9, 28, 38, 44, 83, 86 Potassium Chloride, 44, 83 Potassium Citrate, 3, 9, 44, 83 Potassium hydroxide, 4, 83 Practice Guidelines, 50, 83 Precipitation, 34, 35, 83 Progesterone, 83, 86 Progressive, 37, 70, 74, 83 Prone, 34, 39, 83 Protein C, 67, 78, 83 Protein S, 68, 83 Proteins, 3, 34, 37, 39, 66, 67, 70, 79, 81, 82, 83, 85, 88 Protons, 76, 83 Proximal, 5, 73, 83 Psychoactive, 83, 89 Psyllium, 21, 34, 83 Public Policy, 49, 84 Pulmonary, 68, 84 Pulmonary Artery, 68, 84 Q Quality of Life, 30, 84 R Radioactive, 77, 84 Randomized, 9, 17, 38, 73, 84 Randomized Controlled Trials, 38, 84 Receptor, 65, 67, 84 Rectum, 67, 70, 73, 75, 78, 84 Recurrence, 44, 84 Refer, 1, 68, 70, 84 Refractory, 25, 84 Regimen, 30, 33, 40, 73, 84 Regurgitation, 76, 84 Remission, 84 Renal pelvis, 78, 84 Renal tubular, 72, 84

95

Respiration, 35, 69, 84 Respiratory Paralysis, 65, 84 Retinoids, 85, 89 Risk factor, 16, 30, 85 S Saccharin, 36, 85 Salicylic, 35, 85 Saliva, 29, 85 Salivary, 29, 72, 75, 85, 87 Salivary glands, 29, 72, 75, 85 Saponins, 85, 86 Schizoid, 85, 89 Schizophrenia, 85, 89 Schizotypal Personality Disorder, 85, 89 Screening, 70, 85 Secretion, 16, 29, 72, 79, 85 Senile, 80, 85 Serous, 29, 85 Serum, 17, 18, 19, 34, 37, 70, 78, 85 Sex Characteristics, 65, 85 Shock, 44, 66, 78, 85 Side effect, 65, 85, 88 Skeletal, 19, 28, 33, 86 Skeleton, 65, 75, 86 Skin Care, 35, 86 Soaps, 86 Social Environment, 84, 86 Social Security, 84, 86 Sodium, 3, 6, 8, 9, 16, 25, 32, 44, 86 Sodium Bicarbonate, 32, 44, 86 Sodium Fluoride, 6, 8, 9, 86 Solvent, 74, 76, 80, 82, 86 Somatic, 65, 86 Specialist, 55, 86 Species, 32, 86, 87, 88 Spinal cord, 70, 84, 86 Sterile, 81, 86 Steroid, 39, 68, 85, 86 Steroid therapy, 39, 86 Stomach, 40, 73, 74, 75, 76, 80, 87 Stool, 70, 78, 87 Stress, 26, 44, 80, 87, 88 Stroke, 48, 69, 87 Sublingual, 29, 87 Submandibular, 87 Submaxillary, 29, 87 Subspecies, 86, 87 Substance P, 85, 87 Supplementation, 5, 15, 16, 17, 18, 19, 26, 27, 34, 37, 40, 87 Support group, 5, 87 Synergistic, 40, 87

Systemic, 66, 68, 69, 83, 86, 87 Systolic, 77, 87 T Tetany, 81, 87 Threshold, 77, 87 Thrombocytes, 82, 87 Thyroid, 81, 87 Thyroid Gland, 81, 87 Tissue, 9, 28, 40, 67, 68, 75, 78, 79, 81, 84, 85, 87, 88 Tomography, 68, 87 Tone, 81, 88 Tooth Preparation, 65, 88 Topical, 4, 35, 67, 74, 81, 86, 88, 89 Toxic, iv, 83, 88 Toxicology, 50, 88 Transfection, 68, 88 Transplantation, 70, 88 Triamterene, 44, 88 Tricyclic, 4, 88 Triglyceride, 27, 88 Tuberculosis, 85, 88 U Ureters, 78, 88 Urethra, 88 Uric, 44, 66, 88 Urinary, 3, 5, 17, 20, 30, 34, 37, 38, 44, 69, 72, 88, 89 Urine, 3, 16, 34, 68, 69, 73, 77, 80, 81, 84, 88 Urolithiasis, 16, 88 Urticaria, 66, 88 V Vaccines, 66, 88, 89 Vagina, 69, 79, 88, 89 Valine, 81, 88 Vascular, 66, 87, 88, 89 Vasomotor, 74, 89 Vein, 77, 81, 89 Vertebrae, 5, 86, 89 Vertebral, 4, 89 Veterinary Medicine, 49, 89 Virus, 82, 89 Vitamin A, 26, 30, 89 Vitro, 89 Vivo, 89 Vulva, 89 Vulvovaginitis, 4, 89 W Wheezing, 39, 89 Withdrawal, 32, 89 X Xanthine, 66, 89

96

Calcium Citrate

Xanthine Oxidase, 66, 89 X-ray, 68, 70, 89

Y Yeasts, 75, 89 Z Zinc Oxide, 25, 89

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