Degenerative Arthritis: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

DEGENERATIVE ARTHRITIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCE...

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DEGENERATIVE ARTHRITIS 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., 1960Degenerative Arthritis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84385-6 1. Degenerative Arthritis-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 degenerative arthritis. 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 DEGENERATIVE ARTHRITIS ...................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Degenerative Arthritis .................................................................. 5 The National Library of Medicine: PubMed .................................................................................. 8 CHAPTER 2. NUTRITION AND DEGENERATIVE ARTHRITIS ............................................................ 23 Overview...................................................................................................................................... 23 Finding Nutrition Studies on Degenerative Arthritis................................................................. 23 Federal Resources on Nutrition ................................................................................................... 24 Additional Web Resources ........................................................................................................... 24 CHAPTER 3. ALTERNATIVE MEDICINE AND DEGENERATIVE ARTHRITIS ...................................... 27 Overview...................................................................................................................................... 27 National Center for Complementary and Alternative Medicine.................................................. 27 Additional Web Resources ........................................................................................................... 28 General References ....................................................................................................................... 29 CHAPTER 4. PATENTS ON DEGENERATIVE ARTHRITIS ................................................................... 31 Overview...................................................................................................................................... 31 Patent Applications on Degenerative Arthritis ........................................................................... 31 Keeping Current .......................................................................................................................... 33 CHAPTER 5. BOOKS ON DEGENERATIVE ARTHRITIS....................................................................... 35 Overview...................................................................................................................................... 35 Book Summaries: Online Booksellers........................................................................................... 35 Chapters on Degenerative Arthritis............................................................................................. 35 CHAPTER 6. PERIODICALS AND NEWS ON DEGENERATIVE ARTHRITIS ......................................... 37 Overview...................................................................................................................................... 37 News Services and Press Releases................................................................................................ 37 Newsletters on Degenerative Arthritis ........................................................................................ 39 Newsletter Articles ...................................................................................................................... 39 Academic Periodicals covering Degenerative Arthritis ............................................................... 40 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 43 Overview...................................................................................................................................... 43 NIH Guidelines............................................................................................................................ 43 NIH Databases............................................................................................................................. 45 Other Commercial Databases....................................................................................................... 47 APPENDIX B. PATIENT RESOURCES ................................................................................................. 49 Overview...................................................................................................................................... 49 Patient Guideline Sources............................................................................................................ 49 Finding Associations.................................................................................................................... 51 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 53 Overview...................................................................................................................................... 53 Preparation................................................................................................................................... 53 Finding a Local Medical Library.................................................................................................. 53 Medical Libraries in the U.S. and Canada ................................................................................... 53 ONLINE GLOSSARIES.................................................................................................................. 59 Online Dictionary Directories ..................................................................................................... 59 DEGENERATIVE ARTHRITIS DICTIONARY......................................................................... 61 INDEX ................................................................................................................................................ 87

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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 degenerative arthritis 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 degenerative arthritis, 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 degenerative arthritis, 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 degenerative arthritis. 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 degenerative arthritis, 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 degenerative arthritis. 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 DEGENERATIVE ARTHRITIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on degenerative arthritis.

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

Transient Synovitis of the Hip in Children Source: American Family Physician. 54(5):1587-1591. October 1996. 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 for health professionals discusses transient synovitis of the hip in children. This condition is the most common cause of acute hip pain in children between the ages of 3 and 10. Children with this condition typically present with hip pain for 1 to 3 days, accompanied by limping or the refusal to bear weight. Transient synovitis has an uncertain etiology and remains a diagnosis of exclusion. First,

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septic arthritis must be ruled out, since femoral head destruction, degenerative arthritis, and permanent deformity can occur if septic arthritis is not treated promptly. Septic arthritis should be suspected in a patient with severe pain or spasm on hip movement or palpation, a temperature higher than 37.5 degrees Celsius, and an erythrocyte sedimentation rate of 20 mm per hour or greater. Initial radiographs include an anteroposterior view of the pelvis and a frog-leg lateral view. In transient synovitis, radiographs may reveal hip effusion. Bone scintigraphy is not helpful in differentiating between transient synovitis and septic arthritis. Ultrasound examination can help distinguish transient synovitis from early Legge-Calve-Perthes disease. Hip aspiration is the diagnostic procedure of choice if septic arthritis is suspected. Treatment of transient synovitis consists of bed rest and nonsteroidal antiinflammatory drugs, with regular temperature checks to exclude the onset of fever. If significant pain and limping persist 7 to 10 days after the initial presentation, the patient should be reevaluated. 20 references, 1 figure, and 1 table. (AA-M). •

Complications of Total Ankle Replacement Source: Clinical Orthopaedics and Related Research. Number 391: 105-114. October 2001. Summary: This journal article provides health professionals with information on the complications of total ankle arthroplasty. This procedure is emerging as a viable treatment for patients with symptomatic tibiotalar arthritis who have not responded to nonoperative treatment. The significant complications that accompanied first generation ankle replacement prostheses led many orthopedic surgeons to abandon them. These complications may be broadly grouped into preoperative, prosthetic design, intraoperative, and postoperative complications. Second generation designs have attempted to address some of these problems with innovative new designs. Ankle arthritis differs from other forms of degenerative arthritis in that most of it is posttraumatic in origin and occurs in a younger age group. Correction of alignment is complicated by deformity of the foot distal to the ankle. Published results of second generation ankle replacement systems are limited by the relatively short history of their use, and understanding is necessarily anecdotal. The complications of current second generation total ankle arthroplasty can be divided into preoperative or patient selection problems, complications related to prosthetic design, intraoperative complications, and postoperative complications. Patient selection is critical to limiting complications and obtaining a satisfactory result. Older patients with nontraumatic primary osteoarthritis, minimal angular deformity at the ankle, and excellent range of motion before surgery would seem to be the best candidates for ankle arthroplasty. Other preoperative considerations that may influence complications include the condition of the soft tissue envelope, preoperative alignment, unrecognized or uncorrected foot deformity below the ankle, and failure to adequately assess gastrocnemius-soleus tightness. Intraoperative complications include releasing the tibialis anterior tendon from its sheath, scarring or transecting the superficial or deep peroneal nerves, malpositioning of the prosthetic components, and failing to properly size the components intraoperatively. Postoperative complications can occur early or late. Early complications include wound healing problems, syndesmotic nonunions, swelling, infection, and deep venous thrombosis. Late postoperative complications include malunion, syndesmotic nonunion, loss of dorsiflexion motion, deep infection, subsidence, and polyethylene wear. Total ankle arthroplasty with second generation prostheses is gaining increasing popularity. The surgeon contemplating total ankle arthroplasty should have an understanding of anatomy and lower extremity biomechanics, combined with a thorough knowledge of the total ankle system he or she has decided to use. Although there are many obstacles

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to successful outcome, most complications are preventable with good patient selection and technique. 15 references. (AA-M).

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

Project Title: BIOMECHANICAL FACTORS IN RHEUMATOID ARTHRITIS Principal Investigator & Institution: Guilak, Farshid; Associate Professor; Surgery; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 10-JUN-2003; Project End 31-MAR-2006 Summary: (provided by applicant): Rheumatoid arthritis is a chronic arthropathy characterized by inflammation, proliferation and destruction of the articular cartilage. Although historically cartilage has been considered to be an "innocent bystander" of the disease, recent evidence suggests that the degradation of cartilage in arthritis involves an imbalance of the anabolic and catabolic activities of the articular chondrocytes, secondary to synovitis and joint inflammation. Chondrocyte metabolic activity is strongly influenced by soluble mediators (e.g., cytokines) and biophysical factors (e.g., mechanical stress). In particular, biomechanical factors may play an important role in the onset and progression of degenerative arthritis secondary to joint inflammation in rheumatoid arthritis. However, the sequence of biomechanical and biochemical processes regulating these events in vivo is still unclear. The primary hypothesis of this study is that, in rheumatoid arthritis, a loss of cartilage biomechanical function and the presence of inflammatory cytokines alters the metabolic response of chondrocytes to mechanical stress. Aim 1 of this project is to measure the mechanical properties of the cartilage extracellular and pericellular matrices in RA, and to incorporate this data in a theoretical model of the micromechanical environment of the cell. In Aim 2, we will determine the role of stress magnitude in the stimulation of nitric oxide and prostaglandin E2 production by chondrocytes, and determine the influence of these inflammatory mediators on matrix turnover. In Aim 3, we will determine whether mechanical stress has an additive or antagonistic effect on with certain inflammatory cytokines (interleukin 1, tumor necrosis factor alpha, and interleukin 17) in controlling

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

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the PGE2 synthesis and matrix metabolism. Currently, there is little information on the biomechanical changes in articular cartilage with RA. Understanding the biomechanical and molecular mechanisms of chondrocyte response to physiologic loading in an inflammatory environment may enable new therapies that are specific to the stage of the disease. As many pharmacologic therapies for RA are focusing on the NOS2 and COX2 pathways, investigation of the interaction of physical therapies with these pathways will hopefully lead to more safe and effective treatments for RA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ESTROGEN: CHRODROPROTECTIVE OR DESTRUCTIVE? Principal Investigator & Institution: Frenkel, Sally R.; Associate Professor of Orthopedic; Hospital for Joint Diseases Ortho Inst Orthopaedic Institute New York, Ny 10003 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: This proposal responds to Research Topics 6.2., "Hormonal changes associated with increased risk for peri-and postmenopausal health problems," and 17, "Basic underlying mechanisms of musculoskeletal aging." The aim of the proposed study is to determine whether estrogen is chondroprotective or chondrodestructive, specifically with regard to the development or prevention of arthritis. In addition to estrogen, we will also examine the effects on cartilage of the specific estrogen receptor modulator (SERM) raloxifene, currently used in lieu of estrogen replacement therapy as a preventive and treatment for the postmenopausal patient population at risk for bone loss.This same population has an increased incidence of osteoarthritis (OA) with advancing age. It is therefore important to study the effects of this SERM alongside those of estrogen. The central hypothesis of this proposal is that estrogen has a positive effect on human chondrocyte metabolism and therefore helps to prevent degenerative arthritis. To establish this, we propose to examine the effects of estrogen and raloxifene in vitro on markers of cartilage metabolism and degradation. Real-time PCR will be used to quantitatively determine mRNA levels of these markers. Anabolic markers to be examined are type II collagen, cartilage oligomeric matrix protein, and aggrecan; catabolic markers will include interleukin-1 (IL-1) and matrix metalloproteinase-13. Chondrocytes will be grown in three-dimensional culture conditions in order to closely mimic the natural state. In addition, an exogenous catabolic mediator, IL-1, will be separately added to the estrogen and raloxifene cultures to determine whether estrogen or raloxifene can block IL-l-induced degradation of cartilage. The wide use of estrogen in the OA population makes it extremely important to elucidate whether estrogen and its related SERM raloxifene promote cartilage homeostasis or contribute to its degradation. The inconclusive and contradictory data from human and animal studies render the proposed studies highly significant. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INORGANIC PYROPHOSPHATE METABOLISM IN ARTHRITIS Principal Investigator & Institution: Ryan, Lawrence M.; Professor; Medicine; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2002; Project Start 01-MAY-1987; Project End 31-MAR-2007 Summary: (provided by applicant): Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a common form of arthritis, particularly in the elderly. Prevalence approaches 50 percent in those over 80. CPPD crystals cause acute attacks of gout-like arthritis, but more importantly are associated with debilitating degenerative arthritis. In vitro and in vivo data strongly suggest that these crystals cause or amplify cartilage

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degeneration. This proposal focuses on the source of inorganic pyrophosphate (PPi), the anion constituent of CPPD crystals. Disordered PPi metabolism is clearly implicated in CPPD crystal deposition. Specific emphasis will be placed on mechanisms underlying PPi generation in extracellular cartilage matrix where crystals form. The effector arm of extracellular PPi (ePPi) generation involves the ectoenzyme nucleoside triphosphate pyrophosphohydrolase (NTPPPH), which generates ePPi from extracellular nucleoside triphosphates such as ATP. NTPPPH activity is highly expressed in articular cartilage. The availability of extracellular ATP substrate for NTPPPH is rate-limiting for generation of ePPi and the most likely cellular source of that ATP is the chondrocyte. These studies are designed to determine the effects of factors that modulate ePPi formation upon the release of ATP from chondrocytes. Specific emphasis is placed on growth factors (transforming growth factor-beta and insulin-like growth factor-I), on chondrocyte donor age, on transduction pathways (protein kinase C and cAMP-related), and on purine receptors (P1and P2). All of the aforementioned influence ePPi elaboration by chondrocytes. The second goal of this proposal is to determine the mechanisms of ATP egress from chondrocytes. Specific focus will be on ATP binding cassette proteins (analogues of human ABC1 and p-glycoprotein expressed in chondrocytes), a gap junction protein (connexin 43), and ANK protein as possible transporters. The intent of these studies is to develop insights into the pathogenesis of CPPD deposition disease so that therapeutic options may be generated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRANSGLUTAMINASE PROMOTES CPPD DISEASE IN AGING JOINTS Principal Investigator & Institution: Rosenthal, Ann K.; Medicine; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2002; Project Start 15-MAY-1998; Project End 30-APR-2004 Summary: (Adapted from the Applicant's Abstract): Calcium pyrophosphate dihydrate (CPPD) deposition disease is a common form of degenerative arthritis that preferentially affects the elderly. The causes of CPPD crystal formation in aging articular cartilage are unknown, although many similarities exist between processes of normal cartilage mineralization in growth plate and those of pathologic mineralizing causing CPPD disease. Current evidence suggests that CPPD crystal formation results from excess elaboration of inorganic pyrophosphate (PPi) by chondrocytes, and occurs in or around articular cartilage vesicles (ACVs) and at sites of altered cartilage matrix. The processes known to promote CPPD crystal formation are strongly and uniquely enhanced by transforming growth factor beta (TGF-beta), which is stored in cartilage matrix in a latent biologically inactive form (LTGF-beta). The enzyme transglutaminase (TGase) catalyzes a unique post-translational modification of proteins, resulting in diverse biological effects in various tissues. TGase has recently been identified in mineralizing growth plate chondrocytes. Although TGase participates in processes of cell aging and LTGF-beta activation in other tissues, its role in articular cartilage remains undefined. The applicant's laboratory discovered strikingly high levels of active TGase and type II TGase protein in articular chondrocytes from old pigs compared to chondrocytes from young pigs. Inhibitors of TGase suppress PPi elaboration and reduce levels of activated TGF-beta secreted by old chondrocytes, conditions unfavorable to the formation of CPPD crystals. It is hypothesized that increased TGase activity in aging articular cartilage leads to CPPD crystal formation and the resultant degenerative arthritis. As a consequence, this application proposes to: 1) examine the function of TGase in CPPD deposition by exploring its role in LTGF-beta activation, extracellular

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matrix modulation, and ACV-induced mineralization in a porcine model; 2) explore the regulation of TGase activity in porcine articular cartilage by factors which modulate CPPD crystal formation; and 3) extend these findings to aging human articular cartilage and cartilage affected by CPPD disease. The goal of these studies is to understand the role and regulation of TGase in aging articular cartilage as it relates to CPPD deposition disease. This multifunctional enzyme represents a novel target for new pharmacologic agents directed against this common degenerative disease affecting our rapidly aging population. 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 degenerative arthritis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “degenerative arthritis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for degenerative arthritis (hyperlinks lead to article summaries): •

A comparison of benorylate and naproxen in degenerative arthritis. Author(s): Mayhew SR. Source: Rheumatol Rehabil. 1978 February; 17(1): 29-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=32609&dopt=Abstract

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Acetabular labrum tears: a cause of hip pain and degenerative arthritis. Author(s): Altenberg AR. Source: Southern Medical Journal. 1977 February; 70(2): 174-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=841394&dopt=Abstract

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Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis. Author(s): Najima H, Oberlin C, Alnot JY, Cadot B. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1997 April; 22(2): 183-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9149983&dopt=Abstract

3 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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Ankle fusion for degenerative arthritis secondary to the collagen diseases. Author(s): Wagner FW Jr. Source: Foot Ankle. 1982 July-August; 3(1): 24-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7129267&dopt=Abstract

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Anserina bursitis. A treatable cause of knee pain in patients with degenerative arthritis. Author(s): Brookler MI, Mongan ES. Source: Calif Med. 1973 July; 119(1): 8-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4731586&dopt=Abstract

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Arthroscopic management for degenerative arthritis of the knee. Author(s): Stuart MJ. Source: Instr Course Lect. 1999; 48: 135-41. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10098036&dopt=Abstract

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Arthroscopic management of degenerative meniscus tears in patients with degenerative arthritis. Author(s): Rand JA. Source: Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1985; 1(4): 253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3841640&dopt=Abstract

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Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow. Author(s): Ogilvie-Harris DJ, Gordon R, MacKay M. Source: Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1995 August; 11(4): 437-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7575877&dopt=Abstract

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Arthroscopy and degenerative arthritis of the knee: a review of the literature. Author(s): Burks RT. Source: Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1990; 6(1): 43-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2178619&dopt=Abstract

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Bilateral scapholunate dissociation with degenerative arthritis. Author(s): Hergenroeder PT, Penix AR. Source: The Journal of Hand Surgery. 1981 November; 6(6): 620-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7310092&dopt=Abstract

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Bipolar hemiarthroplasty in degenerative arthritis of the hip. 100 consecutive cases. Author(s): McConville OR, Bowman AJ Jr, Kilfoyle RM, McConville JF, Mayo RA. Source: Clinical Orthopaedics and Related Research. 1990 February; (251): 67-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2295198&dopt=Abstract

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Case report 453: Bilateral scaphoid-radial encroachment as part of disruption of the scapholunate ligament with secondary degenerative arthritis. Author(s): Perlman R. Source: Skeletal Radiology. 1987; 16(8): 670-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3423837&dopt=Abstract

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Cervical degenerative arthritis. Possible cause of neck and arm pain. Author(s): Hirsh LF. Source: Postgraduate Medicine. 1983 July; 74(1): 123-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6866855&dopt=Abstract

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Classification of degenerative arthritis. Author(s): McCracken WJ. Source: Can Med Assoc J. 1978 January 21; 118(2): 116. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=757376&dopt=Abstract

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Classification of degenerative arthritis. Author(s): Mitchell NS, Cruess RL. Source: Can Med Assoc J. 1977 October 8; 117(7): 763-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=907947&dopt=Abstract

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Combined Coventry-Maquet procedure for two-compartment degenerative arthritis. Author(s): Gross AE. Source: Clinical Orthopaedics and Related Research. 1986 February; (203): 311. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3955994&dopt=Abstract

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Combined Coventry-Maquet procedure for two-compartment degenerative arthritis. Author(s): Hofmann AA, Wyatt RW, Jones RE. Source: Clinical Orthopaedics and Related Research. 1984 November; (190): 186-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6488630&dopt=Abstract

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Common pathways of degenerative arthritis of the wrist. Author(s): Harrington RH, Lichtman DM, Brockmole DM. Source: Hand Clin. 1987 November; 3(4): 507-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3693419&dopt=Abstract

Studies

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CT findings of degenerative arthritis of the atlantoodontoid joint. Author(s): Genez BM, Willis JJ, Lowrey CE, Lauerman WC, Woodruff W, Diaz MJ, Higgs JB. Source: Ajr. American Journal of Roentgenology. 1990 February; 154(2): 315-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2105022&dopt=Abstract

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Degenerative arthritis after intra-articular fractures of the knee. Long-term results. Author(s): Volpin G, Dowd GS, Stein H, Bentley G. Source: The Journal of Bone and Joint Surgery. British Volume. 1990 July; 72(4): 634-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2380219&dopt=Abstract

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Degenerative arthritis after tibial plateau fractures. Author(s): Honkonen SE. Source: Journal of Orthopaedic Trauma. 1995; 9(4): 273-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7562147&dopt=Abstract

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Degenerative arthritis arthroscopy and research. Author(s): Poehling GG. Source: Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2002 September; 18(7): 683-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12209424&dopt=Abstract

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Degenerative arthritis at the triscaphe joint. Author(s): Rogers WD, Watson HK. Source: The Journal of Hand Surgery. 1990 March; 15(2): 232-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2324449&dopt=Abstract

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Degenerative arthritis of the adjacent spinal joints following anterior cervical spinal fusion: clinicoradiologic and statistical correlations. Author(s): Cherubino P, Benazzo F, Borromeo U, Perle S. Source: Ital J Orthop Traumatol. 1990 December; 16(4): 533-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2099935&dopt=Abstract

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Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. Author(s): Harrington KD. Source: The Journal of Bone and Joint Surgery. American Volume. 1979 April; 61(3): 35461. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=429402&dopt=Abstract

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Degenerative arthritis of the carpometacarpal joint of the thumb: a clinical follow-up of eleven Niebauer prostheses. Author(s): Ferlic DC, Busbee GA, Clayton ML. Source: The Journal of Hand Surgery. 1977 May; 2(3): 212-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=864218&dopt=Abstract

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Degenerative arthritis of the carpus associated with congenital hypoplastic thumb. Author(s): Bonatz E, Masear VR, Meyer RD, Cohen S. Source: The Journal of Hand Surgery. 1989 July; 14(4): 734-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2754209&dopt=Abstract

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Degenerative arthritis of the cervical spine. Author(s): Hirsh LF. Source: Compr Ther. 1984 August; 10(8): 8-13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6467884&dopt=Abstract

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Degenerative arthritis of the hip. Author(s): Berman AT. Source: Pa Med. 1975 January; 78(1): 59-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1128904&dopt=Abstract

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Degenerative arthritis of the knee in active patients: evaluation and management. Author(s): Cole BJ, Harner CD. Source: J Am Acad Orthop Surg. 1999 November-December; 7(6): 389-402. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11505927&dopt=Abstract

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Degenerative arthritis of the knee secondary to fracture malunion. Author(s): Kristensen KD. Source: Clinical Orthopaedics and Related Research. 1989 August; (245): 311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2752633&dopt=Abstract

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Degenerative arthritis of the knee secondary to fracture malunion. Author(s): Kettelkamp DB, Hillberry BM, Murrish DE, Heck DA. Source: Clinical Orthopaedics and Related Research. 1988 September; (234): 159-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3409571&dopt=Abstract

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Degenerative arthritis of the os peroneum. A case report. Author(s): Burton SK, Altman MI. Source: Journal of the American Podiatric Medical Association. 1986 June; 76(6): 343-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3723373&dopt=Abstract

Studies

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Degenerative arthritis of the trapeziometacarpal joint: arthrodesis or excision? Author(s): Weinman DT, Lipscomb PR. Source: Mayo Clinic Proceedings. 1967 May; 42(5): 276-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5337166&dopt=Abstract

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Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. Author(s): Cohen MS, Kozin SH. Source: The Journal of Hand Surgery. 2001 January; 26(1): 94-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11172374&dopt=Abstract

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Dental attrition and degenerative arthritis of the temporomandibular joint. Author(s): Richards LC, Brown T. Source: Journal of Oral Rehabilitation. 1981 June; 8(4): 293-307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7024487&dopt=Abstract

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Differences between men and women undergoing major orthopedic surgery for degenerative arthritis. Author(s): Katz JN, Wright EA, Guadagnoli E, Liang MH, Karlson EW, Cleary PD. Source: Arthritis and Rheumatism. 1994 May; 37(5): 687-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8185695&dopt=Abstract

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Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion. Author(s): Malerich MM, Clifford J, Eaton B, Eaton R, Littler JW. Source: The Journal of Hand Surgery. 1999 November; 24(6): 1196-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10584941&dopt=Abstract

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Dowel arthrodesis for degenerative arthritis of the tarsometatarsal (Lisfranc) joints. Author(s): Johnson JE, Johnson KA. Source: Foot Ankle. 1986 April; 6(5): 243-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3710322&dopt=Abstract

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Fusion of the first metacarpotrapezial joint for degenerative arthritis. Author(s): Stark HH, Moore JF, Ashworth CR, Boyes JH. Source: The Journal of Bone and Joint Surgery. American Volume. 1977 January; 59(1): 22-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=833170&dopt=Abstract

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Gait analysis after total knee replacement for degenerative arthritis. Author(s): Chen PQ, Cheng CK, Shang HC, Wu JJ. Source: J Formos Med Assoc. 1991 February; 90(2): 160-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1678410&dopt=Abstract

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In vitro and in vivo spin echo diffusion imaging characteristics of synovial fluid: potential non-invasive differentiation of inflammatory and degenerative arthritis. Author(s): Eustace S, DiMasi M, Adams J, Ward R, Caruthers S, McAlindon T. Source: Skeletal Radiology. 2000 June; 29(6): 320-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10929413&dopt=Abstract

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Innominate osteotomy: its role in the arrest of secondary degenerative arthritis of the hip in the adult. Author(s): Wedge JH, Salter RB. Source: Clinical Orthopaedics and Related Research. 1974 January-February; 98: 214-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4817233&dopt=Abstract

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Intertrochanteric osteotomy for degenerative arthritis of the hip. Author(s): Detenbeck LC, Coventry MB, Kelly PJ. Source: Clinical Orthopaedics and Related Research. 1972 July-August; 86: 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5047802&dopt=Abstract

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Intertrochanteric osteotomy for degenerative arthritis of the hip. Author(s): Detenbeck LC, Coventry MB, Kelly PJ. Source: Acta Orthop Belg. 1971 October; 37(5): 488-94. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5146142&dopt=Abstract

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Intra-articular injection of corticosteroid for degenerative arthritis. Author(s): Baker DM, Burland WL. Source: The Practitioner. 1969 March; 202(209): 431-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5767375&dopt=Abstract

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Intra-articular surgery for degenerative arthritis of the knee. A report of the work of the late K. H. Pridie. Author(s): Insall JN. Source: The Journal of Bone and Joint Surgery. British Volume. 1967 May; 49(2): 211-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6026508&dopt=Abstract

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Joint debridement--a complement to high tibial osteotomy in the treatment of degenerative arthritis of the knee. Author(s): MacIntosh DL, Welsh RP. Source: The Journal of Bone and Joint Surgery. American Volume. 1977 December; 59(8): 1094-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=591542&dopt=Abstract

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Leg alignment examination for patients with degenerative arthritis of the knee. Author(s): Ayub G. Source: Radiography. 1979 November; 45(539): 250-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=531187&dopt=Abstract

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Ligament reconstruction and tendon interpositional arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint. Author(s): Liu Y, Chang MC. Source: Zhonghua Yi Xue Za Zhi (Taipei). 1999 November; 62(11): 795-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10575808&dopt=Abstract

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Localisation of vitronectin receptor immunoreactivity and tartrate resistant acid phosphatase activity in synovium from patients with inflammatory or degenerative arthritis. Author(s): Ashton BA, Ashton IK, Marshall MJ, Butler RC. Source: Annals of the Rheumatic Diseases. 1993 February; 52(2): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7680551&dopt=Abstract

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Long-term results of upper tibial osteotomy for degenerative arthritis of the knee. Author(s): Coventry MB, Bowman PW. Source: Acta Orthop Belg. 1982 January-February; 48(1): 139-56. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7090779&dopt=Abstract

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Management of degenerative arthritis of the knee. Author(s): Cordrey LJ. Source: Gp. 1967 June; 35(6): 88-94. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6041921&dopt=Abstract

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Managing degenerative arthritis of the hip. Author(s): Harris WH, Johnston RC. Source: Postgraduate Medicine. 1969 May; 45(5): 242-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5786576&dopt=Abstract

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McKeever metallic hemiarthroplasty of the knee in unicompartmental degenerative arthritis. Long-term clinical follow-up and current indications. Author(s): Scott RD, Joyce MJ, Ewald FC, Thomas WH. Source: The Journal of Bone and Joint Surgery. American Volume. 1985 February; 67(2): 203-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3968110&dopt=Abstract

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Morphologic alterations of the subchondral bone in advanced degenerative arthritis. Author(s): Milgram JW. Source: Clinical Orthopaedics and Related Research. 1983 March; (173): 293-312. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6825342&dopt=Abstract

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Neuropeptides in experimental and degenerative arthritis. Author(s): Niissalo S, Hukkanen M, Imai S, Tornwall J, Konttinen YT. Source: Annals of the New York Academy of Sciences. 2002 June; 966: 384-99. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12114296&dopt=Abstract

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North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. The North of England Non-Steroidal Anti-Inflammatory Drug Guideline Development Group. Author(s): Eccles M, Freemantle N, Mason J. Source: Bmj (Clinical Research Ed.). 1998 August 22; 317(7157): 526-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9712607&dopt=Abstract

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Osteotomy of the hip for degenerative arthritis. Author(s): Coventry MB. Source: Mayo Clinic Proceedings. 1969 August; 44(8): 505-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5807888&dopt=Abstract

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Osteotomy of the lower extremity for degenerative arthritis and deformity. Author(s): Sirbu AB. Source: J La State Med Soc. 1971 April; 123(4): 119-27. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5575754&dopt=Abstract

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Osteotomy of the proximal femur in degenerative arthritis. Author(s): DePalma AF, Rothman RH, Klemek JS. Source: Clinical Orthopaedics and Related Research. 1970 November-December; 73: 10915. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5479765&dopt=Abstract

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Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report by Mark B. Conventry, MD. From the Section of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. 1965. Author(s): Conventry MB. Source: The Journal of Bone and Joint Surgery. American Volume. 2001 September; 83A(9): 1426. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11568209&dopt=Abstract

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Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. 1965. Author(s): Coventry MB. Source: Clinical Orthopaedics and Related Research. 1989 November; (248): 4-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2680204&dopt=Abstract

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Pasteurella multocida infection of the calf in a patient who had moxa cautery treatment for degenerative arthritis. Author(s): Chong Y, Lee HJ, Lee SY, Jahng JS, Yang KH. Source: Yonsei Medical Journal. 1982; 23(1): 65-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7168199&dopt=Abstract

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Pericellular proteoglycan concentrations in early degenerative arthritis. Author(s): Mitchell N, Shepard N. Source: Arthritis and Rheumatism. 1981 July; 24(7): 958-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7259807&dopt=Abstract

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Preceding tonsillectomy and appendicectomy in rheumatoid and degenerative arthritis. Author(s): Patel SB, Eastmond CJ. Source: The Journal of Rheumatology. 1983 April; 10(2): 313-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6864686&dopt=Abstract

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Premature epiphyseal fusion and degenerative arthritis in chronic recurrent multifocal osteomyelitis. Author(s): Piddo C, Reed MH, Black GB. Source: Skeletal Radiology. 2000 February; 29(2): 94-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10741498&dopt=Abstract

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Primary degenerative arthritis of the elbow. Treatment by ulnohumeral arthroplasty. Author(s): Morrey BF. Source: The Journal of Bone and Joint Surgery. British Volume. 1992 May; 74(3): 409-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1587890&dopt=Abstract

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Progressive patterns of degenerative arthritis in scaphoid nonunion demonstrated by three-dimensional computed tomography. Author(s): Hidaka Y, Nakamura R. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1998 December; 23(6): 765-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9888678&dopt=Abstract

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Prosthetic arthroplasty in the treatment of degenerative arthritis of the hip. Author(s): Torgerson WR, Hammond G. Source: Clinical Orthopaedics and Related Research. 1970 September-October; 72: 22432. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5459787&dopt=Abstract

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Prosthetic arthroplasty in the treatment of degenerative arthritis of the hip. Author(s): Hammond G, Torgerson WR. Source: Lahey Clin Found Bull. 1968 October-December; 17(4): 175-86. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5743594&dopt=Abstract

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Proximal tibial osteotomy for degenerative arthritis of the knee. Author(s): Evarts CM, DeHaven K, Nelson CL. Source: The Orthopedic Clinics of North America. 1971 March; 2(1): 231-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5117350&dopt=Abstract

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Pulmonary pseudonodules on computed tomography: a common pitfall caused by degenerative arthritis. Author(s): Haramati LB, Haramati N. Source: Journal of Thoracic Imaging. 1996 Fall; 11(4): 283-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8892199&dopt=Abstract

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Quantitative correlations in degenerative arthritis of the knee. Author(s): Miller R, Kettelkamp DB, Laubenthal KN, Karagiorgos A, Smidt GL. Source: The Journal of Bone and Joint Surgery. American Volume. 1973 July; 55(5): 95662. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4760102&dopt=Abstract

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Quantitative gait analysis after total knee arthroplasty for monarticular degenerative arthritis. Author(s): Simon SR, Trieshmann HW, Burdett RG, Ewald FC, Sledge CB. Source: The Journal of Bone and Joint Surgery. American Volume. 1983 June; 65(5): 60513. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6853565&dopt=Abstract

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Radio-carpal and inter-carpal degenerative arthritis in sequellae of scaphoid injuries. Author(s): Bonnevialle P, Mansat M, Railhac JJ, Rongieres M, Gay R. Source: Ann Chir Main. 1987; 6(2): 89-97. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3426322&dopt=Abstract

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Radiographic changes of the hand in rheumatoid and degenerative arthritis. Author(s): Bjorgen J. Source: Minn Med. 1983 June; 66(6): 363-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6877218&dopt=Abstract

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Relationship of degenerative arthritis to weight-bearing areas in the human hip joint. Author(s): Greenwald AS, Nelson CL Jr. Source: Surg Forum. 1972; 23(0): 463-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4671158&dopt=Abstract

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Rheumatoid and degenerative arthritis; medicolegal decisions. Author(s): Marmor D. Source: Med Trial Tech Q. 1969 June; 15(4): 21-53. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4241322&dopt=Abstract

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Roentgenographic changes of the hip joint following extra-articular operations for degenerative arthritis. Author(s): Scheck M. Source: The Journal of Bone and Joint Surgery. American Volume. 1970 January; 52(1): 99-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5411777&dopt=Abstract

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Short-term benefit of arthroscopic washout in degenerative arthritis of the knee. Author(s): Shannon FJ, Devitt AT, Poynton AR, Fitzpatrick P, Walsh MG. Source: International Orthopaedics. 2001; 25(4): 242-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561500&dopt=Abstract

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Stress radiography in degenerative arthritis of the knee. Author(s): Gibson PH, Goodfellow JW. Source: The Journal of Bone and Joint Surgery. British Volume. 1986 August; 68(4): 6089. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3733839&dopt=Abstract

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Surgical treatment of unicompartmental degenerative arthritis of the knee. Author(s): Kozinn SC, Scott RD. Source: Rheumatic Diseases Clinics of North America. 1988 December; 14(3): 545-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3065841&dopt=Abstract

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Synovial fluid copper and related variables in rheumatoid and degenerative arthritis. Author(s): Scudder PR, McMurray W, White AG, Dormandy TL. Source: Annals of the Rheumatic Diseases. 1978 February; 37(1): 71-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=629608&dopt=Abstract

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Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb. Author(s): Eaton RG, Glickel SZ, Littler JW. Source: The Journal of Hand Surgery. 1985 September; 10(5): 645-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4045141&dopt=Abstract

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The aging skeleton. Osteoporosis and degenerative arthritis. Author(s): McBeath AA. Source: Postgraduate Medicine. 1975 June; 57(7): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1129220&dopt=Abstract

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The classic: Joint debridement: surgical treatment of degenerative arthritis. Author(s): Magnuson PB. Source: Clinical Orthopaedics and Related Research. 1974 June; 101(01): 4-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4601270&dopt=Abstract

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The effectiveness of therapeutic touch for decreasing pain in elders with degenerative arthritis. Author(s): Eckes Peck SD. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1997 June; 15(2): 176-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9165806&dopt=Abstract

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The efficacy of therapeutic touch for improving functional ability in elders with degenerative arthritis. Author(s): Peck SD. Source: Nursing Science Quarterly. 1998 Fall; 11(3): 123-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9923328&dopt=Abstract

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The human incudomalleal joint. Chondroid articular cartilage and degenerative arthritis. Author(s): Gussen R. Source: Arthritis and Rheumatism. 1971 July-August; 14(4): 465-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5564920&dopt=Abstract

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The interpositional arthroplasty procedure in treatment of degenerative arthritis of the second metatarsophalangeal joint. Author(s): Lavery LA, Harkless LB. Source: J Foot Surg. 1992 November-December; 31(6): 590-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1469220&dopt=Abstract

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The pathology of degenerative arthritis of the hip and the use of osteotomy in its treatment. Author(s): Ferguson AB Jr. Source: Clinical Orthopaedics and Related Research. 1971; 77: 84-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5140463&dopt=Abstract

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The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. Author(s): Armstrong AL, Hunter JB, Davis TR. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1994 June; 19(3): 340-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8077824&dopt=Abstract

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The problem of trapeziometacarpal degenerative arthritis. Author(s): Menon J. Source: Clinical Orthopaedics and Related Research. 1983 May; (175): 155-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6839581&dopt=Abstract

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The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. Author(s): Watson HK, Ballet FL. Source: The Journal of Hand Surgery. 1984 May; 9(3): 358-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6725894&dopt=Abstract

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Tibial condylar fractures as a cause of degenerative arthritis. Author(s): Rasmussen PS. Source: Acta Orthopaedica Scandinavica. 1972; 43(6): 566-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4651936&dopt=Abstract

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Tibial osteotomy for the treatment of degenerative arthritis of the knee. Author(s): Torgerson WR Jr, Kettelkamp DB, Igou RA Jr, Leach RE. Source: Clinical Orthopaedics and Related Research. 1974 June; 101(01): 46-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4366335&dopt=Abstract

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Treatment of primary degenerative arthritis of the elbow by ulnohumeral arthroplasty. A long-term follow-up. Author(s): Phillips NJ, Ali A, Stanley D. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 April; 85(3): 347-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12729106&dopt=Abstract

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Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow: long-term outcome and complications. Author(s): Antuna SA, Morrey BF, Adams RA, O'Driscoll SW. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 December; 84A(12): 2168-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473704&dopt=Abstract

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CHAPTER 2. NUTRITION AND DEGENERATIVE ARTHRITIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and degenerative arthritis.

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

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

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

North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. The North of England Non-Steroidal Anti-Inflammatory Drug Guideline Development Group. Author(s): Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA. [email protected] Source: Eccles, M Freemantle, N Mason, J BMJ. 1998 August 22; 317(7157): 526-30 09598138

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nutrition

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

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

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

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

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

Food and Diet Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com

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

The effectiveness of therapeutic touch for decreasing pain in elders with degenerative arthritis. Author(s): Eckes Peck SD. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1997 June; 15(2): 176-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9165806&dopt=Abstract

•

The efficacy of therapeutic touch for improving functional ability in elders with degenerative arthritis. Author(s): Peck SD. Source: Nursing Science Quarterly. 1998 Fall; 11(3): 123-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9923328&dopt=Abstract

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

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

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•

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

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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to degenerative arthritis; 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 Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Methylsulfonylmethane Source: Healthnotes, Inc.; www.healthnotes.com MSM Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,807,00.html

Alternative Medicine 29

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

Patent Applications on Degenerative Arthritis 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 degenerative arthritis:

5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm. 6 This has been a common practice outside the United States prior to December 2000.

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Modular shoulder prosthesis Inventor(s): Heckman, Jon M.; (Warsaw, IN), Maroney, Brian; (Fort Wayne, IN) Correspondence: Paul J. Maginot; Maginot, Moore & Bowman, Llp; Bank One Center Tower; 111 Monument Circle, Suite 3000; Indianapolis; IN; 46204-5115; US Patent Application Number: 20040002765 Date filed: June 28, 2002 Abstract: A shoulder prosthesis and/or prosthesis sizing system, especially for treatment of degenerative arthritis or trauma, has an articulating head component. The shoulder prosthesis includes a humeral stem and a series of humeral heads. The heads are attached to the humeral stem by means of a locking connector. The locking connector allows the humeral head to be oriented in multiple positions of version, varus/valgus angulation, eccentricity and head height, while providing rigid securing of the humeral head to the humeral stem in the selected position relative to the humeral stem. In one form, the locking connector includes an expansion collar that provides radially outward expansion for humeral head position locking. The present shoulder prosthesis provides a means to anatomically position the humeral head relative to the humeral stem and rigidly secure the humeral head in the selected position relative to the humeral stem. This is accomplished by a minimum of components. Excerpt(s): The present invention relates to prosthetic systems for the replacement of limbs or portions thereof. More particularly, the invention concerns a modular shoulder prosthesis system that can be used in the extremities that have experienced bone loss or significant, irreparable bone trauma. For treatment of various problems with the shoulder such as degenerative arthritis and trauma of the shoulder, one method of providing relief to a patient is to replace the articulating surfaces of the shoulder, i.e. the humerus and glenoid articulating surfaces. In such replacement, pin relief, increased motion and anatomic reconstruction of the shoulder joint are goals of the orthopaedic surgeon. With multiple variations in human anatomy, prosthetic systems need to accurately replicated human anatomy with minimal component inventory. Artificial or prosthetic joints for the extremities are well-known. Many of prosthetic joints are modular, meaning that they include a selection of different components to account for differences in patient anatomy or surgical procedures. For example, U.S. Patent No. 5,314,479, owned by the assignee of the present invention, discloses a modular shoulder prosthesis that includes an array of selectable stems, bodies, collars and head members. The modular prosthesis of the '479 Patent allows the orthopaedic surgeon to assemble a custom prosthetic joint by selecting different sizes, shapes and orientations of the individual joint components. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Remedies for degenerative arthritis Inventor(s): Maeda, Yoshizou; (Osaka, JP), Ogawa, Koji; (Osaka, JP), Yonetomi, Yasuo; (Osaka, JP) Correspondence: Sughrue Mion, Pllc; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037; US Patent Application Number: 20030114530 Date filed: August 7, 2002

Patents 33

Abstract: A treatment and/or prevention agent for osteoarthritis comprising Nhydroxy-5-ethoxymethyloxy-2(S)-methyl-4(S)-(4-phenoxybenzoyl)amino pentanamide having an inhibitory activity of matrix metalloproteinases, or a non-toxic salt thereof as active ingredient. Excerpt(s): This invention relates to a treatment and/or prevention agent for osteoarthritis. More particularly, this invention relates to a treatment and/or prevention agent for osteoarthritis comprising N-hydroxy-5-ethoxymethyloxy-2(S)-methyl-4(S)-(4phenoxybenzoyl)aminopenta- namide having an inhibitory activity of matrix metalloproteinases, or a non-toxic salt thereof as active ingredient. The matrix metalloproteinases (MMPs) are neutral metalloproteinases and zinc (Zn.sup.2+) is essential in the active site for their activation. At least 20 classes of MMPs, which differ in primary structure, are identified. Concretely, there are Interstitial Collagenase (MMP1), Neutrophil Collagenase (MMP-8), Collagenase-3 (MMP-13), Gelatinase A (MMP-2), Gelatinase B (MMP-9), Stromelysin-1 (MMP-3), Stromelysin-2 (MMP-10), Matrilysin (MMP-7), metalloelastase (MMP-12) etc. They degrade collagen, laminin, proteoglycans, fibronectin, elastin, gelatin etc. under physiological conditions and therefore, are effective on growth and tissue remodeling of articulation tissue, bone tissue and connective tissue. However, it is consider that a disorganization of various tissues under morbid condition was caused by an increase of an expression or an activity of MMPs which was depend to a bankruptcy of MMP modulation. For example, it was reported that MMP-1, 2, 3, 8, 9, 13 was high-expression in a part of damaged cartilage of patients with osteoarthritis, and these MMPs were deeply concerned with a degradation of cartilage [Igaku no ayumi, 182, 549-553 (1997); J. Clin. Invest., 84, 678-685 (1989)]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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

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

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

Surgical management of degenerative arthritis of the lower limb; ISBN: 0812104978; http://www.amazon.com/exec/obidos/ASIN/0812104978/icongroupinterna

Chapters on Degenerative Arthritis In order to find chapters that specifically relate to degenerative arthritis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and degenerative arthritis 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

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“degenerative arthritis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on degenerative arthritis: •

Otosclerosis Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 467-487. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Otosclerosis is a bone disease limited to the temporal bone and primarily affecting the otic capsule. The growth of spongy bone usually results in stapes fixation but may also involve the cochlea and other parts of the labyrinth. This chapter on the clinical features of otosclerosis is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. Topics include definition; historical perspective; epidemiology; pathogenesis; pathology; history and physical findings; audiometry, including tuning fork tests, standard audiometry, the Carhart notch, and acoustic impedance; radiographic studies; differential diagnosis; medical management; surgical management, including candidate selection and preoperative management; surgical techniques, including stapedioplasty, stapedectomy, stapedotomy, laser stapedectomy, bilateral stapedectomy, closure, and postoperative care; intraoperative problems and complications, including intraoperative vertigo(dizziness), tympanic membrane (eardrum) perforation, obliterative otosclerosis, cerebrospinal fluid otorrhea (fluid from the ear), dehiscence of the facial nerve, floating footplate, and subluxation of the incus; postoperative complications, including vertigo, tinnitus (ringing or other sounds in the ears), cochlear hearing loss, facial paralysis, otitis media (middle ear infection), taste disturbance and oral dryness, perilymph fistula, incus necrosis, middle ear fibrosis, granuloma, postoperative labyrinthitis, meningitis, and recurrence; the evaluation of the results of stapes surgery; results of primary stapes surgery; stapedectomy (removal of the stapes of the middle ear and insertion of a graft and prosthesis) in children; revision stapedectomy; fenestration (surgical opening) and postfenestration stapedectomy; nonotosclerotic lesions of the stapes, including Paget's disease, osteogenesis imperfecta, tympanosclerosis, and degenerative arthritis; and other causes of ossicular fixation, including lateral ossicular fixation and incus annulus fusion. 31 figures. 112 references.

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

News Services and Press Releases One of the simplest ways of tracking press releases on degenerative arthritis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “degenerative arthritis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to degenerative arthritis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “degenerative arthritis” (or synonyms).

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

Periodicals and News

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

Sports, Exercise, and Arthritis Source: Bulletin on the Rheumatic Diseases. 50(6): 1-4. 2001. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter provides health professionals with information on the impact of exercise and sports on the musculoskeletal system. Some observations from animal studies suggest a link between the physical stress of exercise and osteoarthritis (OA). The article reviews human studies on the relationship between vigorous exercise and OA and between physical activity and OA of the knee, as well as the beneficial effects of exercise in patients with either inflammatory or degenerative arthritis. Evidence suggesting that sports participation and exercise contribute over time to degenerative arthritis is fragmentary and difficult to substantiate consistently. However, there is much evidence, even if anecdotal, to support the many benefits of exercise in health and disease. For example, one study found that a dynamic, individually tailored strength training program can be beneficial for people who have inflammatory arthritis by minimizing the effects of disease, inactivity, or both on the neuromuscular system. 22 references.

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

Joint Pain in Ehlers-Danlos Syndrome Source: Loose Connections. XV(3): 9-10,12. September-October 2000. Contact: Available from Ehlers-Danlos National Foundation. 6399 Wilshire Blvd., Suite 510, Los Angeles, CA 90048. (323) 651-3038. Summary: This newsletter article provides people who have Ehlers-Danlos Syndrome (EDS) with information on the causes and management of joint pain. The main theory on joint pain is based on the observation that people who have EDS have more excursion on the ends of the bones than is considered normal. This excessive motion of

40


the joints results in abnormal stretching of the capsule that holds the bone ends together. This in turn results in abnormal stresses across the capsule and triggers nerve endings that signal pain in the area. Treatment focuses on minimizing the unusual motion of the bone ends in an effort to brace the joint. To this end, people who have EDS and joint pain are trained to perform daily exercises in an effort to strengthen the muscles adjacent to the joint to offset the capsule's lack of support. They are also instructed to avoid activities that put the joint in a position allowing abnormal movement. People who have EDS may develop degenerative arthritis (DJD) earlier than would be expected. A mechanism by which patients who have EDS may develop early DJD is based on the observations of the cellular changes that accompany altered direction of forces. The treatment approach for DJD is very similar for all patients who have joint pain. The patient is instructed to minimize activities that will further damage remaining cartilage and achieve optimal body weight. Joint protection and stabilization are the mainstays of treatment for patients who have EDS and joint pain. Nonprescription medications may be used to decrease pain. Surgical joint replacement is an option if there is adequate evidence of loss of articular cartilage and associated pain or joint dysfunction. 4 references.

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

41

APPENDICES

43

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.

44


•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Physician Resources

45

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.

46


•

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 “degenerative arthritis” (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 23447 271 298 46 28 24090

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 “degenerative arthritis” (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.

Physician Resources

47

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.

49

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 degenerative arthritis 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 degenerative arthritis. 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 degenerative arthritis. 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 “degenerative arthritis”:

50

•


Guides on degenerative arthritis Arthritis http://www.nlm.nih.gov/medlineplus/arthritis.html

•

Other guides Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.html Knee Injuries and Disorders http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html Osteoarthritis http://www.nlm.nih.gov/medlineplus/osteoarthritis.html Osteoarthritis http://www.nlm.nih.gov/medlineplus/tutorials/osteoarthritisloader.html Rheumatoid Arthritis http://www.nlm.nih.gov/medlineplus/rheumatoidarthritis.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 degenerative arthritis. 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: •

What You Need to Know About TMJ Disorder Source: Phoenix, AZ: SmartPractice. 199x. [4 p.]. Contact: Available from SmartPractice. 3400 East McDowell, Phoenix, AZ 85008. (800) 522-0800. Fax (800) 522-8329. Website: www.smartpractice.com. PRICE: $34.00 for 100 brochures, plus shipping and handling. Summary: The temporomandibular joints connect the jaw bone to the skull and are located just in front of each ear. Temporomandibular joint (TMJ) disorder is a term used to describe dysfunction of the jaw muscles and joints. This patient education brochure outlines the signs and causes of TMJ disorders, and discusses some of the treatment options available. TMJ disorders can be characterized by pronounced noises associated with movement in the TM joints, pain when the jaw is opened fully, limited range of opening, clenching or grinding of the teeth, facial pain and a sense of facial muscle

Patient Resources

51

fatigue, ear pain not related to ear infection, occasional 'locking' when the jaw seems to stick open temporarily, ringing in the ears (tinnitus), and frequent headaches. TMJ disorders can develop from lost or crooked teeth, overbite, teeth that fit together poorly (malocclusion), degenerative arthritis, various head or neck injuries (such as whiplash), and stress causing clenched teeth (bruxism) and muscle spasms. Because other types of pain have been shown to mimic TMJ disorder, a careful and thorough dental and medical evaluation is essential to arrive at an accurate diagnosis. Treatment options can include correction of a malocclusion, a splint to help prevent bruxism, pain management strategies (including medication), relaxation techniques (including counseling), and physical therapy; only in rare cases is surgery required to correct a TMJ disorder. The brochure includes space for personalization by the dental office. The brochure is illustrated with full color graphics and photographs of smiling patients. 5 figures. 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 degenerative arthritis. 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 degenerative arthritis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with degenerative arthritis.

52


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 degenerative arthritis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “degenerative arthritis” (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 “degenerative arthritis”. 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 “degenerative arthritis” (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 “degenerative arthritis” (or a synonym) into the search box, and click “Submit Query.”

53

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.

54


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

55

•

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/

56


•

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

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

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

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

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

Finding Medical Libraries

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•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

•

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

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

•

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

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DEGENERATIVE ARTHRITIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acid Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.2. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [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] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation

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of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angulation: Deviation from the normal long axis, as in a fractured bone healed out of line. [NIH]

Ankle: That part of the lower limb directly above the foot. [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] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

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Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arthropathy: Any joint disease. [EU] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Aspiration: The act of inhaling. [NIH] Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds, and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bankruptcy: The state of legal insolvency with assets taken over by judicial process so that they may be distributed among creditors. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH]

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Bilateral: Affecting both the right and left side of body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [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] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [NIH] Brace: Any form of splint or appliance used to support the limbs or trunk. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bruxism: A disorder characterized by grinding and clenching of the teeth. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [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 functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] 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]

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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] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Aging: The decrease in the cell's ability to proliferate with the passing of time. Each cell is programmed for a certain number of cell divisions and at the end of that time proliferation halts. The cell enters a quiescent state after which it experiences cell death via the process of apoptosis. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] 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] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] 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

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molecules. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [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] 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 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]

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Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Connexin 43: A 43 kD peptide which is a member of the connexin family of gap junction proteins. Connexin 43 is a product of a gene in the alpha class of connexin genes (the alpha-1 gene). It was first isolated from mammalian heart, but is widespread in the body including the brain. [NIH] Consciousness: Sense of awareness of self and of the environment. [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] 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 Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] 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

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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] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [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] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU]

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Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Eardrum: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Eccentricity: Oddness of behavior or conduct without insanity. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [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] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] 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] Epiphyseal: Pertaining to or of the nature of an epiphysis. [EU] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [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

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deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Expression: Observable changes of expression in the face in response to emotional stimuli. [NIH] 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. 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] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue

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development. [NIH] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Gait: Manner or style of walking. [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] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

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] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste

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afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [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] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Growth Plate: The area between the epiphysis and the diaphysis within which bone growth occurs. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Humeral: 1. Of, relating to, or situated in the region of the humerus: brachial. 2. Of or

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belonging to the shoulder. 3. Of, relating to, or being any of several body parts that are analogous in structure, function, or location to the humerus or shoulder. [EU] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [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] Incision: A cut made in the body during surgery. [NIH] Incus: One of three ossicles of the middle ear. It conducts sound vibrations from the malleus to the stapes. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

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] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU]

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Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] 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] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthitis: Inflammation of the inner ear. [NIH] Lacrimal: Pertaining to the tears. [EU] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils,

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and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Fat. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lucida: An instrument, invented by Wollaton, consisting essentially of a prism or a mirror through which an object can be viewed so as to appear on a plane surface seen in direct view and on which the outline of the object may be traced. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Malleus: The largest of the auditory ossicles, and the one attached to the membrana tympani (tympanic membrane). Its club-shaped head articulates with the incus. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] 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] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH]

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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] Meniscus: A fibro-cartilage within a joint, especially of the knee. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metatarsophalangeal Joint: The articulation between a metatarsal bone and a phalanx. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] 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] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Multidrug resistance: Adaptation of tumor cells to anticancer drugs in ways that make the drugs less effective. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH]

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Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Neck Injuries: General or unspecified injuries to the neck. It includes injuries to the skin, muscles, and other soft tissues of the neck. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system;

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pertaining to orthopaedics. [EU] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] 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] Osteotomy: The surgical cutting of a bone. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otorrhea: A discharge from the ear, especially a purulent one. [EU] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

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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]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perilymph: The fluid contained within the space separating the membranous from the osseous labyrinth of the ear. [NIH] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] P-Glycoprotein: A 170 kD transmembrane glycoprotein from the superfamily of ABC transporters. It serves as an ATP-dependent efflux pump for a variety of chemicals, including many antineoplastic agents. Overexpression of this glycoprotein is associated with multidrug resistance. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

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

Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [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] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile

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strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate

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the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prosthesis: An artificial replacement of a part of the body. [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] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]

Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quiescent: Marked by a state of inactivity or repose. [EU] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and

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cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [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] 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] 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] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [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] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins

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have been removed. [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] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Smiling: A facial expression which may denote feelings of pleasure, affection, amusement, etc. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] 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] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Stabilization: The creation of a stable state. [EU] Stapes: One of the three ossicles of the middle ear. It transmits sound vibrations from the incus to the internal ear. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [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] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU]

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Substrate: A substance upon which an enzyme acts. [EU] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Systemic: Affecting the entire body. [NIH] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [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] Toxic: Having to do with poison or something harmful to the body. Toxic substances

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usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tympanic membrane: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [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] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH]

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Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX A Abdomen, 61, 79 Acetylcholine, 61, 77 Acid Phosphatase, 15, 61 Acoustic, 36, 61, 86 Acuity, 61, 63 Adjuvant, 61, 71 Adrenal Cortex, 61, 67 Adverse Effect, 61, 83 Afferent, 61, 70 Agonist, 61, 81 Albumin, 61, 84 Algorithms, 61, 64 Alpha-1, 61, 67 Alternative medicine, 38, 61 Amino acid, 61, 63, 73, 79, 80, 81, 85 Anabolic, 5, 6, 62 Anal, 62, 71 Analgesic, 62, 77 Analogous, 62, 73, 85 Anaphylatoxins, 62, 66 Androgens, 61, 62, 67 Angiogenesis, 62, 75 Angulation, 32, 62 Ankle, 4, 9, 11, 13, 62 Antibody, 62, 66, 68, 73, 75 Antigen, 62, 66, 73, 75 Antigen-Antibody Complex, 62, 66 Anti-inflammatory, 16, 24, 62, 68, 72, 77 Anti-Inflammatory Agents, 62, 68 Antineoplastic, 62, 68, 79 Antineoplastic Agents, 62, 79 Antipyretic, 63, 77 Apoptosis, 63, 65 Aqueous, 63, 69 Arachidonic Acid, 63, 80 Arginine, 62, 63, 77 Arteries, 63, 64, 67, 76 Arthropathy, 5, 63 Arthroplasty, 4, 13, 15, 17, 18, 20, 21, 22, 63 Arthroscopy, 9, 11, 63 Articular, 5, 7, 11, 14, 19, 21, 40, 63, 78 Articulation, 33, 63, 76 Aspiration, 4, 63 Audiometry, 36, 63 Auditory, 63, 69, 75, 85

B Bacteria, 62, 63, 69, 76, 85 Bacteriophage, 63, 85 Bankruptcy, 33, 63 Base, 21, 63, 68, 74, 84 Basement Membrane, 63, 70, 74 Bed Rest, 4, 63 Bilateral, 9, 10, 36, 64, 78 Biochemical, 5, 64, 78 Biological therapy, 64, 72 Biomechanics, 4, 64 Biotechnology, 8, 38, 45, 64 Blood vessel, 62, 64, 69, 83, 86 Bone Conduction, 63, 64 Brace, 40, 64 Brachial, 64, 72 Bradykinin, 64, 77 Branch, 57, 64, 75, 79, 83, 84 Bruxism, 51, 64 Bursitis, 9, 64 C Calcium, 6, 7, 64, 66, 75 Calculi, 64, 72 Capsules, 64, 71 Carbohydrate, 64, 67, 72, 80 Carbon Dioxide, 64, 71 Case report, 10, 12, 65 Caudal, 65, 80 Cell, 5, 7, 61, 62, 63, 64, 65, 66, 68, 69, 70, 72, 74, 75, 76, 77, 79, 80, 81, 82, 85 Cell Aging, 7, 65 Cell Death, 63, 65 Cell Division, 63, 65, 72 Cell Survival, 65, 72 Cerebral, 65, 70 Cerebral Cortex, 65, 70 Cerebrospinal, 36, 65 Cerebrospinal fluid, 36, 65 Cervical, 10, 11, 12, 65 Cervix, 65 Character, 65, 68 Chemotactic Factors, 65, 66 Cholesterol, 65, 82 Chondrocytes, 5, 6, 7, 65 Chronic, 5, 17, 65, 66, 73, 83 Chronic Disease, 65, 66 Clinical trial, 5, 45, 65, 79, 82 Cloning, 64, 65

88


Cochlea, 36, 66, 73 Cochlear, 36, 66, 84, 86 Cochlear Diseases, 66, 84 Collagen, 6, 9, 33, 62, 63, 66, 70, 71, 75, 79, 80 Collagen disease, 9, 66 Collapse, 21, 66 Combination Therapy, 66, 70 Complement, 15, 62, 66, 67 Complementary and alternative medicine, 27, 29, 66 Complementary medicine, 27, 67 Computational Biology, 45, 67 Computed tomography, 18, 67 Computerized tomography, 67 Conduction, 63, 67 Connective Tissue, 33, 66, 67, 71, 72, 75, 81, 82, 84 Connective Tissue Cells, 67 Connexin 43, 7, 67 Consciousness, 62, 67, 68 Contraindications, ii, 67 Coronary, 67, 76 Coronary Thrombosis, 67, 76 Cortex, 67, 78 Corticosteroid, 14, 67 Cranial, 68, 70, 71, 74, 85, 86 Craniocerebral Trauma, 68, 84 Curative, 68, 84 Cyclic, 68, 72, 77, 81 Cytokines, 5, 68 D Density, 68 Diagnostic procedure, 4, 31, 38, 68 Direct, iii, 68, 75, 76, 80, 82 Discrete, 68, 84 Dissociation, 9, 68 Dissociative Disorders, 68 Distal, 4, 13, 68, 80, 81 Dizziness, 36, 68, 86 Dorsal, 68, 80 Drug Interactions, 68 Dura mater, 68, 76, 78 Dysmenorrhea, 69, 77 Dyspareunia, 69, 70 E Eardrum, 36, 69 Eccentricity, 32, 69 Effector, 7, 61, 66, 69, 77 Efferent, 69, 70 Efficacy, 20, 27, 69 Effusion, 4, 69, 84

Elastin, 33, 66, 69, 70 Electrolyte, 67, 69, 76, 83 Embryo, 69, 78 Emulsion, 69, 71 Endothelium, 69, 77 Endothelium-derived, 69, 77 Endotoxin, 69, 85 Environmental Health, 44, 46, 69 Enzymatic, 62, 64, 66, 69 Enzyme, 7, 61, 69, 72, 76, 81, 84, 86 Epiphyseal, 17, 69 Epithelial, 69, 74 Epithelial Cells, 69, 74 Estrogen, 6, 69, 81, 82 Estrogen receptor, 6, 69 Estrogen Replacement Therapy, 6, 69 Exogenous, 6, 70 Extracellular, 5, 7, 67, 70, 75, 83 Extracellular Matrix, 8, 67, 70, 75 Extracellular Matrix Proteins, 70, 75 Extracellular Space, 70 Extremity, 4, 16, 70, 78, 82 F Facial, 36, 50, 70, 75, 83 Facial Expression, 70, 83 Facial Nerve, 36, 70 Facial Pain, 50, 70 Facial Paralysis, 36, 70 Family Planning, 45, 70 Fat, 63, 67, 70, 72, 75, 82, 83, 84 Fatigue, 70, 76 Fatty acids, 61, 70, 80 Femoral, 4, 71 Femur, 16, 71, 84 Fibrosis, 36, 71, 82 Fibula, 71, 84 Fistula, 36, 71 Fixation, 36, 71 Fovea, 71 Free Radicals, 68, 71 G Gait, 14, 18, 71 Gas, 64, 71, 73, 77 Gelatin, 33, 71, 84 Gene, 64, 67, 71, 85 Gland, 61, 71, 75, 78, 79, 82 Glossopharyngeal Nerve, 70, 71 Glucocorticoids, 61, 67, 72 Glucose, 72, 74 Glycogen, 72, 76 Glycoprotein, 72, 74, 79, 85 Glycosaminoglycans, 70, 72, 81

Index 89

Gout, 6, 72, 77 Governing Board, 72, 80 Graft, 36, 72 Granuloma, 36, 72 Growth, 7, 33, 36, 62, 63, 65, 72, 74, 77, 85 Growth factors, 7, 72 Growth Plate, 7, 72 Guanylate Cyclase, 72, 77 H Homeostasis, 6, 72 Homodimer, 72, 85 Hormonal, 6, 67, 69, 72 Hormone, 67, 69, 72, 74, 82, 85 Humeral, 32, 72 Hydrogen, 63, 64, 70, 73, 76 Hydroxylysine, 66, 73 Hydroxyproline, 62, 66, 73 Hypersensitivity, 73, 82 Hyperuricemia, 72, 73 I Id, 24, 28, 51, 56, 58, 73 Illusion, 73, 86 Immune function, 73, 85 Immune response, 61, 62, 68, 73, 86 In vitro, 6, 14, 73 In vivo, 5, 6, 14, 73 Incision, 73, 74 Incus, 36, 73, 75, 83 Indicative, 35, 73, 79, 86 Infarction, 67, 73, 76 Infection, 4, 17, 36, 51, 64, 65, 73, 75, 82, 83 Inflammation, 5, 61, 62, 64, 71, 73, 74, 76, 78, 79, 81, 82, 83, 84 Inner ear, 64, 66, 73, 74 Innervation, 70, 73, 79, 82 Inorganic, 7, 73 Insulin, 7, 74 Insulin-dependent diabetes mellitus, 74 Insulin-like, 7, 74 Interleukin-1, 6, 74 Interleukin-2, 74 Intracellular, 73, 74, 77, 81 Intracranial Hypertension, 74, 84 Intraoperative Complications, 4, 74 Invasive, 14, 74 Involuntary, 74, 77, 83 Ions, 63, 68, 69, 73, 74 J Joint, 5, 6, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 32, 39, 50, 63, 74, 76, 78, 84 K Kb, 44, 74

L Labile, 66, 74 Labyrinth, 36, 66, 73, 74, 78, 79, 86 Labyrinthitis, 36, 74 Lacrimal, 70, 74 Laminin, 33, 63, 70, 74 Latent, 7, 74 Leukocytes, 65, 68, 74, 76, 85 Library Services, 56, 75 Ligament, 10, 11, 15, 75 Lipid, 74, 75 Localized, 71, 73, 74, 75, 78 Lucida, 74, 75 Lupus, 66, 75 Lymph, 65, 69, 75 Lymph node, 65, 75 Lymphatic, 69, 73, 75 Lymphocyte, 62, 75 M Macrophage, 74, 75 Malleus, 73, 75 Mammary, 75, 82 Matrix metalloproteinase, 6, 33, 75 Meatus, 69, 75, 85 Medial, 75, 84 Mediator, 6, 74, 75 MEDLINE, 45, 75 Membrane, 66, 69, 74, 75, 80, 84, 85 Meninges, 68, 75, 76 Meningitis, 36, 76 Meniscus, 9, 76 Menopause, 76, 80 Mental, iv, 5, 44, 46, 65, 68, 70, 76, 81 Mental Processes, 68, 76, 81 Metabolic disorder, 72, 76 Metastasis, 75, 76 Metatarsophalangeal Joint, 21, 76 MI, 9, 12, 59, 76 Microorganism, 76, 86 Mineralization, 7, 76 Mineralocorticoids, 61, 67, 76 Modification, 7, 62, 76 Modulator, 6, 76 Molecular, 6, 45, 47, 64, 67, 76, 85 Molecule, 62, 63, 66, 68, 69, 76, 81, 82, 86 Monocytes, 74, 75, 76 Mononuclear, 72, 76, 85 Multidrug resistance, 76, 79 Muscle Fatigue, 51, 76 Muscular Diseases, 70, 77 Musculoskeletal System, 39, 77 Myocardium, 76, 77

90


N Naproxen, 8, 77 Neck Injuries, 51, 77 Need, 3, 32, 35, 39, 50, 52, 72, 75, 77 Neoplastic, 70, 77 Nerve, 40, 69, 70, 71, 73, 75, 77, 78, 79, 82, 85, 86 Nerve Endings, 40, 77 Nervous System, 61, 69, 72, 75, 77, 80 Neuroeffector Junction, 77 Neuromuscular, 39, 61, 70, 77 Neurons, 77, 86 Nitric Oxide, 5, 77 Nitrogen, 62, 70, 71, 77, 85 Nuclei, 70, 77, 86 O Ophthalmology, 71, 77 Orofacial, 70, 77 Orthopaedic, 6, 11, 32, 77 Ossicles, 73, 75, 78, 83 Ossification, 78 Osteoarthritis, 4, 6, 28, 33, 39, 50, 78 Osteogenesis, 36, 78 Osteomyelitis, 17, 78 Osteoporosis, 20, 70, 78, 81 Osteotomy, 14, 15, 16, 17, 18, 21, 22, 78 Otitis, 36, 78 Otitis Media, 36, 78 Otolaryngologist, 36, 78 Otolaryngology, 36, 78 Otorrhea, 36, 78 Otosclerosis, 36, 78 P Pachymeningitis, 76, 78 Palliative, 78, 84 Palpation, 4, 78 Pancreas, 74, 78 Paresis, 70, 78 Pathogenesis, 7, 8, 36, 78 Pathologic, 7, 63, 67, 73, 79, 80 Patient Education, 50, 54, 56, 59, 79 Patient Selection, 4, 79 Pelvis, 4, 61, 79, 85 Peptide, 61, 67, 79, 81 Perforation, 36, 79 Perilymph, 36, 79 Peroneal Nerve, 4, 79, 82 P-Glycoprotein, 7, 79 Phallic, 71, 79 Pharmaceutical Preparations, 71, 79 Pharmacologic, 6, 8, 79, 85 Physical Therapy, 51, 79

Physiologic, 6, 61, 79, 80, 82 Pituitary Gland, 67, 79 Plasma, 61, 71, 76, 79 Platelet Aggregation, 62, 77, 79 Platelets, 77, 79, 84 Pneumonia, 67, 79 Polyethylene, 4, 79 Polysaccharide, 62, 80, 81 Pons, 70, 80 Posterior, 9, 62, 68, 72, 78, 80 Postmenopausal, 6, 69, 78, 80, 81 Postoperative, 4, 36, 80 Postoperative Complications, 4, 36, 80 Post-translational, 7, 80 Potentiates, 74, 80 Practice Guidelines, 46, 80 Precursor, 63, 69, 80, 85 Preoperative, 4, 36, 80 Presynaptic, 77, 80 Presynaptic Terminals, 77, 80 Prevalence, 6, 21, 80 Progression, 5, 80 Progressive, 18, 70, 72, 78, 80 Proline, 66, 73, 80 Prostaglandin, 5, 80 Prostaglandins A, 81 Prosthesis, 32, 36, 81 Protein S, 64, 81 Proteins, 7, 61, 62, 66, 67, 68, 70, 72, 74, 75, 76, 77, 79, 81, 82, 85 Proteoglycan, 17, 81 Proteolytic, 61, 66, 81 Proximal, 13, 16, 18, 68, 80, 81 Psychiatry, 71, 81 Psychology, 68, 81 Public Policy, 45, 81 Purulent, 78, 81 Pyogenic, 78, 81 Q Quiescent, 65, 81 R Radiography, 15, 19, 81 Raloxifene, 6, 81, 82 Randomized, 69, 82 Receptor, 15, 62, 82 Recurrence, 36, 82 Refer, 1, 66, 68, 71, 82 Regimen, 69, 82 Relaxation Techniques, 51, 82 Remission, 82 Resection, 13, 82 Restoration, 79, 82, 86

Index 91

Rheumatism, 13, 17, 21, 82 Rheumatoid, 5, 17, 19, 20, 50, 66, 77, 82 Rheumatoid arthritis, 5, 66, 77, 82 S Salivary, 70, 82 Salivary glands, 70, 82 Sciatic Nerve, 79, 82 Sclerosis, 66, 82 Screening, 65, 82 Secretion, 68, 72, 74, 76, 82, 85 Sediment, 82 Sedimentation, 4, 82 Selective estrogen receptor modulator, 81, 82 Septic, 4, 82 Serum, 61, 62, 66, 76, 82, 85 Shock, 83, 85 Side effect, 61, 64, 73, 83, 85 Skeletal, 10, 14, 17, 62, 77, 83 Skeleton, 20, 71, 74, 81, 83, 84 Skull, 50, 64, 68, 83, 84 Smiling, 51, 83 Smooth muscle, 62, 67, 77, 83 Sodium, 72, 76, 77, 83 Soft tissue, 4, 77, 83 Spasm, 4, 83 Spatial disorientation, 68, 83 Specialist, 52, 83 Spinal cord, 64, 65, 68, 75, 77, 78, 82, 83 Splint, 51, 64, 83 Stabilization, 40, 83 Stapes, 36, 73, 83 Steroids, 67, 83 Stress, 5, 19, 39, 51, 82, 83 Subacute, 73, 83 Subclinical, 73, 83 Substrate, 7, 84 Suppositories, 71, 84 Suppression, 68, 84 Symptomatic, 4, 84 Synovial, 14, 20, 84 Synovial Fluid, 14, 84 Synovial Membrane, 84 Synovitis, 3, 5, 84 Systemic, 66, 73, 74, 84 T Talus, 84 Temporal, 36, 75, 84 Tendon, 4, 15, 20, 64, 84 Therapeutics, 84

Thermal, 68, 84 Thigh, 71, 84 Thrombus, 67, 73, 79, 84, 86 Tibia, 17, 71, 84 Tinnitus, 36, 51, 78, 84, 86 Tissue, 33, 62, 63, 65, 66, 67, 68, 69, 70, 71, 72, 75, 77, 78, 79, 82, 83, 84, 86 Tomography, 67, 84 Toxic, iv, 33, 84, 85 Toxicity, 68, 85 Toxicology, 46, 85 Toxins, 62, 73, 85 Transduction, 7, 85 Transfection, 64, 85 Transforming Growth Factor beta, 7, 85 Translational, 85 Transmitter, 61, 75, 85 Trauma, 11, 32, 85 Trigeminal, 70, 85 Tryptophan, 66, 85 Tumor Necrosis Factor, 5, 85 Tympanic membrane, 36, 75, 78, 85 U Unconscious, 73, 85 Uric, 72, 73, 85 Uterus, 65, 85 V Vascular, 69, 73, 77, 84, 86 Vasodilators, 77, 86 Vasomotor, 70, 86 Vector, 85, 86 Vein, 86 Venous, 4, 81, 86 Venous Thrombosis, 4, 86 Ventricles, 65, 86 Vertigo, 36, 78, 86 Vestibule, 66, 73, 86 Vestibulocochlear Nerve, 84, 86 Vestibulocochlear Nerve Diseases, 84, 86 Veterinary Medicine, 45, 86 Viral, 85, 86 Virus, 63, 85, 86 Vitro, 86 Vivo, 86 W Weight-Bearing, 19, 86 Wound Healing, 4, 75, 86 X X-ray, 67, 86

92


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