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

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

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Pregnancy: 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: 0-597-83665-5 1. Pregnancy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on pregnancy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PREGNANCY.............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Pregnancy ................................................................................... 21 E-Journals: PubMed Central ..................................................................................................... 130 The National Library of Medicine: PubMed .............................................................................. 143 CHAPTER 2. NUTRITION AND PREGNANCY .................................................................................. 229 Overview.................................................................................................................................... 229 Finding Nutrition Studies on Pregnancy .................................................................................. 229 Federal Resources on Nutrition ................................................................................................. 234 Additional Web Resources ......................................................................................................... 235 CHAPTER 3. ALTERNATIVE MEDICINE AND PREGNANCY ........................................................... 237 Overview.................................................................................................................................... 237 The Combined Health Information Database............................................................................. 237 National Center for Complementary and Alternative Medicine................................................ 240 Additional Web Resources ......................................................................................................... 251 General References ..................................................................................................................... 268 CHAPTER 4. DISSERTATIONS ON PREGNANCY ............................................................................. 269 Overview.................................................................................................................................... 269 Dissertations on Pregnancy....................................................................................................... 269 Keeping Current ........................................................................................................................ 311 CHAPTER 5. CLINICAL TRIALS AND PREGNANCY ........................................................................ 313 Overview.................................................................................................................................... 313 Recent Trials on Pregnancy ....................................................................................................... 313 Keeping Current on Clinical Trials ........................................................................................... 332 CHAPTER 6. PATENTS ON PREGNANCY ........................................................................................ 335 Overview.................................................................................................................................... 335 Patents on Pregnancy ................................................................................................................ 335 Patent Applications on Pregnancy ............................................................................................ 399 Keeping Current ........................................................................................................................ 422 CHAPTER 7. BOOKS ON PREGNANCY ............................................................................................ 423 Overview.................................................................................................................................... 423 Book Summaries: Federal Agencies............................................................................................ 423 Book Summaries: Online Booksellers......................................................................................... 426 The National Library of Medicine Book Index ........................................................................... 441 Chapters on Pregnancy .............................................................................................................. 442 Directories.................................................................................................................................. 453 CHAPTER 8. MULTIMEDIA ON PREGNANCY ................................................................................. 457 Overview.................................................................................................................................... 457 Video Recordings ....................................................................................................................... 457 Audio Recordings....................................................................................................................... 464 Bibliography: Multimedia on Pregnancy................................................................................... 465 CHAPTER 9. PERIODICALS AND NEWS ON PREGNANCY .............................................................. 467 Overview.................................................................................................................................... 467 News Services and Press Releases.............................................................................................. 467 Newsletters on Pregnancy ......................................................................................................... 472 Newsletter Articles .................................................................................................................... 474 Academic Periodicals covering Pregnancy ................................................................................ 476 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 477 Overview.................................................................................................................................... 477

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U.S. Pharmacopeia..................................................................................................................... 477 Commercial Databases ............................................................................................................... 483 Researching Orphan Drugs ....................................................................................................... 484 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 489 Overview.................................................................................................................................... 489 NIH Guidelines.......................................................................................................................... 489 NIH Databases........................................................................................................................... 491 Other Commercial Databases..................................................................................................... 502 The Genome Project and Pregnancy .......................................................................................... 502 APPENDIX B. PATIENT RESOURCES ............................................................................................... 507 Overview.................................................................................................................................... 507 Patient Guideline Sources.......................................................................................................... 507 Associations and Pregnancy ...................................................................................................... 535 Finding Associations.................................................................................................................. 545 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 547 Overview.................................................................................................................................... 547 Preparation................................................................................................................................. 547 Finding a Local Medical Library................................................................................................ 547 Medical Libraries in the U.S. and Canada ................................................................................. 547 ONLINE GLOSSARIES................................................................................................................ 553 Online Dictionary Directories ................................................................................................... 554 PREGNANCY DICTIONARY ..................................................................................................... 555 INDEX .............................................................................................................................................. 689

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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 pregnancy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about pregnancy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to pregnancy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on pregnancy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to pregnancy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on pregnancy. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON PREGNANCY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on pregnancy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and pregnancy, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “pregnancy” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Special Report: AIDS/HIV and Pregnancy Source: PWAC NY Newsline; July/Aug 1995. Contact: People With AIDS Coalition of New York, 50 W 17th St 8th Fl, New York, NY, 10011-1607, (212) 647-1415. Summary: This article presents interviews with women who are or have been pregnant and HIV positive. The first woman, along with her partner, relates how they arrived at the decision to have a child together. The second woman, unexpectedly pregnant several years after discovering her HIV status, discusses her prenatal care and support system. A young Latina talks about being pregnant and HIV positive in her native Puerto Rico. The final woman states how her pregnancy made her admit her HIV status to others and seek help. She and her baby are part of a correctional program that allows mothers and

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children to stay together during the mother's incarceration. The article also includes a conversation with two gay men who adopted two HIV- positive children, both of whom have since seroconverted. They explain how they decided to adopt, outline the adoption process, and describe the fears and hopes involved in raising such children. •

Midwifery Care for Women With Human Immunodeficiency Virus Disease in Pregnancy; A Demonstration Project at the Johns Hopkins Hospital Source: Journal of Nurse - Midwifery; Vol. 38, No. 2, March/Apr. 1993. Contact: Johns Hopkins University, School of Medicine, Division of Pediatric Infectious Diseases, Pediatric AIDS Clinical Trials Group, 600 N Wolfe St Blalock 1142, Baltimore, MD, 21287, (410) 955-9728. American College of Nurses - Midwives, 818 Connecticut Ave NW Ste 900, Washington, DC, 20006, (202) 728-9860, http://www.midwife.org. Summary: This article describes a project at Johns Hopkins Hospital to integrate nursemidwifery care into the routine obstetric and HIV-related care for 73 women with HIV disease. It details how midwifery care can help strengthen the family unit, and decrease infant abuse and neglect. In addition, midwives can increase prenatal and postpartum utilization of specialty HIV care. The authors contend that nurse-midwives are qualified to attend to HIV-infected women and comanagement with physicians can provide optimal medical and psychological care.

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Comments on An Evaluation of An Abstinence - Only Adolescent Pregnancy Prevention Program Source: Family Relations; Vol. 41, Oct. 1992. Contact: National Council on Family Relations, Family Resources Database, 3989 Central Ave NE, Suite 550, Minneapolis, MN, 55421, (612) 781-9331. Summary: This article comments on several methodological and analytical aspects of earlier articles by Roosa and Christopher evaluating the effectiveness of an abstinenceonly pregnancy prevention program for adolescents, the "Success Express" project. It also disputes the conclusions in the previous articles that abstinence-based prevention programs do not work. The authors of this article are current and former Chief Evaluators for the Office of Population Affairs in the U.S. Department of Health and Human Services, which funded the demonstration prevention program. They indicate the program may not have been implemented as planned, question the differences in the control groups and participants, critique the statistical and replication analyses used in the evaluations, and argue that further evaluations of the revised project must be performed before conclusions can be drawn about abstinence-based education programs.

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Project Taking Charge: An Evaluation of An Adolescent Pregnancy Prevention Program Source: Family Relations; Vol. 40, 1991. Contact: National Council on Family Relations, Family Resources Database, 3989 Central Ave NE, Suite 550, Minneapolis, MN, 55421, (612) 781-9331. Summary: This article presents the results of an evaluation of an abstinence-based intervention program, Project Taking Charge, a combined sex and vocational education program for seventh grade students in high pregnancy-risk areas. The review used a pretest and post-test control group research design. Predicted changes in adolescent

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self-esteem, educational aspirations, and sexual attitudes and behavioral intentions were not found. Neither were predicted changes found on several measures of parentadolescent communication about sexual and vocational issues. However, both adolescents and parents realized significant knowledge gains in the areas of human sexuality, sexual development, and sexually transmitted diseases (STDs). •

Evaluation of An Abstinence - Only Adolescent Pregnancy Prevention Program: A Replication Source: Family Relations; Vol. 39, 1990. Contact: National Council on Family Relations, Family Resources Database, 3989 Central Ave NE, Suite 550, Minneapolis, MN, 55421, (612) 781-9331. Summary: This article presents the results of the authors' second evaluation of the "Success Express Program", an abstinence-only adolescent pregnancy prevention program. This replication of an earlier evaluation indicates that none of the desired changes in attitudes or behavior occurred for the 528 adolescents in the sample as a whole or for the subgroup who were sexually inexperienced. The authors conclude that the results call into question the federal government's policy of relying exclusively on abstinence-only behavior modification programs.

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Common Dermatoses: How To Treat Safely and Effectively During Pregnancy, Part 1 Source: Consultant. 41(7): 1037-1044. June 2001. Summary: This journal article, the first of a two part article, provides health professionals with information on the treatment of common dermatoses such as on acne, perioral dermatitis, rosacea, and seborrheic dermatitis during pregnancy. For pregnant women with acne, category B topical antibiotics can be applied after washing with a mild facial cleanser. These antibiotics include clindamycin gel, lotion, pledgets, or solution; multiple vehicles of erythromycin 1.5 percent or 2 percent; and azelaic acid 20 percent cream. Medicated cleansers such as benzoyl peroxide and nonprescription salicylic acid can be used once or twice daily to wash affected areas. For patients with severe acne, oral macrolides are a safe alternative to oral tetracyclines, which are contraindicated during pregnancy. Acne medications that are absolutely contraindicated during pregnancy include topical tazarotene and oral isotretinoin. The treatment of perioral dermatitis during pregnancy is limited primarily to topical agents such as metronidazole 0.75 percent or 1 percent cream or erythromycin 2 percent gel. Oral and vaginal preparations of metronidazole are contraindicated during the first trimester because of an increased risk of birth defects; however, the topical formulation appears to be safe when applied to a small area. Topical metronidazole is also effective in treating rosacea. Clindamycin lotion and erythromycin 2 percent gel are alternatives for pregnant women with rosacea but are sometimes less effective. Oral erythromycin may also be prescribed. For pregnant women with seborrheic dermatitis, ciclopirox, a synthetic topical antifungal, has a better safety profile than other therapies such as corticosteroids. 8 figures, 2 tables, and 26 references. (AA-M).

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Low Back Pain During Pregnancy: Helping Patients Take Control Source: Journal of Musculoskeletal Medicine. 17(4): 223-226,229-232. April 2000. Summary: This journal article, the third in a special series on orthopedic and musculoskeletal problems in women, introduces health professionals to a system of physical therapy assessment and treatment of low back pain (LBP) during pregnancy.

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This approach allows the patient to self manage LBP up to and after delivery. Theories about the causes of LBP during pregnancy focus on hormonal changes, vascular changes, and anatomic and biomechanical alterations caused by the enlarging fetus or the loosening of ligaments that occurs pursuant to hormonal changes. LBP that occurs during pregnancy is not always temporary and can recur; therefore, effective treatment is not palliative but requires close cooperation between the patient and her health care providers. Back pain can be mechanical or nonmechanical. Mechanical pain occurs in a pattern, becoming better or worse with certain positions, movements, and activities. Patient management begins with a history, physical examination, and specific mechanical testing procedures. Issues that need to be considered when obtaining a patient history include determining how and when the symptoms began, where the symptoms occurred at onset, where current symptoms are located, whether the symptoms are constant or intermittent, and how daily activities affect symptoms. The physical examination involves determining lumbar position through visual inspection and manual palpation; observing how well the lumbar spine moves into flexion, extension, and lateral flexion; determining which positions or movements intensify or alleviate symptoms; and conducting a neurologic screening and other standard physical examination procedures. The results of these assessments form the basis for an exercise and activity modification program that the patient can practice at home or work. Most pregnant women with LBP find that extension activities, such as walking or bending backward, provide more relief than flexion based maneuvers. 4 figures, 1 table, and 24 references. (AA-M). •

Avoiding and Overcoming Pregnancy-related Problems of SLE Source: Journal of Musculoskeletal Medicine. 14(5):24-26,31-32,34,40; May 1997. Summary: This journal article for health professionals focuses on pregnancy-related problems of systemic lupus erythematosus (SLE), focusing on risks to the mother and the fetus, the assessment of maternal and fetal well-being, and the use of various medications during pregnancy and lactation. Approximately half of pregnancies in women with SLE come to term. Poor pregnancy outcomes are associated with renal disease, hypertension, previous poor obstetric outcome, and presence of antiphospholipid antibodies. Risk of disease activity and fetal loss is reduced if disease is controlled in the 6 months before conception. Whether pregnancy is an independent risk factor for SLE disease flare is unknown. Distinguishing disease activity from preeclampsia is important yet difficult because the clinical pictures are similar. Most babies delivered of mothers with SLE grow and develop normally. Fertility is usually not affected in women with SLE, and barrier methods for contraception are preferred. 23 references and 5 tables. (AA-M).

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Autoantibodies Reactive With Ro(SSA) and La(SSB) and Pregnancy Source: Journal of Rheumatology. 24(Supp. 50):12-16; September 1997. Summary: This journal article for health professionals discusses the effect of maternal anti-Ro(SSA) or anti-La(SSB) antibodies on the fetus. Women with these antibodies are at risk for having infants with manifestations of neonatal lupus. Although some of the manifestations of neonatal lupus are transient, the most serious manifestation, congenital heart block (CHB), is generally irreversible. The article discusses maternal autoantibodies and pregnancy in terms of the target antigens of the Ro(SSA) and La(SSB) system, the pathogenicity of anti-Ro(SSA) and anti-La(SSB) antibodies and CHB, and the accessibility of target antigen to antibody. It reviews studies on maternal autoantibody profile and risk of CHB. Findings suggest that mothers who do not have

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anti-La(SSB) antibodies and have anti-Ro(SSA) antibodies of low titer that do not recognize either the 60 or 52 kDa component appear to be at lower risk. The article highlights studies that investigated the long-term health status of mothers who had children with neonatal lupus. Overall, results show that asymptomatic mothers do not invariably become ill and that, if asymptomatic mothers do become ill, it is not necessarily life threatening. In addition, the article presents data on mortality, morbidity, and recurrence rates of CHB obtained from a national registry of neonatal lupus and presents a clinical approach to the management of the cardiac manifestations of neonatal lupus. 47 references. •

Hip, Knee, and Foot Pain During Pregnancy and the Postpartum Period Source: Journal of Family Practice. 43(1):63-68; July 1996. Summary: This journal article for health professionals describes a study that investigated the prevalence and characterized the nature of lower extremity pain in women of childbearing age and assessed the impact of recent pregnancy on these symptoms. Participants were 107 consecutive postpartum women and 91 nulliparous women who completed a questionnaire regarding hip, knee, and foot pain and potentially influencing factors. Results indicate that postpartum participants had more symptoms of leg and foot pain than did the controls. A significant majority of pain began during the second and third trimesters. Postpartum subjects also had a significantly higher prevalence of hip pain and foot pain. History of previous pain complaints also were found to be risk factors for lower extremity pain during pregnancy for case subjects and in the past year for controls. There was a trend toward older age as a risk factor as well. Multiple pain complaints were more common among case subjects than among controls. Regular exercise appeared to be neither protective against nor a risk factor for lower extremity pain during pregnancy. The timing of symptom onset in mid- to late pregnancy may suggest that biomechanical factors play a larger role than hormonal influences. 34 references, 1 figure, and 2 tables. (AA-M).

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Cytomegalovirus and Pregnancy Source: Current Opinion in Obstetrics and Gynecology. 4(5): 670-675. October 1992. Summary: Cytomegalovirus is the most common congenital infection worldwide, with approximately 1 percent of all newborns infected in utero. Of those infected in utero, approximately 10 percent will have signs and symptoms of cytomegalovirus infection at birth and develop sequelae, especially mental retardation, hearing deficit, or both. This article discusses the pathogenesis of congenital infection, the rates of infection during pregnancy, day-care center transmission of cytomegalovirus, risks for mothers and caretakers, and strategies for prevention. The author concludes that the best approach for preventing disease due to congenital cytomegalovirus infection would be maternal vaccination; however, such vaccines are still in development. The author outlines which patient groups should be screened for cytomegalovirus during pregnancy. 2 figures. 3 tables. 20 references. (AA-M).

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Use of Proton Pump Inhibitors During Pregnancy and Rates of Major Malformations: A Meta-Analysis Source: Digestive Diseases and Sciences. 47(7): 1526-1529. July 2002. Contact: Available from Kluwer Academic Publishers. Customer Service Department, P.O. Box 358, Accord Station, Hingham, MA 02018-0358. (781) 871-6600. Fax (781) 6819045. E-mail: [email protected]. Website: www.wkap.nl. Distribution Centre, P.O. Box

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322, 3300 AH Dordrecht, The Netherlands. 31 78 6392392. Fax: 31 78 6546474. E-mail: [email protected]. Summary: Proton pump inhibitors (PPIs) are used to treat gastroesophageal reflux, a symptom common in pregnancy. This article reports on a study undertaken to systematically analyze the available data on the risk for malformations following use of these agents in the first trimester of pregnancy. The authors searched Medline, EMBASE, published abstracts, and reference lists for articles reporting on PPI use during pregnancy. Five cohort studies met the inclusion criteria for this meta-analysis. With almost 600 exposed pregnancies, the overall relative risk was 1.18. The authors conclude that PPIs do not present a major teratogenic (resulting in fetal abnormalities) risk when used in recommended doses. These data are reassuring for the countless patients who have used these agents in the early part of their pregnancies. 2 figures. 1 table. 18 references. •

Viral Hepatitis in Pregnancy Source: Viral Hepatitis Review. 6(1-4): 205-215. 2000. Contact: Available from Harcourt Brace and Company Ltd. Journals Subscriptions Department, Foots Cray, Sidcup, Kent DA14 5HP UK. Telephone +181 300 3322. Summary: The association of viral hepatitis (liver infection) and pregnancy goes beyond recognition and management of the individual patients with acute or chronic hepatitis. Public health measures directed at the entire pregnant population provide an excellent opportunity for implementation of widespread screening and primary and secondary prophylaxis, particularly with regard to hepatitis B and the subsequent development of hepatocellular carcinoma (HCC, liver cancer). This review article discusses important epidemiological features of viral hepatitis in the pregnant population; clinical features and diagnosis of acute viral hepatitis, fulminant hepatitis, and chronic viral hepatitis in the pregnant patient; management of viral hepatitis in pregnancy; and preventive measures for mothers and babies. Acute viral hepatitis is the most common cause of jaundice in pregnancy and in most cases neither the liver disease nor the pregnancy (mother or fetus) is affected by the presence of the other. The most important epidemiological association of pregnancy and viral hepatitis is chronic hepatitis B where pregnancy perpetuates the prevalence of HBV by its high rate of vertical transmission (mother to fetus) with resulting chronic hepatitis B, cirrhosis, and hepatocellular carcinoma. This vertical transmission is preventable in 85 percent of cases by screening all pregnancy women for hepatitis B and by subsequent immunoprophylaxis of the babies. Vertical transmission of HCV is much less than HBV and chronic hepatitis C and pregnancy appear to have little effect on one another. Hepatitis E and herpes simplex hepatitis are rare in developed countries but are frequently fulminant (rapid and severe) in pregnancy with resulting high maternal and fetal mortality (death). 2 tables. 53 references.

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Liver Disease in Pregnancy Source: American Family Physician. 59(4): 829-836. February 15, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article reviews liver disease in pregnancy. Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of acute hepatitis is unaffected by pregnancy, except in patients with hepatitis E and disseminated herpes

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simplex infections, in which maternal and fetal mortality rates increase significantly. Chronic hepatitis B or C infections can be transmitted to neonates, although hepatitis B virus transmission is effectively prevented by perinatal hepatitis B vaccination and prophylaxis with hepatitis B immune globulin. Cholelithiasis (gallstones) occurs in 6 percent of pregnancies; complications can be safely treated with surgery. Women with chronic liver disease or cirrhosis exhibit a higher risk of fetal loss during pregnancy. Preeclampsia is associated with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, acute fatty liver of pregnancy, and hepatic infarction and rupture. These rare diseases result in increased maternal and fetal mortality. Treatment involves prompt delivery, whereupon the liver disease quickly reverses. Therapy with penicillamine, trientine, prednisone, or azathioprine can be safely continued during pregnancy. 2 figures. 37 references. (AA). •

Diagnosing and Managing Liver Abnormalities in Pregnancy Source: IM. Internal Medicine. 20(5): 31-32, 35-40. May 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Summary: This article reviews the diagnosis and management of liver abnormalities in pregnancy. The authors note that certain effects of pregnancy can create the impression of liver disease where none exists. However neither serum transaminase nor bilirubin is altered during normal pregnancy; therefore, these tests are reliable indicators of liver disease. When a pregnant patient presents with evidence of liver disease, there are three options to consider. She may have one of the liver problems that are unique to pregnancy, which include abnormalities associated with hyperemesis gravidarum, intrahepatic cholestasis of pregnancy (IHCP), preeclampsia eclampsia HELLP syndrome, and acute fatty liver of pregnancy (AFLP). Or she could have a liver disease for which pregnancy is a predisposing factor, such as Budd Chiari syndrome or herpes hepatitis. If neither is the case, then she either has underlying liver disease or has acquired it coincidentally. Some of these latter situations, such as hepatitis B during pregnancy, may also have important implications for the infant. The author concludes that while corrective treatment is often not possible, timely detection and control of liver disease in pregnancy are always important to an optimal outcome. The article includes a diagnostic algorithm for liver disease in pregnancy. 1 figure. 1 table. 17 references.

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Inflammatory Bowel Disease and Pregnancy Source: Gastroenterology Clinics of North America. 27(1): 213-224. March 1998. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article reviews the interplay of inflammatory bowel disease (IBD) and pregnancy. The author begins by cautioning that many of the research studies are somewhat dated and often did not distinguish between the subtypes of IBD. However, general implications for practice can be ascertained. Topics include fertility, inheritance and IBD, the influence of ulcerative colitis (UC) on fetal outcome, the influence of Crohn's disease on fetal outcome, the influence of pregnancy on the course of UC and of Crohn's disease, episiotomy in IBD, the influence of drug therapy on the pregnant woman and the fetus, smoking, the effect of surgery for IBD on subsequent pregnancies, and the management of IBD during pregnancy. Drugs discussed include 5aminosalicylic acid agents (mesalamine, olsalazine), corticosteroids, immunosuppressives, cyclosporine, methotrexate, and antibiotics. Rates of healthy

10 Pregnancy

babies, congenital abnormalities, stillbirths, and spontaneous abortions are roughly the same in women with UC and Crohn's disease as in the normal population. The presence of UC did not influence the mode of delivery (vaginal versus cesarean section) or the incidence of preeclampsia during gestation. However, if a severe exacerbation requiring surgery occurs during pregnancy, the fetal mortality is high. 71 references. •

Gastroesophageal Reflux Disease During Pregnancy Source: Gastroenterology Clinics of North America. 27(1): 153-167. March 1998. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Gastroesophageal reflux disease (GERD) and its most common symptom, heartburn, are seen frequently in the United States population. Symptoms of GERD are common in pregnancy, and although GERD rarely endangers maternal or fetal health, GERD can significantly affect patient comfort and quality of life. This article reviews the presentation, pathophysiology, diagnosis, and treatment of GERD as it relates to the pregnant patient. Although symptoms are often mild and easily controlled in pregnancy, symptoms of GERD may be severe enough to interfere with diet and create a risk of malnutrition as well as to interfere with sleep and general quality of life. Therapy should be administered in a systematic fashion as for any patient with GERD, but conservative measures including lifestyle modifications and dietary changes, and nonsystemic therapies, such as antacids, alginic acid, and sucralfate, play a more prominent role in pregnant patients than drug therapy with H2 antagonists or other agents. If symptoms are not adequately relieved or if complications develop, treatment with cimetidine or ranitidine should be considered; these are the preferred H2 receptor antagonists for pregnant patients. Nizatidine cannot be recommended. Proton-pump inhibitors should be used with caution because little human experience is available. Despite this caveat, both proton-pump inhibitors (omeprazole and lansoprazole) are likely to be safe during pregnancy. 4 figures. 3 tables. 74 references.

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Inflammatory Bowel Disease in Pregnancy Source: Practical Gastroenterology. 22(10): 21, 25-26, 30-31. October 1998. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: Young women with inflammatory bowel disease (IBD) should be counseled before pregnancy about the need to defer conception until their disease is under reasonable control in order to enhance the likelihood of an uncomplicated course. This article helps health care providers undertake this counseling role and other aspects of patient care management for pregnancy in women with IBD. Many decisions are required once pregnancy occurs, among them whether such drugs as prednisone and 5ASA products should be continued or begun if a flare up occurs. Questions on immunosuppressive therapy and certain antibiotics may need to be addressed, as will concerns about endoscopic procedures and radiologic studies. The authors also discuss the impact of major abdominal surgery during pregnancy, the mode of delivery, and potential complications from an episiotomy. Although the great majority of pregnancies in patients with IBD proceed uneventfully, providing information and involving the patient in decisionmaking should substantially reduce the understandable anxiety that may occur. 27 references. (AA-M).

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Review Article: The Management of Inflammatory Bowel Disease During Pregnancy Source: Alimentary Pharmacology and Therapeutics. 12(11): 1039-1053. November 1998. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: The management of inflammatory bowel disease (IBD) during pregnancy is a particular challenge because adequate disease control before and during gestation is essential for both maternal and fetal health. This review article is designed for the practicing clinician, to guide the management of patients with IBD before and during pregnancy. The authors note that the literature is conflicting at times and that data on some issues are scanty, so recommendations are based on the balance of evidence including extrapolation if necessary. Many of the clinical, biochemical, radiological, and endoscopic investigations used to monitor and assess disease activity are difficult to use and interpret during pregnancy. Furthermore, patients and clinicians are often concerned about the safety of medical and surgical treatments for the fetus. Discussions on fertility and pregnancy should be incorporated into the general education of a patient, because a quarter of patients conceive after their disease is diagnosed. If the IBD is inactive, a patient should expect to be able to conceive, carry a fetus to term, and deliver a healthy baby. At the beginning of a pregnancy, more detailed reassurance should be given about the safety of the drugs and the importance of maintaining good control of disease activity. Most of the drugs for IBD can be used safely during pregnancy, but the benefit must be clear. Relapses should be treated aggressively, because the danger to the fetus results from the active disease and not from the drug regimens. 6 tables. 127 references.

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Management of the Zollinger-Ellison Syndrome in Pregnancy Source: American Journal of Obstetrics and Gynecology. 176(1, Part 1): 224-233. January 1997. Summary: This article reports on a study to ascertain the appropriate management approach to patients with functional pancreatic endocrine tumors, such as ZollingerEllison syndrome, during pregnancy. Five women with Zollinger-Ellison syndrome who had seven pregnancies were the subjects of the study. In patients with Zollinger-Ellison syndrome diagnosed before conception, various medical or surgical treatments were established before conception and were used to control acid secretion throughout the pregnancy. The presence of upper gastrointestinal symptoms during pregnancy, maternal and fetal complications, gender, and weight of the infant were determined in all cases. Acid control was determined in four of the five patients during six pregnancies. All patients had symptoms from gastric hypersecretion; four of the five patients had positive secretin and calcium provocative tests. Two patients had multiple endocrine neoplasia type 1. Acid secretion was treated during pregnancy with antacids only (one patient), ranitidine alone (one patient), prior curative gastrinoma resection (one patient, two pregnancies), prior parietal cell vagotomy with incomplete tumor resection (one patient, two pregnancies), and prior parathyroidectomy and use of ranitidine in a patient with multiple endocrine neoplasia type 1. In the two cases with poor acid control and unrecognized Zollinger-Ellison syndrome, mild fetal complications occurred. The authors conclude that, if Zollinger-Ellison syndrome is diagnosed before pregnancy, curative resection or resection with parietal cell vagotomy may obviate the need for gastric antisecretory drugs. If metastases are present or the diagnosis of Zollinger-Ellison syndrome is made after conception, ranitidine in the

12 Pregnancy

lowest possible dose should be used to control acid secretion. 4 figures. 2 tables. 25 references. (AA-M). •

Review: Intrahepatic Cholestasis. A Puzzling Disorder of Pregnancy Source: Journal of Gastroenterology and Hepatology. 13(3): 211-216. March 1997. Contact: Available from Blackwell Science Pty Ltd. P.O. Box 378, Carlton, Victoria 3053, Australia. Phone: 61 3 9347 0300; Fax: 61 3 9347 5001; E-mail: [email protected]. Web site: http://www.blacksci.co.uk. Summary: This article provides information about intrahepatic cholestasis of pregnancy, a puzzling disorder characterized by skin pruritus and a biochemical cholestasis of mild to moderate severity appearing mainly during the third trimester and disappearing after delivery. It recurs in 40 to 60 percent of future pregnancies. The intensity of pruritus (itching) and the laboratory alterations (increased serum bile salts and transminases in almost all patients, hyperbilirubinemia in 20 percent of patients) fluctuate during one pregnancy and also vary in subsequent affected pregnancies. The disease has no meaningful consequences for the mother; in contrast, it is associated with an increased risk of fetal distress, causing premature deliveries and stillbirths. Cholestasis of pregnancy has been recognized in most countries and ethnic groups but its prevalence is higher in Chile (14 percent of deliveries in 1975 and approximately 4 percent in 1995) and in Sweden than in other countries. The cause is unknown. Sex hormones, mainly estrogen and progesterone, appear to be involved in its pathogenesis. An interplay between a genetic metabolic predisposition and some environmental factor(s) is apparently relevant. Clinical and experimental studies suggest that a marginal selenium deficiency could be a dietary pathogenic factor. Some drugs attenuate pruritus and improve maternal cholestasis, but not the fetal prognosis. Urosdeoxycholic acid (UDCA) administration provides a significant improvement in maternal pruritus and in the biochemical abnormalities, with no adverse effects in the mother or child. 59 references. (AA-M).

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Hepatitis C in Pregnancy Source: Obstetrics and Gynecology. 89(5, Part 2): 883-890. May 1997. Contact: Available from Elsevier Science, Inc. 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Summary: This article reports on a study undertaken to review the epidemiology and clinical course of hepatitis C virus (HCV) infection, to examine current data on the vertical transmission of HCV to neonates from their mothers, and to develop recommendations for intrapartum (during pregnancy) and postpartum (after pregnancy) follow up of neonates born to mothers infected with HCV. The authors reviewed the English-language medical literature from 1988 to 1996 through MEDLINE. Case series evaluating vertical transmission of HCV infection in neonates were reviewed and summarized. Vertical transmission of HCV infection was examined with respect to maternal HIV status (as heterosexual transmission of HCV is enhanced in HIV-positive patients) and chronicity of HCV infection. Vertical transmission of HCV from HIVnegative mothers with chronic hepatitis C ranged from 0 to 18 percent. Vertical transmission of HCV from HIV-positive mothers with chronic hepatitis C ranged from 6 to 36 percent. The risk of HCV vertical transmission from HIV-negative mothers with acute hepatitis C may be higher than that from mothers with chronic HCV infection. The highest rates of vertical transmission of HCV were noted in women with high HCV

Studies 13

RNA or concurrent HIV infection. No studies have documented transmission of HCV infection to infants via breastfeeding. 3 tables. 85 references. (AA-M). •

Fertility and Pregnancy in Inflammatory Bowel Disease Source: International Journal of Gynecology and Obstetrics. 58(2): 229-237. August 1997. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636 or (212) 633-3730. E-mail: [email protected]. Summary: This article reports on a retrospective study of fertility and pregnancy in inflammatory bowel disease (IBD), conducted in women aged 16 to 45 years during 1967 through 1986, and carried out in North East Scotland. Five hundred and three women were identified: 15 patients had died from unrelated causes and 22 had emigrated, but 409 of the remaining 466 patients (88 percent) replied to the study questionnaire. Results showed that women with ulcerative colitis and Crohn's disease (the two subsets of IBD) had normal fertility when compared with the general population of North East Scotland. However, unresolved infertility problems were more frequent in women who had undergone surgery for IBD compared with those who had not (12 percent versus 5 percent for Crohn's disease; 25 percent versus 7 percent for ulcerative colitis). Disease relapse rates did not increase in pregnancy. The authors conclude that, overall, at conception women with active disease were as likely to have a normal full-term pregnancy as those in remission. However, spontaneous abortion occurred in five (36 percent) pregnancies of women who had undergone previous surgery for Crohn's disease and had evidence of recurrent disease. Three of these pregnancies were associated with active disease. This study should encourage women with IBD to proceed with pregnancy if they so desire because they are likely to have normal fertility and their disease is not a contraindication. 5 tables. 27 references. (AA-M).

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Clinical Features of Hepatitis C Virus (HCV) Infection in Pregnancy Source: International Journal of Gynecology and Obstetrics. 58(2): 245-246. August 1997. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636 or (212) 633-3730. E-mail: [email protected]. Summary: This article briefly reports on a study that evaluated the incidence of hepatitis C virus (HCV) infection, its development, and the role of pregnancy in its evolution in 141 anti-HCV-positive pregnant women. Risk factors were present in 77 subjects (54.6 percent) and absent in 64 (45.4 percent). Clinical evaluations were performed at the beginning of the study, then at 24 to 26 weeks of gestation, at delivery, and 6 months after delivery. Newborns underwent a clinical evaluation to check for HCV infection. In most of the subjects (56.7 percent) HCV positivity was found for the first time during pregnancy or at delivery. Acute hepatitis was reported by only a small number of patients (11.3 percent). This result underscores the importance of screening for HCV positivity in every pregnancy. HCV-RNA positivity was found in 5 out of 56 newborns checked (8.9 percent). The authors note that the literature reports that HIV infection seems to increase the possibility of HCV transmission between mother and newborn (vertical transmission). However, in this study, the 5 infected babies had HIV negative mothers, which confirms the possibility of vertical transmission of HCV in low-risk populations as well. 1 table. 4 references.

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Celiac Disease and Pregnancy Outcome Source: American Journal of Gastroenterology. 91(4): 718-722. April 1996.

14 Pregnancy

Summary: This article reports on a study that investigated the effect of a gluten-free diet on pregnancy outcome and lactation in 125 women affected with celiac disease. In the case-control study, comparison of 94 untreated with 31 treated celiac women indicated that in untreated mothers the relative risk of abortion was 8.90 times higher, the relative risk of low birth weight baby was 5.84 times higher, and duration of breastfeeding was 2.54 times shorter. Abortion, low birth weight of baby, and duration of breastfeeding did not significantly relate to the severity of celiac disease among untreated women. In the before-after study, 12 pregnant celiac women in either treated or untreated condition were compared. Results indicated that the gluten-free diet reduced the relative risk of abortion by 9.18 times, reduced the number of low birth weight babies from 29.4 percent to zero, and increased duration of breastfeeding 2.38 times. Both studies indicated that threatened abortion and premature delivery did not significantly relate to treatment of celiac disease. The authors conclude that the high incidence of abortion, of low birth weight babies, and of short breastfeeding periods is effectively corrected by gluten-free diet in women with celiac disease. 6 tables. 20 references. (AA-M). •

Considerations Regarding Fertility and Pregnancy in the Management of Inflammatory Bowel Disease Source: Practical Gastroenterology. 20(1): 12, 14, 17-20, 23. January 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, one in a series on gastrointestinal (GI) disorders during pregnancy, addresses considerations regarding fertility and pregnancy in the management of patients with inflammatory bowel disease (IBD). Although the gravid woman with IBD possesses a greater potential for complications (more so with Crohn's disease than with ulcerative colitis), the majority of patients will experience an uneventful, normal pregnancy. The authors stress that understanding the interaction between pregnancy and the state of the IBD as well as the relative safety and potential risks of treatments is paramount in family planning and patient education. Conception at a time when IBD is under control offers the greatest likelihood of an uncomplicated pregnancy. Physicians caring for patients with IBD must recognize, and inform their patients, that most medications needed to suppress the disease should be continued throughout pregnancy. Drugs discussed include sulfasalazine, corticosteroids, antibiotics, immunosuppressive agents, and oral contraceptives. The article concludes with a brief discussion of breastfeeding by a woman with IBD and the correlation between smoking and Crohn's disease. 45 references. (AA-M).

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Anorectal Complications of Pregnancy and Childbirth Source: Practical Gastroenterology. 20(2): 24, 29-30, 33-34, 37-38. February 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, one in a series on gastrointestinal (GI) disorders during pregnancy, addresses the anorectal complications of pregnancy and childbirth. Fecal incontinence is the major functional impairment that results from anorectal damage and is the focus of this review. Vaginal delivery may cause fecal incontinence by direct anal sphincter injury, by pudendal nerve damage, or by weakening the pelvic floor and allowing gradual stretching and deterioration of the pudendal nerves over many years. Risk factors for incontinence include episiotomy, anal sphincter tears, forceps delivery, multiparity, a prolonged second stage of labor, and high birth weight. A careful history

Studies 15

and examination, anorectal manometry, and possibly electromyography and anal endosonography are necessary to evaluate postdelivery incontinence. The author notes that none of these measures are possible unless the patient seeks medical attention for her incontinence. Treatment for incontinence, including drugs, diet, exercises, biofeedback training, or surgery, is usually helpful. 5 figures. 2 tables. 22 references. (AA-M). •

Liver Diseases in Pregnancy Source: Practical Gastroenterology. 20(7): 14, 16-18, 20, 25-26, 28, 30-32, 37. July 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, one in a series on gastrointestinal (GI) disorders during pregnancy, reviews liver diseases in pregnancy. Liver diseases during pregnancy range from benign to fatal, and from diagnostically straightforward to challenging. In this review article, the authors discuss the pathophysiology, diagnosis, and management of some important hepatobiliary disease that may affect pregnant patients. First, they review the entities peculiar to pregnancy, such as cholestasis of pregnancy, hyperemesis gravidarum, preclampsia and eclampsia, and acute fatty liver of pregnancy. In the second section, they discuss a number of important hepatobiliary diseases that may be coincidental with pregnancy, including viral hepatitis, the portal hypertensive state, autoimmune hepatitis, primary biliary cirrhosis, Wilson's disease, hemochromatosis, gallstones, Budd-Chiari syndrome, Dubin-Johnson syndrome, acute porphyrias, and liver mass lesions. The authors focus in particular on the diagnostic approach to the pregnant patient, as well as outcome for the fetus and the afflicted mother. Finally, they briefly consider the role of liver transplantation in pregnancy. 71 references. (AA-M).

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Bowel Obstruction in Pregnancy Source: Surgical Clinics of North America. 75(1): 101-113. February 1995. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: In this article, the authors consider bowel obstruction as a complication during pregnancy, a relatively uncommon occurrence, but one that causes significant morbidity and mortality for both the fetus and the mother. The authors provide a review of all cases reported in the English literature from 1945 to the present. After a brief introduction, the article covers incidence and epidemiology; management considerations, including diagnostic tests, differential diagnosis, and surgery; and specific types of intestinal obstruction, including adhesions, volvulus, intussusception, and less frequent causes of intestinal obstruction. The authors stress that the delay from presentation to admission and from admission to definitive management continues to be a significant cause of morbidity and mortality; readers are encouraged to diagnose and treat their pregnant patients on the same timeline as their nonpregnant patients. 2 figures. 1 table. 49 references.

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Surgical Management of Intra-Abdominal Inflammatory Conditions During Pregnancy Source: Surgical Clinics of North America. 75(1): 15-31. February 1995. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452.

16 Pregnancy

Summary: In this journal article, from a special issue on surgery in the pregnant patient, the authors review the surgical management of intra-abdominal conditions during pregnancy. The article covers appendicitis, including diagnosis, operative treatment, and maternal-fetal outcome; biliary tract disease, including symptoms, management, surgical treatment, and maternal-fetal outcome; liver disease, including diagnosis, management, and maternal-fetal outcome; imaging, including the choice of imaging modality, upper abdominal disorders, and the lower abdomen and pelvic region; and the use of empiric antibiotic therapy. The authors caution that delays in diagnosis and definitive treatment represent the most significant risk factor for both mother and fetus in these cases. 1 figure. 2 tables. 39 references. •

Hemorrhoids, Anal Fissure, and Carcinoma of the Colon, Rectum, and Anus During Pregnancy Source: Surgical Clinics of North America. 75(1): 77-88. February 1995. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: In this journal article, from a special issue on surgery in the pregnant patient, the authors review the problems of hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. The chapter covers the etiology, symptoms, complications, conservative therapy, and surgery for hemorrhoids; the etiology and treatment of anal fissures; colorectal carcinoma, including presenting symptoms and signs, treatment considerations, and outcome; and anal carcinoma. The authors stress the need for open discussions between patient and physician about the pros and cons of operative and nonoperative approaches. 3 tables. 33 references.

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Gastrointestinal Motility Disorders During Pregnancy Source: Practical Gastroenterology. 19(8): 14, 17-18, 21-22, 24-25. September 1995. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: In this article, the author covers gastrointestinal (GI) motility disorders during pregnancy. Symptoms of disturbance in GI motility often occur during pregnancy, probably due to elevations in sex hormones, especially progesterone. However, this does not explain all of the symptoms and dysmotilities. Initial treatment of these symptoms consists of dietary and lifestyle modifications along with the use of medications that are not systemically absorbed. Pregnancy-related symptom complexes include nausea and vomiting of pregnancy (emesis gravidarum); hyperemesis gravidarum; constipation; diarrhea; and gallstones. The author stresses that, if possible, systemically absorbed medications should be reserved for the second and third trimester of pregnancy in refractory patients. Care must be taken not to forget the direct effects of absorbed medications on the fetus in utero and of medications secreted in breast milk on the neonate. 2 figures. 38 references. (AA-M).

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Endoscopy in Pregnancy Source: Practical Gastroenterology. 19(8): 52K-52O. September 1995. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected].

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Summary: In this article, the authors review the usefulness and safety of endoscopy in the pregnant patient. They note that it can be difficult to distinguish common gastrointestinal (GI) disorders from the GI complications of pregnancy. When possible, one should delay diagnostic and therapeutic measures until after delivery. Generally accepted indications for endoscopic evaluation during pregnancy include intractable nausea and vomiting, gastrointestinal bleeding, suspected peptic ulcer disease, and suspected or known inflammatory bowel disease (IBD). The authors conclude that recent studies suggest that endoscopy performed in stable pregnant patients is infrequently associated with maternal or fetal complications. 1 figure. 2 tables. 11 references. (AA-M). •

Esophageal Disorders During Pregnancy Source: Practical Gastroenterology. 19(9): 22, 24, 29-30, 32-34, 36. October 1995. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article discusses esophageal disorders during pregnancy, ranging from common problems such as heartburn to exceedingly rare disorders such as achalasia. The authors note that increased levels of female sex hormones can result in reversible lower esophageal sphincter dysfunction, which accounts for heartburn and a propensity for aspiration during obstetric anesthesia. The authors discuss the pathogenesis, clinical features, diagnosis, and treatment of gastroesophageal reflux in pregnancy; a final section considers the same of achalasia. They stress that systemic therapies should be used cautiously in consideration of the safety of the fetus. 3 figures. 1 table. 33 references. (AA-M).

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Gastroesophageal Reflux in Pregnancy Source: Gastrointestinal Endoscopy Clinics of North America. 4(4): 699-712. October 1994. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This review article addresses the epidemiology, pathophysiology, diagnosis, and treatment of gastroesophageal reflux disease (GERD) in pregnancy. GERD symptoms occur in approximately 45 to 80 percent of pregnant women. The authors caution that diagnostic tools and therapeutic regimens that might ordinarily be used without hesitation must be considered carefully in the pregnant patient due to potential fetal risks. Patients should be reassured that symptoms usually resolve soon after delivery. 41 references. (AA-M).

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Hepatic Emergencies in Pregnancy Source: Medical Clinics of North America. 77(5): 1115-1127. September 1993. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This article reviews the rare but dramatic association of liver disease and pregnancy, with its potential devastating effects on the mother as well as the fetus. The author stresses the considerations that one must take into account when liver disease is recognized in a pregnant woman. These include the trimester of pregnancy, the degree and nature of the liver test abnormalities, the health status of the patient before

18 Pregnancy

pregnancy, and the epidemiologic history of exposure to risk factors. Conditions include hyperemesis gravidarum; intrahepatic cholestasis of pregnancy (ICP); acute fatty liver of pregnancy; toxemia of pregnancy, including hepatic rupture, and Budd-Chiari syndrome; hemolysis, elevated liver enzymes, and low platelets (HELLP); and viral hepatitis. The author concludes with a discussion of the effect of pregnancy in patients with chronic liver disease. 5 tables. 82 references. (AA-M). •

Biliary Tract Disease and Pancreatitis in Pregnancy Source: Practical Gastroenterology. 15(2): 46-48, 51. February 1991. Summary: Biliary colic, acute cholecystitis, and acute pancreatitis occasionally complicate pregnancy and can result in difficult diagnostic and therapeutic challenges. Pregnancy seems to predispose women to gallstone formation. However, since cholelithiasis is common in women of childbearing age, the biliary tract disease that sometimes occurs in pregnant women may be coincidental rather than the result of pregnancy. Initial treatment of both biliary tract disease and pancreatitis in pregnancy is almost always medical, especially in the first and third trimesters. Elective surgery, when indicated, may be safely carried out during the second trimester or after delivery. In the vast majority of cases, acute biliary and pancreatic disorders, if properly managed, do not adversely affect the pregnancy. 18 references. (AA-M).

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Questions and Answers About Pregnancy and IBD Source: Foundation Focus. p. 8-9. November 1991. Contact: Available from Crohn's and Colitis Foundation of America, Inc. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 343-3637 or (800) 932-2423 or (212) 685-3440. Summary: Written in a question and answer format, this article about pregnancy, fertility, and inflammatory bowel disease (IBD), addresses topics including the effect of IBD on fertility; how IBD will affect the outcome of a pregnancy; whether or not pregnancy will worsen IBD; the effect of drug therapy for IBD on the course of pregnancy and on the fetus; which diagnostic tests are safe during pregnancy; and the impact of surgery on pregnancy. The author concludes that women who have inactive IBD or disease that is under control with medication can anticipate an uncomplicated pregnancy.

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Jaundice in Pregnancy Source: European Journal of Gastroenterology and Hepatology. 3(12): 892-896. December 1991. Summary: This article presents an overview of the occurrence of jaundice in pregnancy. Topics include the causes of jaundice; disorders specific to pregnancy, including hyperemesis gravidarum, benign recurrent intrahepatic cholestasis of pregnancy, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), toxemia/eclampsia and liver disease, biliary disease and pregnancy, infections of the liver during pregnancy, hepatocellular disorders and pregnancy, vascular hepatic disorders and pregnancy, and hepatic tumors and pregnancy. The author stresses that knowledge of the biochemical changes that are physiological and that occur in normal pregnancy is imperative in order to avoid mistaken interpretation of the biochemical tests during pregnancy. 1 table. 30 annotated references.

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Drug Hepatotoxicity in Pregnancy Source: European Journal of Gastroenterology and Hepatology. 3(12): 883-891. December 1991. Summary: This article reviews drug hepatotoxicity in pregnancy. Topics covered include the nature and extent of drug use during pregnancy; the diagnosis of druginduced liver disease in pregnancy; and hepatic injury due to individual medicinal agents, including antibiotics, antiemetics, anesthetics, anticonvulsants, antidepressants, cardiovascular drugs, analgesics and anti-inflammatory agents, penicillamine, drugs used in the treatment of inflammatory bowel disease, agents to dissolve gallstones, oral hypoglycemic agents, antithyroid compounds, anti-ulcer agents, laxatives, oral contraceptive steroids, vitamins, and miscellaneous drugs. The author notes that pregnancy does not appear to enhance or diminish the likelihood of hepatic injury from medicinal agents and any drug that is capable of causing jaundice in the non-pregnant state may do so in a pregnant woman. 2 tables. 37 annotated references.

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Outcome of Pregnancy Among Immigrant Women with Diabetes Source: Diabetes Care. 26(2): 327-332. February 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study of the outcome of pregnancy among immigrant women with diabetes. The women came from regions of the world with high incidence of impaired glucose tolerance (IGT) and type 2 diabetes. Prevalences, secular trends, and sociodemographic risk factors of diabetes were also explored. Data from the Medical Birth Registry of Norway on all births from 1988 to 1998 for mothers born in South Asia and North Africa (n = 11,268) and Norway (n = 601,785) were analyzed. The prevalence of pregestational diabetes among the immigrants was 8.9 per 1,000 births, which was more than twice the rate among ethnic Norwegians (3.6 per 1,000 births). Time trends indicated an increasing prevalence in both groups. Among the immigrants, diabetes was closely associated with maternal age. Maternal diabetes was associated with a significantly increased risk of pregnancy complications in both study groups. Increased risks were found for low birth weight, macrosomia (large body size), preterm birth, preeclampsia, and cesarean sections. Among ethnic Norwegians, maternal diabetes conferred a significantly increased risk of infant perinatal death. In the sample of immigrant women with predominantly type 2 diabetes, maternal diabetes was not significantly associated with perinatal death or congenital malformations in the offspring. The authors conclude that the high prevalence of diabetes among immigrants from South Asia and North Africa represents a challenge for health care providers. To prevent adverse pregnancy outcomes and later cardiovascular and renal morbidity among these groups, early diagnosis of diabetes, adequate metabolic control, and relevant preventive measures are needed. 3 tables. 26 references.

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Safety of Nonsteroidal Antiinflammatory Drugs in Pregnant Patients With Rheumatic Disease Source: Journal of Rheumatology. 23(6):1045-1049; 1996. Summary: This journal article for health professionals describes a study that compared pregnancy outcome in a cohort of 45 patients with rheumatic disease exposed to standard doses of nonsteroidal anti- inflammatory drugs (NSAIDs) and a cohort of 43 patients who were not treated with NSAIDs during pregnancy to determine whether

20 Pregnancy

active arthritis in pregnant patients can be safely treated with NSAIDs. The possible long-term effects of intrauterine exposure to NSAIDs were also evaluated in the offspring by telephone interview. Patients were recruited from a prospective study on pregnancy and rheumatic disease, and they were divided into groups treated and not treated with NSAIDs. The groups did not differ with regard to demographic data. Results indicate that there were no differences between the groups with regard to pregnancy outcome, duration of labor, complications at delivery, or neonatal health. No significant differences were found between the groups with respect to the health and development of offspring at follow up. Results suggest that NSAID therapy is not teratogenic and has no harmful long-term effects on a child. 26 references and 6 tables. (AA-M). •

Outcome of Hepatitis E Virus Infection in Indian Pregnant Women Admitted to a Tertiary Care Hospital Source: Indian Journal of Medical Research, Indian Council of Medical Research. Ansari Nagar, New Delhi 1120029. 6515497/6866258. Fax 6868662. Contact: Available from Indian Council of Medical Research. Ansari Nagar, New Delhi 110029. 6515497 or 6866258. Fax 6868662. Summary: Information on the incidence and prevalence of hepatitis E virus (HEV) infection in Indian pregnant women is scanty. Only a few studies have been done so far to document the vertical route (from mother to fetus during pregnancy or to child during birth) of transmission of this virus. This article reports on a study undertaken to determine the prevalence of HEV infection in pregnant women (n = 50) with hepatitis and to note the outcome of their pregnancies. After informed consent, their blood samples were tested for potential causes of hepatitis including hepatitis A, B, C, and E infections. Of the 50 cases, 20 patients (40 percent) were found to be positive for IgM anti HEV (group A) and 30 (60 percent) ewre negative for IgM anti HEV antibodies (group B). Overall, 19 patients were in their second trimester, while 30 were in their third trimester. Of those in the second trimester, 52.6 percent (10 out of 19) had fulminant liver (hepatic) failure (FHF). Of those in their third trimester, 50 percent (15 of 30 patients) had FHF. Only one patient presented in the first trimester; she had acute viral hepatitis (AVH) and recovered completely. Of the HEV infected women (n = 20), 70 percent were in their third trimester and the remaining 30 percent were in their second trimester of pregnancy. A similar percentage (i.e., 14 of 20 or 70 percent) manifested with FHF while 6 (30 percent) had acute hepatitis leading to recovery. The percentage of women with FHF and acute hepatitis was 36.6 and 63 percent, respectively, in group B. Upon follow up, 13 of the 14 HIV infected patients with FHF died before delivery, while one died just after delivering her baby, thus all had fatal outcome. The fatality rate in HEV infected patients was not different between the second and third trimesters (66.6 percent versus 71.43 percent, respectively). The authors conclude that HEV causes high mortality in pregnant women compared to non HEV infected pregnant women. This pilot study indicates that steps should be taken to prevent HEV infection during pregnancy. 2 tables. 14 references.

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Safety of Drug Therapy for Inflammatory Bowel Disease in Pregnant and Nursing Women Source: Inflammatory Bowel Diseases. 2(1): 33-47. Spring 1995. Summary: This article reviews the safety of drug therapy for inflammatory bowel disease (IBD) in pregnant and nursing women. The author stresses that drug therapy is

Studies 21

justified in pregnant patients with active IBD. Selection of medical treatment depends on disease severity and the potential for fetal toxicity. Preferably, pregnancy should be planned to coincide with periods of disease quiescence, so that drug requirements can be minimized. Sulphasalazine and prednisolone are clearly safe in pregnancy and lactation. Preliminary studies suggest that low to moderate doses of mesalamine are well tolerated in pregnant and nursing mothers. Immunosuppressive therapy during pregnancy in transplant and nontransplant recipients may be associated with an increased risk of fetal growth retardation and prematurity. The risk of congenital malformations from azathioprine and cyclosporin is not markedly increased, although exposure to methotrexate during the first trimester may cause fetal loss and characteristic anomalies. Shortterm therapy with metronidazole in the first trimester is not associated with an increased risk of teratogenicity, although the safety of this drug in pregnancy using higher doses for prolonged periods has not been confirmed. 171 references. (AA-M). •

Prevalence of Asymptomatic Hepatitis B Infection in Pregnant Mexican-American Women Source: Obstetrics and Gynecology. 76(2): 239-240. August 1990. Summary: Recent reports document high rates of asymptomatic hepatitis B virus infection in pregnant Hispanic women of Caribbean and Latin American origin, frequently in the absence of identifiable risk factors. The authors of this article hypothesized that the prevalence of asymptomatic hepatitis B virus infection in Mexican-American women was much lower, and that most of these women belonged to established risk groups. Three thousand, seven hundred and eighty-nine pregnant women, 77 percent of whom had Hispanic surnames, were screened for hepatitis B surface antigen upon admission in labor to Medical Center Hospital in San Antonio. Twelve women, six of whom had Hispanic surnames, were found to have asymptomatic hepatitis B infections. The prevalence of asymptomatic infections was 3.2 per 1000 in the total population; 2.0 per 1000 in those with Hispanic surnames, and 7.0 per 1000 in those with non-Hispanic surnames. Risk factors were found in five of the positive patients overall and in only one of the positive patients with an Hispanic surname. The authors conclude that, although asymptomatic hepatitis B infection is uncommon in these pregnant Mexican-American women, the absence of identifiable risk factors in the majority of those infected suggests that routine screening in this population is justified. 6 references. (AA-M).

Federally Funded Research on Pregnancy The U.S. Government supports a variety of research studies relating to pregnancy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions.

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).

22 Pregnancy

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 pregnancy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore pregnancy. The following is typical of the type of information found when searching the CRISP database for pregnancy: •

Project Title: A MOOD MANAGEMENT INTERVENTION FOR PREGNANT SMOKERS Principal Investigator & Institution: Cinciripini, Paul M.; Professor; Immunology; University of Texas Md Anderson Can Ctr Cancer Center Houston, TX 77030 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 30-APR-2008 Summary: (provided by applicant): The majority of studies evaluating smoking cessation treatments for pregnant smokers have employed minimal intervention strategies that have achieved limited success. We believe a significant reason for this lack of efficacy is the failure of minimal treatment approaches to address symptoms of depression and stress among pregnant smokers who fail to quit on their own. Data from our recently completed trial of a videotape smoking cessation intervention for pregnant smokers indicated that significant levels of affective impairment were present in this group. Over 50 percent of the women met DSM-IV criteria for major depression on the Prime MD, or had CES-D scores > 16. Depressive symptoms were frequently chronic. In addition, research indicates that high levels of stress, poor coping resources, and low levels of social support satisfaction are predictive of depression and continued smoking during pregnancy. The proposed study will address these issues by evaluating the efficacy of an intervention designed to impact these risk factors. Approximately 375 women will be randomized to either a mood management (MM) intervention, health education (HE), or usual care (UC) control condition. The MM and HE interventions will be delivered in 7 60-minute counseling sessions that will incorporate 10 minutes of brief smoking cessation counseling based on the Clinical Practice Guidelines that will include a specific focus on smoking and pregnancy. Participants in the MM condition will receive an additional 50 minutes of counseling emphasizing the development of affect management skills. The MM protocol will be based on Cognitive Behavioral Analysis System of Psychotherapy (CBASP), a psychotherapy developed for the treatment of chronic depression that has been shown to be highly effective in reducing depression in this difficult-to-treat population. HE participants will receive an additional 50 minutes of standard pre/postnatal health education focused on non-smoking related issues relevant to maintaining a healthy pregnancy. The UC condition will receive 7 3 to 5minute Clinical Guidelines-based brief counseling sessions that will be similar in content to the smoking cessation counseling component of the MM and HE interventions. We hypothesize that cessation rates during pregnancy and at 3 and 6 months postpartum will be significantly greater for smokers in the MM versus the HE and UC control conditions. In addition, we hypothesize that smokers with significant levels of depression and/or positive histories of depression at the start of the intervention will quit significantly less often than nondepressed smokers and negative depression history smokers. We will also evaluate the role of coping, self-efficacy, social support, perceived counselor support, perceived stress, negative affect, and depression as mediators of treatment outcome. As secondary aims we will assess whether levels of depression are significantly reduced for smokers in the MM condition relative to those in the HE or UC conditions, and we will assess the role of neuroticism in the relationship between

Studies 23

depression and nicotine dependence. We will also evaluate the extent of smoking reduction (cigarettes smoked/cotinine) among women who fail to quit, as a function of treatment, depression history, and current depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREGNANCY

ACUPUNCTURE

TREATMENT

OF

DEPRESSION

DURING

Principal Investigator & Institution: Manber, Rachel; Associate Professor; Psychiatry and Behavioral Sci; Stanford University Stanford, CA 94305 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2007 Summary: (TAKEN FROM APPLICANT): Objective: The aim of the proposed randomized controlled study is to assess the efficacy and effectiveness of acupuncture treatment of depression during pregnancy. Significance: Depression is, unfortunately common during pregnancy and it has significant deleterious effects on mother and infant, including low birth weight, preterm delivery, and continued depression into postpartum. Few medically acceptable treatments are available for the treatment of depression during pregnancy. Our preliminary work provides evidence that acupuncture may be a safe and acceptable treatment option for depression. Specific aims: 1) to evaluate the efficacy of brief 8-week treatment with SPEC acupuncture for major depression during pregnancy relative to the two control treatments; 2) to evaluate the efficacy and clinical significance (pregnancy outcome) of continued treatment with SPEC acupuncture relative to the two control treatments; and 3) to evaluate the differential impact of treatment with SPEC acupuncture for major depression on the incidence of postpartum depression. Participants. Design: To test the efficacy of acupuncture designed specifically to address depressive symptomatology during pregnancy (SPEC) it will be compared, using random assignment, to the following 2 control conditions: 1) valid acupuncture that does not directly address depressive symptoms (NSPEC), thus controlling for the belief in the efficacy of the treatment; and 2) prenatal massage (MSSG), thus controlling for attention, physical contact, relaxation and respite from daily stress. The study includes three phases, acute, continuation and follows up. Participants: 180 participants meeting western diagnostic criteria for Major Depression with a score >: 14 on the first 17 items of the 24-item Hamilton Depression Rating Scale (HRSD) will be randomized. The ethnic distribution of the sample will be representative of the ethnic distribution in the San Francisco Bay Area. Treatments: The acute phase of treatment consists of 16 half-hour treatment sessions delivered over 8 weeks. To consolidate treatment gains and to prevent post partum depression, participants who have full or partial response at the end of the acute phase will continue to receive the same, but less frequent, treatment until 10 weeks post partum, and will be followed up for 6 more months. Main Outcome Measure(s): The primary outcome measures are the HRSD and the depression portion of the SCID-IV, to be administered monthly during the treatment phases and at 3 and 6 months follow up. Other important measures include the Beck Depression Inventory (weekly), expectations (of the participants and the providers), and delivery and infant measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADAPTATION OF ISLETS OF LANGERHANS TO PREGNANCY Principal Investigator & Institution: Sorenson, Robert L.; Professor; Cell Biology and Neuroanatomy; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, MN 554552070

24 Pregnancy

Timing: Fiscal Year 2002; Project Start 01-DEC-1984; Project End 30-JUN-2007 Summary: (provided by applicant): Pregnancy is a unique condition in the life history of islet beta-cells. At this time there is an increased need for insulin secretion at normal glucose concentrations. This demand is met by major alterations in islet structure and function. The most important are: (a) an increase in glucose-stimulated insulin secretion (4-10 fold at normal blood glucose levels); (b) a lowering of the threshold for glucosestimulated insulin secretion:and (c) increased beta-cell proliferation. Using lactogenic hormones from the same species (i.e., placental lactogen or prolactin which share a common receptor), we have shown that these hormones induce all of the changes in islets that occur during pregnancy. The common theme in this project is the PRL signaling pathway and how it changes insulin secretion, islet cell division and how lipids interact with this process during pregnancy. Using islets from pregnancy and islets treated with lactogenic hormones in vitro we will determine: (1) Why prolactin (PRL) receptor activation is so effective in enhancing islet function? (2) How PRL receptor activation increases insulin secretion? (3) How PRL receptor activation increases islet cell growth? (4) How lipids interact with islets in the presence of lactogens? (5) How complete is our understanding of the PRL receptor/JAK/STAT pathway in accounting for the changes in islet function during pregnancy? The overall goal is to understand the cellular mechanisms responsible for increasing islet function during pregnancy. This information will provide insight into the long-term regulation of islet function and beta-cell mass in the maintenance of normal blood glucose. Failure of islets to adapt to the increased need for insulin during pregnancy leads to gestational diabetes, a condition that is detrimental to normal fetal development as well as the health of the mother. Understanding the regulation of beta-cell glucose sensitivity is critical for understanding the progression of events that lead to gestational and type Il diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AIR POLLUTION AND ADVERSE BIRTH OUTCOMES Principal Investigator & Institution: Ritz, Beate R.; Associate Professor; Epidemiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 18-JUL-2001; Project End 30-JUN-2004 Summary: Although fetal development is one of the human growth periods most vulnerable to toxins, epidemiologic data concerning the effects of ambient air pollution exposures during this period are limited. Studies conducted previously in Los Angeles, China, Brazil, the Czech Republic, Mexico, and the United States suggest exposure to ambient air pollution during pregnancy may cause adverse birth outcomes, such as low birth weight (LBW) or intrauterine growth retardation (IUGR), preterm birth, and intrauterine and postneonatal mortality. We recently reported that air pollution, specifically carbon monoxide (CO) and particulate matter less than 10 microns in diameter (PM10), increased the risk of giving birth to LBW and preterm infants in the Los Angeles metropolitan area between 1989-1993 (Ritz and Yu, 1999). Further analyses also indicated increases in CO exposure during the second month of pregnancy may be related to certain cardiac defects. While our research and the Brazilian study suggest that motor vehicle-related pollution may be responsible for the observed effects, no study to date has examined this potential association. Furthermore, no information exists on whether exposures received in specific microenvironments, such as exposure from indoor sources and in-vehicle exposures while commuting are important. The objective of the proposed research is to determine whether exposure to elevated ambient

Studies 25

air pollution during pregnancy results in LBW, preterm birth, intrauterine and postneonatal mortality, or cardiac defects in infants born to women living in the South Coast Air Basin (SoCAB). We will examine whether: (1) these effects are attributable to traffic-related sources relying on measures of proximity to high traffic density roadways; (2) short-term increases in air pollution prior to birth or fetal death and/or medium-term exposures accumulated over months or trimesters of pregnancy are more important; (3) observed effects are stable when adjusting for risk factor information not available in previous studies; (4) maternal exposures to additional indoor, in-vehicle, or occupational sources confound or modify the effect observed for ambient pollutants; and (5) effects are different for population subgroups (e.g., older mothers, working mothers etc.). We will use a two-tiered approach. First, we will perform a cohort study of all births (1994-1999) and fetal and infant deaths (1989-1997) in the SoCAB region and model short and long term exposures to pollutants on term LBW, preterm birth, intrauterine and postneonatal mortality and cardiac defects. Second, we will conduct a standardized mail survey for a nested group of 2000 LBW and/or preterm births to collect additional exposure, confounder, and effect modifier data for children born most recently. Finally we are collecting data that will allow us to validate the traffic density and ambient air pollution measures using a small sample of personal, indoor, and outdoor monitoring data for carbon monoxide and particulate matter. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALLOIMMUNITY IN AUTO IMMUNE DISEASE Principal Investigator & Institution: Nelson, J Lee.; Professor; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, WA 98109 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 30-JUN-2004 Summary: Advances with molecular biological techniques have led to the appreciation that there is bi-directional traffic of cells during pregnancy. Fetal cells are found in maternal peripheral blood in the majority of first pregnancies and evidence for maternal cells has been found in over 40 percent of cord blood samples. Recently, the surprising observation was reported that fetal cells also can persist in maternal blood for decades after pregnancy completion. This observation raises the important question as to whether maternal cells also persist long-term in some offspring. It is well known that maternal cells engraft and persist in infants with severe combined immunodeficiency, but no previous study has investigated long-term persistence of maternal cells in normal individuals. In support of this probability, a cytogenetic study of male infants who received in utero transfusions from their mothers revealed some lymphocytes were XX at more than five years of age. In initial studies from our laboratory we report evidence for long-term persistence of maternal cells in some individuals up to 47 years after birth. Bi-directional traffic of cells during pregnancy, and long-term persistence of microchimerism in some individuals, when considered together with observations in experimental models and in human diseases characterized by chimerism (nonhost cells), led the investigator to propose the hypothesis that alloimmunity may contribute to some autoimmune disease. Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease for which a well-recognized experimental model involves the introduction of parental cells into F1 progeny. Some manifestations of SLE are also mimicked in human chronic graft-versus-host-disease that occurs after allogenic hematopoietic stem cell transplantation. The studies in this proposal are designed to investigate the hypothesis that maternal cells and/or DNA persist in some progeny and that maternal microchimerism contributes to the pathogenesis of some autoimmune diseases, specifically SLE. The proposed studies will investigate qualitative and quantitative

26 Pregnancy

aspects of persistent maternal microchimerism. To further address pathogenicity disease-affected tissues of SLE patients will be examined for maternal DNA and cells. The HLA- relationship of mother and her progeny will be investigated as a potential factor in the persistence and/or pathogenicity of persistent maternal microchimerism. The studies that are proposed may result in a new understanding of immunologic aspects and consequences of pregnancy. If persistent maternal microchimerism is involved in the pathogenesis of SLE new therapeutic modalities could be developed on this basis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


ANGIOTENSIN

(1-7)

IN

NORMAL

AND

PREECLAMPTIC

Principal Investigator & Institution: Merrill, David C.; Obstetrics and Gynecology; Medical College of Wisconsin Po Box26509 Milwaukee, WI 532264801 Timing: Fiscal Year 2001; Project Start 24-SEP-2001; Project End 31-AUG-2002 Summary: Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. It is estimated to affect 6 percent to 10 percent of all pregnancies in the United States. Despite extensive research, the pathophysiology of preeclampsia is still poorly understood. It is well known that the renin- angiotensin-aldosterone system (RAAS) is stimulated in normal pregnancy. The physiological consequences of the stimulated RAAS in normal pregnancy are incompletely understood; and even less understood is the question of how this system may be altered and contribute to the hypertensive disorder of pregnancy. The cardiovascular consequences of normal pregnancy include an increase in cardiac output by 30-40 percent and plasma volume by 50 percent, which are associated with a decrease in total peripheral resistance (TPR). Thus, blood pressure is normal or reduced by the end of the first trimester and reaches its nadir by the second trimester. The reasons for the reduced TPR are not established, but a number of vasodilator substances have been studied. In preeclampsia, the cardiovascular consequences associated with hypertension include increased TPR, failure to develop the hypervolemia of pregnancy, reduced renal blood flow, and glomerular filtration rate. It has been suggested that preeclampsia may arise not only because of stimulation of vasoactive substances, but because of a defect in the contribution of the vasodilator systems. New data from our laboratory in normal human subjects have indicated that a novel vasodilator of the RAAS, angiotensin-(1-7) [Ang-(1-7)], is increased in pregnancy and reduced in preeclampsia subjects. It is our hypothesis that normal pregnancy is a balance of the RAAS comprising both vasoconstrictor [Ang II] and vasodilator [Ang-(17)] pathways. Preeclampsia shifts the balance of the RAAS by maintaining an elevated vasoconstrictor component in the face of a reduced vasodilator pathway. The hypothesis will be tested by the following Specific Aims: 1) Determine the time course of circulating and urinary profiles of the vasoconstrictor (Ang II) and the vasodilator [Ang-(1-7)] components during normal pregnancy and preeclampsia. Other indices of the RAAS, including plasma total renin, active renin, and prorenin, Ang I, platelet AT1 receptor binding and/or mRNA, serum ACE activity and monocyte ACE mRNA, in normal and preeclampsia pregnant subjects will be measured. 2) Determine the physiological role of the Ang-(1-7) by measuring the blood pressure and systemic (cardiac output and total peripheral resistance) and regional (muscle and skin) hemodynamic changes to the vasodilator Ang-(1-7) and its antagonist D-Ala Ang-(1-7) in normal and preeclampsia subjects. In summary, the ultimate goal of this study is to understand the contribution of both vasodilator and vasoconstrictor components of the RAAS to blood pressure regulation in normal and preeclampsia pregnancy.

Studies 27

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

Project Title: ANGIOTENSINOGEN VARIANTS AND ADVERSE PREGNANCY OUTCOMES Principal Investigator & Institution: Ward, Kenneth; Senior Scientist; ObstetricsGynecology; University of Utah 200 S University St Salt Lake City, UT 84112 Timing: Fiscal Year 2001; Project Start 20-AUG-1995; Project End 31-JUL-2003 Summary: (Adapted from Investigator's Abstract) Early in normal gestation, there is a decrease in maternal vascular resistance accompanied by a 20% of 100% expansion of maternal blood volume. At the same time, the uterine arteries undergo profound remodeling and dilation -- termed "physiologic change" -- to provide adequate blood flow to the developing conceptus. Failed volume expansion and failed or abnormal physiologic change are associated with a variety of common pregnancy complications, including preeclampsia, intrauterine growth retardation (IUGR), and preterm labor. Molecular variants of the angiotensinogen gene, which increase angiotensinogen expression in certain local systems, predispose women to develop preeclampsia and related pregnancy complications. This competing renewal proposes to test the hypothesis that disease-associated angiotensinogen alleles promote abnormal spiral artery remodeling and inhibit maternal plasma volume expansion. Three interrelated approaches are proposed: 1) an affected sister-pair linkage analysis of polymorphisms in angiotensinogen and other relevant genes, 2) gene expression and quantitative histology studies of spiral artery remodeling using an existing large collection of human pregnancy tissues, and 3) transgenic mouse and human studies to evaluate the newlydescribed paracrine tubular renin angiotensinogen system's role in maternal blood volume expansion. The investigators state that this work may lead to predictive and diagnostic tests that indicate a woman's increased risk for complications early in pregnancy, allowing improved monitoring, earlier diagnosis, and new opportunities for treatment. They further state that the ultimate goal of this research is the development of improved preventive measures and effective treatments for these common pregnancy disorders. Through an understanding of particular genetic subsets of preeclampsia, they note that they may find that once promising therapies, such as low-dose aspirin, do have a role in some patients. Finally, they note that new biologic pathways may be discovered that suggest novel therapeutic strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANTIGEN-SPECIFIC MEMORY CD8+ T-CELLS IN PREGNANCY Principal Investigator & Institution: Constantin, Carolyn M.; None; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 17-SEP-2001 Summary: This study will employ an experimental design to determine if the in viva generation of antigen-specific memory CDS+ T-cells in response to an acute viral infection is altered in pregnancy. Lymphocyticchoriomeningitis virus (LCMV) infection in mice will serve as the experimental model. Analysis will include comparing the frequencies of antigen-specific CD percent memory T-cells generated in mice infected with LCMV in early pregnancy (day 7 of gestation) with nonpregnant mice infected at the same time. Genetically identical S-10 week old female C57BL/6 mice will be randomly assigned to the experimental (N=50) and control (N=50) group. The experimental group will be impregnated, then both groups infected with LCMV (Armstrong strain) and allowed to clear the virus. Antigen-specific memory CD8+ T-

28 Pregnancy

cells will be enumerated by major histocompatibility complex (MHC) class I tetramer staining for the three immunodominant epitopes." Functional capability of the cells will be evaluated using intracellular cytokine (ICC) staining for the presence of interferongamma (IFNy) and tumor necrosis factor-alpha (TNF) in response to stimulation with cognate peptide as well as plaque assays to assess clearance of the virus. This study will produce data to determine if there is a difference in the generation of antigen specific memory CD8+ T-cells to an acute viral infection in pregnant mice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: APPRAISAL, COPING, & EMOTIONS IN PREGNANCY AFTER LOSS Principal Investigator & Institution: Cote-Arsenault, Denise Y.; School of Nursing; Syracuse University Syracuse, NY 13210 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant) While nearly 25% of women experience a perinatal loss, little is known about how women cope with the subsequent pregnancies and which ways of coping are the most effective in reducing negative emotions. Findings from all published studies on pregnancy after perinatal loss (PAL), using either quantitative or qualitative methodologies, report that women in PAL have significant higher anxiety. Specifically, women in PAL fear recurrence of loss are hypervigilant throughout the pregnancy and attempt to protect/cushion themselves emotionally. High anxiety during pregnancy has been associated with increased negative obstetrical outcomes, neonatal difficulties and hypervigilant parenting styles. However, no longitudinal study of women's anxiety associated with subsequent pregnancy after a previous loss has been conducted. Thus, there are no evidence-based guidelines by which to guide care to pregnant women with a previous prenatal loss. Therefore, this proposed longitudinal study will examine the relationships between threat appraisal, coping (problem-focused and emotion-focused), and emotional states (positive affect, negative affect, pregnancy anxiety) at three points in time across the pregnancies of one group of 68 multigravidas with a history of perinatal loss. Lazarus and Folkman's (1984) framework of cognitive appraisal will be used to guide the study. Specifically, the primary purpose is to examine the effects of time on threat appraisal, coping, and emotional state (pregnancy anxiety, positive affect, and negative affect) in women pregnant after perinatal loss. The secondary purpose is to determine whether coping mediates the effect of threat appraisal on emotional states and what type of coping predicts more positive affect, less negative emotions, and less pregnancy anxiety. Data will be collected once each trimester, at 10 week intervals, beginning at 10-15 weeks gestation on the main study variables operationalized by the Moneyham Threat Index, the Ways of Coping Checklist-Revised, the MAACL-R, and Pregnancy Anxiety Scale. Multiple regression and path analysis will be used to answer the research questions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ARTERIAL VASODILATION IN PREGNANCY, CIRRHOSIS AND HIGH OUTPUT CARDIAC FAILURE Principal Investigator & Institution: Schrier, Robert W.; Professor; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, CO 800450508 Timing: Fiscal Year 2001 Summary: The circulatory responses to pregnancy, high-output cardiac failure and cirrhosis are characterized by vasodilation-mediated arterial underfilling. The present study will examine the effect of normalizing the hyperdynamic circulation in these

Studies 29

states by inhibiting nitric oxide synthase (NOS) with or without cyclooxygenase inhibition. The non- osmotic arginine vasopressin (AVP) stimulation of aquaporin-2 (AQP-2) and resultant water retention with inhibition. Renin-angiotensin- aldosterone and Na retention with NOS inhibition will also be examined. Since a rise in neuronal NOS (nNOS) has been found in several organs in pregnancy, it is possible that increased nNOS in the effect of nNOS inhibition on GFR and the integrity of the TG feedback mechanism will therefore be examined. The further study of the role of specific NOS isoforms in pregnancy will be examined in pregnant eNOS, nNOS and iNOS knockout mice as compared to wild-type pregnant mice. The results of these studies will provide background information for future of understanding pre-eclampsia. Studies will also examine the effect of V2 AVP antagonist on AQP-2 water channels and water retention in rats with an aortocaval fistula and high output cardiac failure. The role of NO and prostaglandins in the arterial underfilling and any resultant effect on vasopressinmediated AQP-2 water channels will be examined with NOS and cyclooxygenase inhibitors. The role of ANP and proximal tubule fluid reabsorption in high-output cardiac failure will also be studied using ANP and AQP-1 knockout mice, and ANP receptor antagonists. NO inhibition with L-NAME exerts a profound effect in reversing Na and water retention and ascites formation in cirrhotic rats. While the role of eNOS and iNOS have been studied from a molecular standpoint, a potential role of nNOS in cirrhosis has not been examined. Selective nNOS inhibitor will therefore be used in cirrhotic rats to examine the effects on systemic and renal hemodynamics, hormonal profile, as well as Na and water retention and ascites formation. The role of vasodilator peptides which enhance NO activity and are increased in cirrhosis (substance P, calcitonin gene-related peptide, and bradykinin) will be examined using cyclooxygenase inhibition. Several studies will be undertaken in knockout mice with cirrhosis to examine 1) the effect of specific NOS isoforms (eNOS, nNOS and iNOS knockout mice), 2) ANP (ANP knockout mice), and 3) proximal fluid reabsorption (AQP-1 knockout mice). In summary, the results of these studies will advance our knowledge of the important clinical states of pregnancy, cardiac failure nd cirrhosis. It is such experimental studies which have led to ongoing clinical investigations in patients using aquaretic agents (V2 vasopressin antagonist) in cardiac failure in cirrhosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ASSESSMENT OF UTERINE CONTRACTILITY & CERVICAL RIPENING DURING PREGNANCY Principal Investigator & Institution: Garfield, Robert E.; Professor; University of Texas Medical Br Galveston 301 University Blvd Galveston, TX 77555 Timing: Fiscal Year 2001 Summary: This study evaluates two obstetrical instruments on human pregnant patients. Both instruments are non-invasive and offer tremendous advantages for following the progression of pregnancy. One device measures uterine contractility from electrodes, which are placed on the abdominal surface. The other device measures collagen content of the cervix during pregnancy. At present, we have no good objective devices to monitor the uterus or cervix during pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BCRP REGULATION

IN

PREGNANCY:

ACTIVITY,

EXPRESSION

AND

Principal Investigator & Institution: Mao, Qingcheng; University of Washington Seattle, WA 98195

30 Pregnancy

Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: While the importance of P-glycoprotein (P-gp) in determining drug disposition has been well recognized, the role of Breast Cancer Resistance Protein (BCRP) in this regard has just begun to be realized. Both P-gp and BCRP are expressed in the apical membranes of small intestinal epithelium, the liver canalicular membranes, and the placental syncytiotrophoblasts. Thus, it is not surprising that BCRP, like P-gp, affects the bioavailability and fetal distribution of drugs. Pregnant women are routinely administered various drugs such as antivirals, anti-epileptics, antibiotics, antihypertensives, and anti-histamines. Many of these drugs are substrates or modulators of P-gp. As BCRP and P-gp have considerable degree of substrate overlap, many of these drugs are also likely to be substrates of BCRP. In order to assess if BCRP plays an important role in determining the safety and bioavailability of drugs given during pregnancy, it is critical that we first determine which of the drugs routinely administered to pregnant women are substrates of BCRP. BCRP has the highest expression levels in the placenta where it functions, like P-gp, to protect the fetus from Xenobiotics. Preliminary data from our laboratories indicate that expression of both BCRP and P-gp in the placenta is gestational-age dependent, suggesting regulation by pregnancy-specific hormones. The Hypothesis and Specific Aims outlined below are designed to address these clinically relevant questions. Hypothesis: BCRP and placental P-gp activity and expression is up-regulated during pregnancy and alters the absorption, distribution (including across the placenta), and elimination of drugs BCRP and P-gp substrates) routinely administered to pregnant women. To test the above hypothesis we will determine: 1. If drugs routinely administered to pregnant women (e.g., anti-HIV protease inhibitors, anti-epileptic drugs, antibiotics, ani-hypertensives and antihistamines) are high-affinity substrates of BCRP. 2. If in vitro and in vivo expression of BCRP and P-gp is regulated by pregnancy-specific hormones. 3. The molecular mechanism by which BCRP and P-gp expression is regulated by pregnancyspecific hormones. 4. If the in vivo absorption and fetal distribution of a high-affinity BCRP substrates (routinely administered to pregnant women) is affected y pregnancy in P-gp-deficient mice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BI-DIRECTIONAL INTERACTIONS BETWEEN IMMUNITY & PREGNANCY Principal Investigator & Institution: Mosmann, Tim R.; Professor and Director; Microbiology and Immunology; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: During normal pregnancy, the fetus expresses many antigens that are foreign to the mother and could be recognized and attacked by the maternal immune system. However, several mechanisms ensure that allogeneic fetuses survive and flourish during normal pregnancy. The overall hypothesis is that the maternal immune system is selectively inhibited during pregnancy, to achieve the best compromise between resistance to disease versus fetal survival. In particular, a previously-developed model suggests that inflammatory Th1 and cytotoxic responses, which are harmful to the fetus, are selectively inhibited during pregnancy. This may protect the fetus, but also results in increased susceptibility to diseases that require Th1 or cytotoxic responses for their eradication. This model has been modified to reconcile reports of generalized and specific inhibition of immunity during pregnancy, with other studies suggesting that the mother can respond normally against paternal antigens. The new model proposes that

Studies 31

strong but not weak Th1 or CD8 cytotoxic T cell responses are inhibited during pregnancy, so that the maternal immune response could still make effective Th1 responses against some pathogens, and would only be inhibited when the risk of fetal damage became significant. This model will be tested using T cell receptor transgenic T cells as tracer cells to analyze suppression induced by strong or weak immune responses during pregnancy. Immune responses will be varied by increasing the antigen amount, and by inducing simultaneous inflammation or infection. Potential non-specific or paternal antigen-specific suppression of Th1 immune responses will be tested. Possible diversion of T cells into other, less damaging effector phenotypes will also be examined. Finally, the role of Progesterone in suppressing the differentiation and activation of Th1 cells will be analyzed. A clearer understanding of alterations in maternal immunity may aid the design of vaccines for use during pregnancy, and may also lead to improved strategies for inhibiting autoimmunity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRIEF INTERVENTION FOR DRUG USE IN PREGNANT WOMEN Principal Investigator & Institution: Svikis, Dace S.; Associate Professor of Psychology; Psychology; Virginia Commonwealth University Richmond, VA 232980568 Timing: Fiscal Year 2002; Project Start 01-FEB-1998; Project End 31-JAN-2004 Summary: (Applicant's Abstract) Prenatal drug use is associated with a variety of medical and developmental consequences. Although many women spontaneously quit substance use on learning they are pregnant, others continue to use throughout pregnancy. Compared to alcohol and tobacco, little is known about prenatal quitting rates for illicit drug use. Also, little is known about the influence of alcohol and tobacco use on prenatal illicit drug use, and about psychological and other factors that account for the differences in ability of pregnant women to quit illicit drug use. Finally, better interventions are needed to enhance prenatal substance use quitting rates. Currently, the most common intervention is brief professional advice (BPA), which has only limited clinical effectiveness. To address these issues, a random-assignment clinical trial will be conducted to assess the effectiveness of two promising interventions of increasing clinical intensity on reducing prenatal opiate and/or cocaine use. Subjects will be pregnant women of lower socioeconomic status with less than a high school education (estimated gestational age at admission 20 weeks). Subjects with pre-pregnancy/prior prenatal opiate and/or cocaine use will be randomly assigned to one of three intervention groups (N=237/group): (1) BPA only (standard medical practice); (2) BPA in combination with behavioral incentives (BI); and (3) BPA in combination with BI and Motivational Enhancement Therapy (MET). Subjects will be followed prospectively throughout pregnancy and into the post partum period to determine changes that occur in substance use. Both self-report and objective measures of substance use will be employed. The study will also identify psychological and other factors (e.g., depression, maternal-infant interactions, drug use by significant other) that influence quitting and relapse to prenatal substance use. A comparison group of non-opiate/cocaine users (N=237) will be included to assess effects of prenatal opiate and/or cocaine use on maternal and infant outcomes. The study will also determine the influence of prepregnancy substance use on within-pregnancy quitting rates of illicit drug use, and the impact of quitting on maternal and infant health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

32 Pregnancy

•

Project Title: BRIEF INTERVENTION TO PREVENT PRENATAL ALCOHOL USE Principal Investigator & Institution: Kraemer, Kevin L.; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 23-SEP-1999; Project End 31-AUG-2003 Summary: Prenatal alcohol use by women is the most frequent and preventable known cause of mental retardation and birth defects in the United States. Although most women who drink abstain from alcohol after learning they are pregnant, 10 percent to 20 percent continue to drink during pregnancy and many will return to levels of alcohol intake after delivery that place their next pregnancy at risk. Brief motivational interventions to encourage women to change their prenatal alcohol use have the potential to prevent alcohol-related injury to the fetus in the current and subsequent pregnancies. The specific aims of this randomized, controlled, single-blinded, study are to: 1) assess the effect of brief motivational interventions on the alcohol intake of women during pregnancy and at 12 months postpartum, 2) assess how readiness to change and self-efficacy for change moderate or mediate the relationship between brief intervention and alcohol use, 3) identify maternal and intervention factors that predict drinking behaviors and mediate the effect of brief intervention, and 4) determine in what way the knowledge, attitudes, and beliefs of the significant other (male partner, family member, or friend) affect maternal alcohol use following intervention. The primary hypothesis of this study is that, compared to usual care, women randomized to the brief intervention group will be more likely to abstain or to significantly decrease alcohol intake during pregnancy and at 12 months postpartum. Pregnant women presenting for their first prenatal clinic visit will be screened for alcohol use. Four hundred twenty-eight protocol-eligible subjects will be enrolled over an 18-month period and randomized to usual care or to brief intervention. Subjects in the brief intervention arm will meet with a nurse therapist for motivational interviews at time of enrollment, 4 and 8 weeks later, and at 6 weeks postpartum. The significant others of study subjects in the intervention arm will be given brief telephone advice on supporting healthy prenatal drinking behaviors at baseline and at 6 weeks postpartum. Research assistants who are blinded to treatment assignment will perform telephone assessments at 6 and 12 months postpartum, and in-person assessments of the study subject and newborn infant at delivery. The primary study outcome measure will be alcohol use during pregnancy and at 12 months postpartum. If proven effective, this type of intervention could be broadly implemented as a method to decrease the incidence of fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental defects. This study will also provide valuable data on maternal and social factors that influence the effect of brief interventions and on which components of a brief intervention are most crucial for producing behavioral change in this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BUPROPION FOR SMOKING CESSATION IN PREGNANCY Principal Investigator & Institution: Miller, Hugh S.; Obstetrics and Gynecology; University of Arizona P O Box 3308 Tucson, AZ 857223308 Timing: Fiscal Year 2002; Project Start 05-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Smoking in pregnancy is associated with a variety of complications, including low birth weight (LBW), intrauterine growth restriction (IUGR), antenatal bleeding and pre-term birth (PTB). These significant health hazards could largely be prevented with successful antepartum smoking cessation. In recognizing both the success and the limitations of counseling based smoking cessation

Studies 33

programs, we are interested in piloting the use of pharmacologic agents for reduced smoking during pregnancy. The first objective of the proposed research is to evaluate the efficacy of a pharmacologic aid for successful smoking cessation in pregnancy. The specific aims include evaluating bupropion SR's efficacy for both cessation and reduction of antenatal smoking by comparing pregnant women receiving smoking cessation counseling combined with placebo to those pregnant women who receive smoking cessation counseling combined with bupropion SR. The second objective of the proposed research is to evaluate the safety of bupropion SR used for smoking cessation in pregnancy. The specific aims include determining the adverse events and adverse effects associated with antenatal bupropion administration. Secondarily, the pilot seeks to evaluate the impact of bupropion SR on maternal well being, anxiety, depression, psychosocial variables and neonatal outcome (birth weight, Apgar scores, and neonatal intensive care unit admission rate). This research will consist of a pilot double blind placebo controlled randomized trial in which pregnant women who self-report continued smoking at the inception of prenatal care, will be randomized to one of two groups. The interventions will consist of brief smoking cessation counseling in combination with either placebo or bupropion SR. Participants will be surveyed to determine important demographic factors, psychosocial variables, and intercurrent medical illnesses, including measures of psychiatric disease, particularly concurrent depression. Maternal outcome measures will include cessation and smoking reduction rates by self-report and biochemical analysis (urinary cotinine and breath carbon monoxide analysis). The proposed research seeks to evaluate whether a pharmacologic aid (bupropion SR) administered antenatally can achieve higher rates of smoking cessation and smoking reduction without imposing serious adverse outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CALCIUM ADOLESCENTS

KINETICS

IN

PREGNANT

&

LACTATING

Principal Investigator & Institution: O'brien, Kimberly O.; Professor of International Health; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: Adolescent pregnancy is a significant problem in the United States. Special nutritional concerns are present in this group to insure that optimal nutritional needs can be met by both the fetus and the growing adolescent. The additional nutritional demands of pregnancy may be of primary concern when the mother has not yet completed her linear growth and has not fully achieved her peak bone mass. The aim of the proposed study is to address the impact of pregnancy and lactation on the efficiency of calcium absorption and rates of bone calcium deposition and resorption in adolescent non-Hispanic white and non-Hispanic black girls between the ages of 11-17 y. Fifteen girls from each group who intend to breastfeed their infants will participate in a longitudinal calcium kinetic study designed to address the efficiency of calcium absorption and rates of bone calcium turnover during both the third trimester of pregnancy (34-36 weeks of gestation) and during lactation (1-2 months post partum). All adolescents will be screened for positive predictors of lactation performance prior to the start of the study. In each kinetic study, girls will be admitted to the General Clinical Research Unit at Johns Hopkins Hospital. On the morning of each study, girls will consume a glass of milk containing a stable calcium isotope (46Ca), and following breakfast a second stable calcium isotope (42Ca) will be administered intravenously. Timed blood samples will be obtained for 8 hours following the isotope dosing, and a complete 24 hour urine demands of adolescence and the calcium demands of pregnancy

34 Pregnancy

and lactation. collection will be made. Additional spot urine samples will be collected for 5 days following each isotope study. To address the hormonal response to pregnancy and lactation, calcitropic hormones will be measured during each study using a fasting blood sample. Rates of bone calcium deposition and resorption in response to these physiological changes will be determined using multicompartmental modeling. These studies will provide novel information on the physiological alterations in calcium absorption and bone calcium turnover which occur to support both the increased calcium Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARBOHYDRATE METABOLISM IN LATE PREGNANCY Principal Investigator & Institution: Connolly, Cynthia C.; Molecular Physiol & Biophysics; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: During late pregnancy, women with insulin-dependent diabetes (IDDM) are vulnerable to more frequent and more severe hypoglycemic episodes. The cause of this is not known, but has been suggested to be due in part to the intensive insulin treatment necessary to minimize perinatal morbidity and mortality. However, a few studies in pregnant women and the pregnant rat have indicated that the glucagon response, and probably the epinephrine response, to insulin-induced hypoglycemia is blunted by pregnancy itself. I have demonstrated in the pregnant dog that the increment in circulating norepinephrine is blunted as well, suggesting that a reduction in activation of the sympathetic nervous system in response to hypoglycemia may also accompany pregnancy. In the nonpregnant state, the magnitude of the counterregulatory hormone response appears to be modulated by a variety of factors that include sensitivity of the brain to insulin or the degree of hypoglycemia. The aim of this proposal is to examine which counterregulatory mechanisms are altered by pregnancy. The ensuing metabolic consequences of potential impairments will also be assessed. The techniques required to answer the questions posed are invasive and the experimental conditions are potentially harmful to the fetus. Thus, a novel canine model of pregnancy will be employed to address these issues. Arteriovenous difference techniques across the pancreas will be used to assess whether there is a defect in the alpha cell's ability to respond to a fall in glucose in pregnancy, and whether the defective glucagon response to insulin-induced hypoglycemia correlates with a decrease in neural drive to the pancreas. A technique for cannulation of the third cerebroventricle will be used to establish brain neuroglycopenia to assess whether pregnancy causes changes in the brain's sensitivity to hypoglycemia per se. Finally, the altered endocrine environment of pregnancy is the likely cause of the altered counterregulatory response, and three of the major hormones of pregnancy (estrogen, progesterone and prolactin) will be chronically elevated in nonpregnant female dogs to determine whether re-creating part of the hormonal environment of pregnancy attenuates the rise in counterregulatory hormones in response to insulininduced hypoglycemia, similar to that seen in pregnancy. The studies in this proposal should help to identify which counterregulatory mechanisms are affected by pregnancy, thereby potentially contributing to the more frequent and severe episodes of hypoglycemia experienced by pregnant women with diabetes. Preliminary studies in the pregnant dog model in fact suggest that multiple counterregulatory mechanisms are altered by pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 35

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Project Title: CARDIOVASCULAR DISEASE FOLLOWING HYPERTENSIVE PREGNANCY Principal Investigator & Institution: Wolf, Myles S.; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Candidate: Dr. Myles Wolf received the M.D. degree in 1996 from SUNY-Brooklyn. He completed internal medicine and nephrology training at MGH. In 2002, he received the Master of Medical Sciences degree in clinical physiological investigation from Harvard Medical School through its NIH K30supported Scholars in Clinical Science Program. Mentor: David Nathan, M.D., is a world-renowned clinical investigator who has trained numerous investigators in the areas of diabetes and insulin resistance, a field in which he has published extensively. As Director of the MGH GCRC and as a founding member of the Scholars in Clinical Science Program, Dr. Nathan will ensure the success of Dr. Wolf's research training, project and overall career development. Research: cardiovascular disease (CVD) is the leading cause of mortality among women in the U.S. Reducing its burden requires further understanding of its early mechanisms. Women with hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, return to their normotensive baseline soon after delivery, yet they are at increased risk for CVD in later years. Therefore, these women represent in-vivo human models of the pre-CVD state in whom its early mechanisms may be studied. In their first study, they will test the hypothesis that otherwise asymptomatic women with prior HDP display evidence of increased CVD risk relative to those with normal pregnancy as early as one year postpartum. In addition to examining traditional CVD risk factors, they will focus on insulin resistance, inflammation and microalbuminuria, factors that are associated with HDP but have been understudied in the postpartum period. In a second physiological study, they will examine vascular reactivity using brachial artery ultrasound, and insulin sensitivity using intravenous glucose tolerance tests. The hypotheses to be tested are that women with HDP display evidence of endothelial dysfunction during the early postpartum period and that this alteration is related to insulin resistance. All subjects will be identified from the MGH Obstetric Maternal Study, the largest pregnancy cohort in Massachusetts, and the source of several important studies during pregnancy. The proposed study is sufficiently powered (>90%), IRB-approved and pilot data support its feasibility. They believe the results will provide critical insight into mechanisms of CVD in women and potentially suggest means to alter their CVD risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CEREBROVASCULAR HYPERTENSION

CHANGES

IN

PREGNANCY

AND

Principal Investigator & Institution: Cipolla, Marilyn J.; Neurology; University of Vermont & St Agric College 340 Waterman Building Burlington, VT 05405 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Eclampsia is a serious complication of pregnancy that occurs when hypertension develops with neurologic symptoms, including headaches, nausea, visual disturbances and convulsions. While numerous organs are affected by hypertension in pregnancy, cerebrovascular involvement is the direct cause of death in approximately 40 percent of patients. The major cerebrovascular changes that occur have been shown to be similar to hypertensive encephalopathy in which acute elevations in blood pressure (i.e., acute hypertension) overcome the myogenic

36 Pregnancy

vasoconstriction of the cerebral arteries and arterioles causing autoregulatory failure, hyperperfusion and edema. Because women who develop eclampsia in general are normotensive prior to pregnancy, there is evidence that pregnancy affects the cerebral circulation in a way that makes the vessels susceptible to autoregulatory failure and hyperperfusion during acute hypertension. The long-term objective of this proposal is to investigate how pregnancy affects the structure and function of the cerebral circulation focusing on diameter regulation in response to changes in pressure (myogenic reactivity) and how those changes affect vascular permeability that promotes edema. Aim 1 will use isolated and pressurized posterior cerebral arteries from pregnant and nonpregnant rats to determine the pressure at which forced dilatation occurs and investigate underlying mechanisms of pregnancy-induced alterations in diameter regulation, including vascular smooth muscle actin and endothelial cell influences (e.g., nitric oxide and prostaglandins). In addition, since hypertension alone has been shown to cause significant remodeling and reactivity changes in the cerebral circulation, Aim 1 will also investigate how elevated mean arterial pressure during pregnancy affects myogenic activity and diameter regulation in a rat model of hypertension in pregnancy (nitric oxide inhibition). Acute hypertension and eclampsia are associated with significant edema formation due to disruption of the normally impermeable cerebral endothelium. Therefore, Aim 2 will investigate pregnancy-induced changes in endothelial cell permeability during acute hypertension, including enhanced fluid phase endocytosis (transcellular flux) and tight junction disruption (paracellular flux). The influence of pregnancy on permeability during forced dilatation will be determined using a combination of techniques, including clearance of fluorescent tracers and transmission electron microscopy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHANGING MYOMETRIAL PHENOTYPES DURING PREGNANCY Principal Investigator & Institution: Macdonald, Paul C.; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2001 Summary: The research proposed is designed to characterize the functional phenotypes of the uterus during pregnancy (before and during labor) and to define the cellular changes that establish the phenotypic differences. The studies described are closely aligned with those designed to determine the biomolecular mechanisms by which the transitions in parturition phase are effected. The studies are based on the hypothesis that thre are three major components of a fail-safe system that ensures myometrial quiescence for the first 90-95 percent of human pregnancy: (i) the actions of estrogenprogesterone; (ii) hormones, neuropeptides and eicosanoids acting via heptahelical receptors linked to Galpha/S adenylyl cyclase; and, (iii) natriuretic peptide-activated membrane receptor/guanylyl cyclase, which effects an increase in intracellular cGMP. The 3 system components that serve to effect myometrial quiescence must be muted late in pregnancy as uterine phase O is suspended. There also is a group of ligands that act in myometrium via heptahelical receptors linked to Galpha/i/q/11-causing inhibition of adenylyl cyclase and activation of phospholipase C (PLC). An increase in responsiveness to Galpha/i/q/11-linked receptor ligands likely facilitates the establishment of uterine phase 1, ultimately eventuating in the completion of the uterine transition to phase 2, i.e., active labor. Myometrial membrane preparations from preterm and term pregnancies (before and during labor) will be used to evaluate responsiveness to multiple (9 different) ligands operative via Galpha/S- linked heptahelical receptors that activate adenylyl cyclase. The cAMP- activation state of the

Studies 37

myometrium will be evaluated by determining endogenous levels of cAMP and the steady-state activity of protein kinase A (PKA). Various components of the system will be explored to define the nature of cellular changes that account for phenotypic differences among tissues: heptahelical receptors and linkage to G-proteins, total (activatable) adenylyl cyclase, G-protein expression and subcellular distribution. Responsiveness of myometrial membrane preparation to activation of membrane receptor/guanylyl cyclase by natriuretic peptides will be evaluated together with the levels of endogenous cGMP and the steady state cGMP-induced protein kinase. Tissue responsiveness to ligands that act via Galpha/i/q/11,-linked heptahelical receptors to activate phospholipase C also will be assessed. Estrogen receptor-transfected human myometrial cells will be used to define the cause of cellular changes that account for the changes in functional phenotypes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC HYPOXIA, UTERINE ARTERY VASOREGULATION & GROWTH Principal Investigator & Institution: Moore, Lorna G.; Professor; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, CO 800450508 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2003 Summary: (Adapted from applicant's abstract) The investigator proposes to determine the mechanisms by which pregnancy and chronic hypoxia influence uterine artery vasoregulation and growth, and thus contribute to fetal growth restriction and possibly pre-eclampsia. The central working hypothesis is that chronic hypoxia impairs vasoregulatory and growth related responses of the uterine artery. The hypothesis will be tested by experiments performed in three specific aims. (1) Determine the effects of pregnancy and chronic hypoxia on uterine artery vasodilators/constrictor responses to the physiological stimuli of flow, pressure, and pharmacological agents; (2) Determine the effect of pregnancy and/or chronic hypoxia on uterine artery growth; and (3) Determine the effect of pregnancy and/or chronic hypoxia on the relationship of indices of impaired uterine artery vasoregulation and growth to uterine artery blood flow, intrauterine growth restriction, and pre-eclampsia. Aims #1 and #2 are to be conducted on pregnant and non-pregnant guinea pigs kept at 1600m and 3962m throughout pregnancy. Aim #3 focuses on women residing at either low or high altitude in whom Doppler flow velocimetry and ultrasound imaging will be used to measure uterine artery blood flow. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CIGARETTE SMOKING AND POST-PARTUM BREAST CANCER RISK Principal Investigator & Institution: Hsieh, Chung-Cheng; Professor of Medicine; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, MA 01655 Timing: Fiscal Year 2001; Project Start 13-SEP-2001; Project End 31-JUL-2003 Summary: Cigarette smoking has been hypothesized to have both carcinogenic and antiestrogenic effects that may offset each other to produce no overall effect on breast cancer risk. A full-term pregnancy also appears to have opposing effects on breast cancer risk: 1) an adverse effect shortly after delivery and 2) a beneficial effect over time. If the transient increase risk of breast cancer is due to the growth-enhancing consequences of elevated pregnancy hormones on already initiated cells, then cigarette smoking during

38 Pregnancy

pregnancy, through its anti-estrogenic effect, can be expected to dampen this risk. Conversely, with its carcinogenic effect, cigarette smoking during pregnancy might also reduce the long-term protection against breast cancer afforded by a full-term pregnancy. We propose to examine the effects of cigarette smoking on the risk of postpartum breast cancer occurring at different intervals following delivery. We will use a database that links together the Swedish Medical Birth Register, National Cancer Register, and Register of Causes of Death. Members of the study population are all mothers who delivered a liveborn or stillborn baby after a gestation period of at least 28 weeks in Sweden between 1973 and 1998. We have adopted a nested case-control sampling design to allow more efficient analyses. Cases are approximately 3,500 women who had one or more childbirths between 1973 and 1998 and who had a breast cancer diagnosis during the same period. For each case subject, five controls who were born in the same year as the index case, were alive at the date of the diagnosis for the index case, and had not been diagnosed with breast cancer by that date, will be randomly selected from the source population. Logistic regression analysis will be applied to examine cigarette smoking as a risk determinant for postpartum breast cancer adjusting for age, parity, and age at first full-term pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CIGARETTE TAXES AND PRENATAL SMOKING Principal Investigator & Institution: Joyce, Theodore; Professor; None; Bernard M. Baruch College 17 Lexington Ave New York, NY 10010 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: Prenatal smoking is the most important modifiable risk factor for poor pregnancy outcomes in the United States. Upwards of 20 percent of all low birth weight births are attributable to smoking and the external costs associated with maternal smoking are estimated at between 11.1 and 18.9 billion. In the only published study to date. economists demonstrated that a 10 percent increase in cigarette prices due to an increase in cigarette excise taxes was associated with a 5 percent decline in smoking by pregnant women, an elasticity of-0.5. In 1999, California increased the excise tax on cigarettes by $0.50; New York raised the excise tax by $0.55 in March of this year. The impact of such large taxes increases on prenatal smoking and thus, infant health, is potentially significant. In this study we use data from the Centers for Disease Control's Pregnancy Risk Assessment Monitoring System (PRAMS) to evaluate the effect of cigarette excise taxes on pre-pregnancy, prenatal and postpartum smoking. PRAMS is a random, stratified monthly survey of 100-200 recent mothers selected from birth certificates. By the time the 1999 survey is complete, PRAMS will contain information on over 170,000 births delivered between 1988 and 1999 in 16 states. The primary advantage of PRAMS is the detailed information on smoking before, during and after pregnancy. These data allow us to test a simple model that predicts that smoking is more sensitive to cigarette taxes in the period prior to pregnancy relative to the period during pregnancy. Our model implies that previous work may have underestimated the impact of cigarette taxes on smoking by pregnant women. Another advantage of information about smoking at various points around pregnancy is that we can analyze the determinants of quitting during pregnancy and re-starting after birth. Thus, we can test whether changes in the money price of cigarettes induced by a rise in the cigarette excise tax affects the probability of quitting during pregnancy, an analysis not previously attempted. A third advantage is that the screen for smoking on PRAMS is more sensitive that the screen on birth certificates. Thus, we lessen the potential bias associated with underreporting of smoking during pregnancy. Finally, PRAMS also has more detailed

Studies 39

information on the mother than is available on birth certificates, which enables us to more effectively model the demand for smoking by pregnant women than has been previously possible in multi-state analyses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMPUTER-AIDED PREGNANCY/STDS

COUNSELING

TO

PREVENT

Principal Investigator & Institution: Gold, Melanie A.; Children's Pittsburgh/Upmc Hlth Sys of Upmc Health Systems Pittsburgh, PA 15213

TEEN Hosp

Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 30-MAR-2007 Summary: (provided by investigator): Adolescent unintended pregnancy and STDs remain at epidemic levels in the United States. Healthy People 2010 Objectives set a goal to increase to 90 percent the proportion of sexually active adolescents who use contraception that both effectively prevents pregnancy and provides barrier protection against disease. How to effectively counsel adolescents to reach this goal is unclear. Counseling and feedback based on the Transtheoretical Model (TTM) have demonstrated greater success than standard, action-oriented advice in several domains of behavior change. The effectiveness of this type of counseling to alter female adolescents' sexual and contraceptive behaviors has not been rigorously evaluated. We propose recruiting 660 female adolescents, ages 13 to 21 years, from an inner-city, hospital-based clinic and randomizing them to either an innovative Computer-Assisted Motivational Intervention (CAMI) or a Didactic Educational Control (DEC). The CAM! group will receive three, 30-minute sessions of one-on-one counseling with a counselor that is guided by computer-generated personalized feedback. The CAMI is based on the principles of the TTM and on Motivational Interviewing. The DEC provides three 30minute sessions of one-on-one didactic information on contraception, STD prevention, and abstinence. The two interventions are identical in length and timing but vary in educational content, counseling style, and the provision of personalized feedback. We will track the two groups of female adolescents in this study through a 6-month intervention phase and a 12-month follow-up phase to assess differences in sexual and contraceptive behaviors by group. The primary specific aim for the study is to evaluate the efficacy of the CAMI as compared to the DEC in reducing sexual behaviors that increase the risks of both unintended pregnancy and STDs. We will examine protective sexual behaviors in three ways: 1) behaviors that protect against pregnancy; 2) behaviors that protect against STDs; and 3) behaviors that protect against both pregnancy and STDs. Our primary hypothesis is that the CAMI will decrease the proportion of subjects who engage in any intercourse that is poorly protected against pregnancy and against STDs. We also predict that among sexually active subjects, the CAMI will increase the percentage of episodes of intercourse that are well protected by the use of both condoms plus another contraceptive. Finally, we also predict that the CAMI will increase the prevalence of abstinence among the entire sample. If proven effective, computer-assisted personalized motivational counseling could be broadly implemented as a method to decrease the incidence of unintended pregnancy and STDs among female adolescents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTROL OF CORTICOTROPIN DURING PREGNANCY Principal Investigator & Institution: Keller-Wood, Maureen Pharmacodynamics; University of Florida Gainesville, FL 32611

E.;

Professor;

40 Pregnancy

Timing: Fiscal Year 2003; Project Start 01-JUL-1987; Project End 31-JAN-2007 Summary: (provided by applicant): The overall objective of the proposed research is to determine the mechanism for increased ACTH secretion during pregnancy. This increase is necessary for normal maternal and fetal homeostasis, and occurs without symptoms associated with increased steroid action, such as hypertension. We have hypothesized that action of corticosteroids at mineralocorticoid receptors (MR) leads to reduced MR action in pregnancy, and that progesterone mediates this effect as a competitive antagonist at MR. The studies done thus far have supported this hypothesis, showing changes in hippocampal MR consistent with reduced activation and the presence of antagonist activity, during progesterone treatment or pregnancy. The proposed studies will extend these studies to test the following hypotheses: 1) Progesterone treatment in vivo blocks MR effects on 5HT1A expression in hippocampal neurons, resulting in increased plasma ACTH levels. The magnitude of the effects on both 5HT1A expression and ACTH is related to the levels of cortisol relative to progesterone. 2) Progesterone treatment in vivo has selective effects on neurons in hippocampal regions expressing mineralocorticoid receptors (MR) but not progesterone receptors (PR) (including CA1 and dentate gyrus). 3) The increase in ACTH caused by pregnancy or progesterone treatment is caused by an increase in serotonin effects in the brain; 4) The interaction between cortisol and progesterone in hippocampal cells in vitro involves competition at MR, producing opposing effects on 5HT1A mRNA and on the hyperpolarization response to 5HT (serotonin); and 5) Progesterone inhibits activation of MR, resulting in reduced MR binding to specific response elements, including those in the 5HT1A promoter. The first 3 aims will be studied in experiments in sheep. The sheep will be studied either after chronic progesterone treatment, ovariectomy or during pregnancy; MR binding and 5HT1A mRNA, as well as MR, GR and PR mRNA will be measured in hippocampus, hypothalamus and medulla. To test whether changes in 5HT1A occur in the same types of cells in hippocmapus as express MR (but not PR), mRNA will also be determined by in situ hybridization. To test the role of 5HT1A during pregnancy, the ability of a 5HT1A agonist to inhibit the ACTH levels in pregnancy and in progesterone-treated ewes will also be determined. The final 2 aims will be tested in cultures of hippocampal neurons. The effect of progesterone on MR binding, 5HT1A mRNA and electrical responses to a 5HT agonst will be tested; single cell PCR will also be used to determine if cells contain MR, but not PR. The action of progesterone at MR will also be tested by using MR-selective antagonist and agonist, and GR-PR antagonist. Finally, the ability of progesterone to inhibit MR activation will be tested in gel-shift and super-shift assays using specific response elements in the 5HT1A promoter, including a nGRE and the SP-1 site. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTROL OF MATERNAL-FETAL INTERACTION BY PAS GENES Principal Investigator & Institution: Pru, James K.; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2003 Summary: (provided by applicant): The aryl hydrocarbon receptor (AHR), AHR nuclear translocator (ARNT) and hypoxia-inducing factor-la (HIF-l a) are members of the Per/Arnt/Sim (PAS) family of proteins that regulate transcription of target' genes in response to physiological (e.g., endogenous signals) and pathological (e.g., environmental toxicants) cues. Interestingly, PAS family members, including the AHR and ARNT, are constitutively expressed in many tissues, including those of the female reproductive system. Of relevance to this application, expression of the AHR and ARNT

Studies 41

at uterine implantation sites (fetal and maternal interfaces), coupled with the fact that Ahr-deficient female mice have reduced litter sizes, suggest that the members of the PAS family have a biological function during pregnancy. Moreover, chemical Iigands of the AHR, such as polycyclic aromatic hydrocarbons (PAH) derived from the incomplete combustion of fossil fuels and tobacco smoke, have been implicated from both epidemiological and animal studies to have deleterious effects on pregnancy. Computer-based sequence analysis of a number of genes previously shown to be functionally required for the establishment of pregnancy and decidualization, in addition to novel genes regulated by the embryo (presented herein), has revealed that the promoters of many of these genes harbor AHR response elements. Such findings are in keeping with results from Dr. Tilly's lab using PAH-exposed ovaries in gene profiling experiments (microarrays), Which identified many of these same genes as being putative targets for the AHR. Based on these observations, it is hypothesized that PAS family members serve as key regulatory switches to coordinate the expression of specific genes in the uterus during pregnancy, both in response to the decidualization process and in response to an embryonic-derived factor(s). Of particular interest for consideration of PAS transactivation are the genes cylooxygenase-2, prostaglandin '2 synthase, peroxisome proliferator-activated receptor- and retinoic acid X receptor a (general decidualization process), and acid sphingomyelinase and interferon stimulated gene 15 (induced by the embryo). Furthermore, the candidate also hypothesizes that environmental toxicants, such as PAH, alter the expression of these genes in a manner incompatible with the establishment or maintenance of pregnancy. As such, results from the proposed experiments will not only shed new light on the role of PAS family members and their target genes in embryo implantation and pregnancy, but also how the magnitude and temporal aspects of this expression must be precisely coordinated for pregnancy to occur. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COPING DURING SPONTANEOUS SMOKING CESSATION IN PREGNANCY Principal Investigator & Institution: Scheibmeir, Monica; None; University of Kansas Medical Center Msn 1039 Kansas City, KS 66160 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): Up to 30 percent of pregnant smokers spontaneously quit smoking during pregnancy. Unfortunately, the effects of cessation are short-lived with relapse rates reaching up to 70 percent within three to six months following delivery. In spite of established behavioral interventions and pharmacotherapies discovered in the past ten years, the prevalence of smoking in pregnant women, as well as relapse in the postpartum period, remains very high. Gaps in our knowledge exist about the efficacy of coping strategies used by pregnant women to successfully quit smoking. This exploratory study will assess the smoking cessation strategies used by low-income women attending publicly funded prenatal clinics who spontaneously quit smoking during pregnancy and after delivery using quantitative and qualitative methods. The specific aims are to: (1) Describe the coping strategies that low-income spontaneous quitters use during pregnancy and the early postpartum period, (2) Compare the self-efficacy to quit smoking of low-income spontaneous quitters with that of low-income pregnant smokers, and (3) Clarify the relationship between coping strategies and self-efficacy among low-income spontaneous quitters during pregnancy and the early postpartum period. Two county health prenatal clinics will be used to recruit 30 participants for the sample of spontaneous quitters and 150

42 Pregnancy

women will be recruited for the sample of continuous smokers. Data collection for the sample of spontaneous quitters will include face-to-face interviews with participants and questionnaire data collected twice during the pregnancy and once at six-weeks postpartum. For participants who continue to smoke during pregnancy, data collection will be done once and include written questionnaire information. Data analysis methods will include descriptive statistics, Pearson Product Moment correlations, mixed linear modeling and qualitative content analysis. Triangulation of the qualitative and quantitative data will enhance the validity of the findings. This study will address a critical gap in our knowledge of the primary strategies used by women to remain abstinent from cigarettes. New insights on the key factors associated with successful abstinence will be used to enhance this window of opportunity that pregnancy provides for women smokers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CRYPTIC RETARDATION

TELOMERE

ABNORMALITIES

IN

MENTAL

Principal Investigator & Institution: Ledbetter, David H.; Robert W. Woodruff Professor of Human Ge; None; University of Chicago 5801 S Ellis Ave Chicago, IL 60637 Timing: Fiscal Year 2001; Project Start 05-MAR-1999; Project End 28-FEB-2003 Summary: (Adapted from the applicant's abstract) Visible cytogenetic abnormalities are detected in approximately 10-20 percent of children with mild to severe mental retardation (including autism) and approximately 2-5 percent of couples with recurrent pregnancy loss. As current cytogenetic banding resolution only detects imbalances greater than 2 million basepairs of DNA, it is likely that submicroscopic abnormalities affecting the ends of chromosomes, the telomeres, may play a role in a significant proportion of unexplained ("idiopathic") mental retardation and pregnancy loss. The hypothesis to be tested is that submicroscopic gene dosage imbalances at human telomeres contribute significantly and disproportionately to idiopathic mental retardation and recurrent pregnancy loss. Special features of human telomeres which suggest they may be disproportionately represented compared to other regions of the genome include the fact that telomeres are the most gene rich regions of the human genome, and therefore very small imbalances are likely to have significant genetic consequences. Aspects of telomere structure and polymorphism may mediate nonhomologous chromosome pairing and unequal cross-over events leading to gene dosage imbalance. Studies to address these hypotheses only recently have become possible due to development of a complete set of specific human telomere probes. Of 41 human telomeres, unique probes within 300 kb of the end of the chromosome are available for 40. This probe set provides an entree into more detailed biological studies of the architecture of human telomeres, as well as the frequency, mechanisms, and consequences of telomeric rearrangements in idiopathic mental retardation, autism, pregnancy loss, birth defects and cancer. Specific aims are: (1) Molecular characterization of polymorphism and recent evolutionary duplications/rearrangements of subtelomeric transition zones by analysis of human populations and nonhuman primates, (2) Determination of the frequency and pattern of cryptic deletions and translocations in unexplained mental retardation/autism probands with a family history suggestive of chromosomal translocation, and (3) Determination of the mechanisms and consequences of telomere imbalance by detailed molecular analysis of the size of the imbalance, breakpoints, gene/EST content, and parental origin. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 43

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Project Title: DEPRESSION & BIRTH OUTCOMES OF AFRICAN AMERICAN WOMEN Principal Investigator & Institution: Gavin, Amelia R.; None; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 31-DEC-2003 Summary: (provided by applicant): Depression during the prenatal period may be an important factor underlying the African American/White disparity in low birth weight (LBW) and preterm delivery (PTD), which is one of the most persistent and least understood public health concerns in the United States (Hoffman and Hatch, 2000; Deal and Holt, 1998; Kvale, Cronk, Glysch, and Aronson 2000; Din-Dzietham and HertzPicciotto 1998; Institute of Medicine 1985). Although the overall infant mortality rate has been declining since 1933, in any given year, African American women are twice as likely as White women to give birth to a low birth weight infant and/or deliver preterm (Ventura et al 1999; Singh and Yu 1995). Using the life course perspective as a theoretical framework, this application seeks to identify the relationship of depressive symptoms during the second trimester of pregnancy to the occurrence of LBW and PTD among African American women. Data from the prospective, NICHD funded, Michigan-based Pregnancy Outcomes and Community Health (POUCH) Study will be used to test the moderating influence of depressive symptoms as a function of low childhood socioeconomic status on pregnancy outcomes. Logistic regression analysis will be used to control for the potential ways in which maternal characteristics may affect pregnancy outcomes. This research will shed light on the roles of life course socioeconomic status and depressive symptoms in explaining the Black/White disparity in birth outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: DEPRESSION, HPA AXIS ACTIVITY, AND NEONATAL OUTCOME Principal Investigator & Institution: Suri, Rita; Psychiatry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: (Adapted from applicant's description) This revised application proposes Rita Suri, M.D. for a K23 Mentored Patient-Oriented Research Career Development Award for the study of depressive disorders during pregnancy. A limited body of knowledge regarding the impact of mood state on the fetus complicates the management of major depression during pregnancy. The purpose of this prospective study is to examine the effects of maternal depression on the hypothalamic-pituitaryadrenal (HPA) axis during pregnancy and its impact on variables related to neonatal outcome. This will be achieved by studying mood, plasma corticotropin releasing hormone (CRH), salivary cortisol, and neonatal outcome in the following groups of pregnant women: 1) 50 women with major depression who are depressed and not on antidepressants; 2) 50 women with a history of major depression who are treated with an SSRI and are euthymic; 3) 50 women without a history of major depression who are euthymic and not on antidepressants. Maternal mood state and anxiety will be assessed across each month of pregnancy; an assessment of HPA axis activity will be made in each trimester with measurements of plasma CRH and salivary cortisol. Neonatal outcome measures will include infant birth weight, gestational age, and performance on the Brazelton Neonatal Behavioral Assessment Scale. Information gained from this study will help clinicians and patients better understand the impact of untreated maternal depression versus treatment with antidepressants on HPA axis activity and the neonate and better assess the risks and benefits of treatment versus no medication

44 Pregnancy

during pregnancy. During the Award period, Dr. Suri will follow an organized program of interdisciplinary training and supervised research under the sponsorship of Dr. Lori Altshuler. She will undergo coursework in endocrinology, physiology, embryology, neuroscience, biostatistics, and research design. She will complete a methodologically sound study of mood and endocrinology across pregnancy and effects on neonatal outcome. This research and career development plan will provide a foundation for future independent investigation regarding the management of psychiatric disorders during pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIETARY SUPPLEMENTS & SUPPRESSION OF BONE RESORPTION & LEAD MOBILIZATION Principal Investigator & Institution: Hu, Horward; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2001 Summary: This project will take place in Mexico City, taking advantage of our current Superfund (SF)-supported project. Recent evidence indicates that there is a marked increase in the mobilization of lead from maternal bone stories into circulation during pregnancy and lactation. Furthermore, our SF data and the data of others indicate that this phenomenon carries a significant risk of fetal toxicity in the form of growth (decreased birth weight, head circumference, birth length) and subsequent cognitive development. These findings pose a major public health problem, even among societies with declining lead exposure, given the persistence of pockets of high lead exposure (including some communities living in proximity to hazardous waste) as well as the long residence team of lead in bone (years to decades). As suggested by our SF data and other studies, one possible strategy for suppressing the mobilization of metal bone lead stores during pregnancy is nutritional intervention. We propose to recruit a new sample of women of women in Mexico City who have relatively high bone lead levels and conduct a randomized, double-blinded, placebo-controlled trial of supplements containing calcium as a means of suppressing bone resorption and the resulting mobilization of lead from bone supplements containing calcium as a means of suppressing bone resorption and the resulting mobilization of lead from bone into plasma during pregnancy, and into breast milk during the postpartum period. We will take maternal measurements of (1) pre-pregnancy and postpartum-bone lead using our K-x-ray fluorescence technology; (2) bone resorption (by assaying (1) pre-pregnancy and postpartum bone lead using our K-x-ray fluorescence technology; (2) bone resorption (by assaying N-telopeptide of type I collagen in urine [urinary NTX]), (3) whole blood lead, and (4) plasma lead (using special collection techniques and measured by IDTIMSJ during pre-pregnancy, the first, second, third trimesters and at one and four months postpartum; and (5) breast milk lead levels are at one and four months postpartum. We will measure maternal plasma and breast milk lead levels as these are the most direct sources of fetal and infant lead exposures, and recent research suggests that maternal venous blood levels do not adequately reflect either of these parameters. We will test the hypothesis that supplements will significantly decrease urinary NTX, plasma lead, and breast milk lead levels. We will also explore the relationship plasma lead levels We will also explore the relationship of plasma lead levels to birth anthropometry measures. This research, if successful, may provide a means of preventing secondary toxicity from accumulated lead burdens among women of reproductive age. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 45

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Project Title: DOMESTIC ABUSE IN PREGNANCY AND ADVERSE BIRTH OUTCOMES Principal Investigator & Institution: Saftlas, Audrey Frieda.; Associate Professor; Epidemiology; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2005 Summary: Recent studies suggest that 2.4 % to 5.6 % of pregnant women are physically abused each year in the United States. Domestic violence is hypothesized to cause adverse pregnancy outcomes through two mechanisms: physical trauma and prenatal stress. To date, research into the association of domestic violence in pregnancy and adverse birth outcomes provides inconsistent evidence. Most studies, however, have been small in size, used an endpoint of low birthweight, and focused primarily on lowincome women, who are at highest risk of both domestic violence and adverse pregnancy outcomes. We propose to conduct a population-based case-control study to investigate the independent and joint effects of domestic violence and prenatal stress on the risk of preterm delivery (N=950) and intrauterine growth retardation (N=1210). In addition, patterns of abuse will be examined over three points in time (prepregnancy, pregnancy, postpartum) among control subjects (N=950) to determine if the pregnancy or postpartum periods are high-risk times for domestic abuse. The influence of contextual factors, such as pregnancy intendedness, will also be examined. The study population, identified from the Iowa live birth certificate file, will be comprised of residents of three Iowa counties who deliver between August 1, 2001 and July 31, 2003. Domestic violence and prenatal stress will be assessed using well-tested, established instruments, including the revised Conflict Tactics Scale (CTS2) and the Prenatal Life Events Scale. Data will be collected using computer-assisted telephone interviews, covering the primary study exposures and risk factors for domestic violence and the two study outcomes. Subjects will be interviewed 3 to 6 months postpartum and compensated for their participation. Medical chart abstractions will be conducted to validate case definitions and document prenatal care variables, medical history, and pregnancy complications. With at least 80 % power, the study will be able to detect increased risks of 2.0 for the least prevalent exposure, domestic violence. This study will be the first to examine the effect of prenatal stress in conjunction with domestic violence on adverse pregnancy outcomes, and offers a unique combination of methodological and conceptual strengths to address these issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ECONOMIC IMPACT OF HIV PREVENTION ON STDS Principal Investigator & Institution: Johnson-Masotti, Ana P.; Assistant Professor; Psychiatry and Behavioral Med; Medical College of Wisconsin Po Box26509 Milwaukee, WI 532264801 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2003 Summary: Sexual risk reduction interventions to prevent the transmission of HIV also have beneficial effects on other social health concerns, such as non-HIV STDS and unintended pregnancy. Most prior studies of the cost-effectiveness of HIV prevention interventions focus only on the impact of the intervention on HIV outcomes. Studies that neglect the impact of these interventions on other STDs and unintended pregnancies may underestimate the economic benefits of sexual behavior change. Furthermore, little is known regarding the cost-effectiveness of HIV prevention interventions viewed as STD (or unintended pregnancy) prevention programs. This application seeks funding to conduct a cost-effectiveness analysis of a community-level

46 Pregnancy

sexual behavior risk reduction intervention that was implemented at multiple locations in the U.S. The intervention targets low-income, predominantly African- American adolescents living in urban housing developments. This analysis will allow us to: 1) estimate the number of HIV and STD infections and the number of unintended pregnancies prevented by the intervention, as well as associated savings in medical care costs and lost economic productivity; 2) evaluate the cost-effectiveness of the intervention with regard to HIV (measured by the cost per HIV case averted), STDs (measured by the cost per chlamydia, gonorrhea, syphilis, HPV, or HBV case averted), and unintended pregnancies (measured by the cost per unintended pregnancy prevented); 3) compare the cost-effectiveness of this intervention with other HIV, STD, and unintended pregnancy prevention interventions; and 4) determine how much difference the addition of non-HIV STDs and unintended pregnancy outcomes make to the estimated HIV prevention cost-effectiveness of the intervention. The proposed, more inclusive, approach to estimating the cost-effectiveness of HIV prevention should produce more accurate estimate for use in policy analyses and resource allocation decision-making. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ECTOPIC TRANSPLANTATION OF INVASIVE TROPHOBLAST Principal Investigator & Institution: Adams, Alison P.; J a Baker Inst for Animal Hlth; Cornell University Ithaca Office of Sponsored Programs Ithaca, NY 14853 Timing: Fiscal Year 2001; Project Start 15-JUL-2001 Summary: This proposal is based upon the hypothesis that the trophoblast has the capacity to regulate maternal immune responses during pregnancy, independent of the hormonal status of the mother or the site of implantation. A system for transplanting equine invasive trophoblast cells to ectopic sites has been developed as a means to assess the maternal immune responses to the developing conceptus. Preliminary studies demonstrate that transplanted trophoblast: 1) differentiate and function in sites other than the uterus, 2) evoke strong cellular and humoral immune responses by the recipient, 3) downregulate MHC class I antigens as they do after invading the uterus in normal pregnancy, and 4) survive for 28 days or longer after transplantation. Based on the trophoblast transplant model, this proposal would address the following questions: 1) Are the humoral and cellular immune responses to invasive trophoblast altered in a non-uterine mucosal site (vulvar mucosa) when compared to those which occur 1n normal pregnancy? Immune responses to trophoblast transplants would be compared to those induced by normal pregnancy or by skin allografting using the following assays: lymphocyte microcytotoxicity assay to determine the cytotoxic antibody titer, duration, and onset, Western blot technique to identify the molecular target(s) of the antibody response, ELISA capture assay to determine antibody isotypes, quantitative RT-PCR assay to identify cytokine profiles, and cytotoxic lymphocyte (CTL) assay to assess cellular immune functions. 2) What mechanisms do invasive trophoblast cells employ to regulate maternal immune responses? Molecular assays would be used to determine if invasive trophoblast cells control immune effector function by synthesizing immunosuppressive factors, such as indoleamine 2,3- dioxygenase (IDO) and FasL. Quantitative and in situ RT-PCR assays would be performed on allogeneic and MHC class I compatible trophoblast transplants to determine the presence and temporal expression of these transcripts. The proposed study should provide important insights into the relative roles of the trophoblast, the uterine site, and the pregnant state in influencing fetal evasion of maternal immune responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 47

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Project Title: EFFECT DEVELOPMENT

OF

CHRONIC

INFECTION

ON

PLACENTAL

Principal Investigator & Institution: Boggess, Kim A.; Obstetrics and Gynecology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2003; Project Start 13-MAR-2003; Project End 28-FEB-2006 Summary: (provided by applicant): Periodontal disease is a chronic, polymicrobial oral infection that affects up to 50% of pregnant women. This oral infection has recently been associated with adverse pregnancy outcome. Pregnant women with active chronicoral infection have a three to five-fold increased risk for spontaneous miscarriage, preeclampsia, and small-for-gestational age infants. The mechanisms by which chronic maternal oral infection disrupts normal pregnancy is unknown, although there are animal and human data to demonstrate systemic dissemination of oral pathogens to the maternal and fetal circulation, and to the placenta. Maintenance of normal pregnancy is predicated by normal placentation and placental development. This application seeks to study the mechanisms that chronic maternal oral infection could affect pregnancy outcome. The purpose of this investigation is to develop a rabbit model to study the effects of chronic maternal infection with oral pathogens on fetal growth and placental development. The hypothesis of this application is that chronic maternal infection with oral pathogens results in translocation of these pathogens to the utero-placental unit, altering maternal-placental interaction at the time of implantation, thus impairing fetal growth. Redundancy exists at the maternal-fetal interface that protects against maternal complement activation and inflammation, which allows normal embryo attachment and placental invasion. Chronic maternal infection with oral pathogens may alter the balance necessary to allow normal placental development to occur. In Specific Aim 1, a model of chronic maternal infection with oral pathogens, distant from the uterus, will be developed in the rabbit and used to measure the effect on fetal growth. In Specific Aim 2, maternal and fetal protective factors that allow normal implantation will be characterized in the rabbit, and placental inflammation and maternal immune tolerance will be compared between rabbits chronically infected with oral pathogens and those uninfected. The presence or absence of biomarkers of inflammation and immune tolerance within the placenta will be correlated with recovery or oral pathogens from the placenta and newborn weight. Understanding of these mechanisms may assist in the development of interventions to protect the fetus and placenta from damage as a result of chronic maternal infection with oral pathogens. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECT OF MATERNAL CALCIUM SUPPLEMENTATION ON INFANT BONE MINERAL CONTENT Principal Investigator & Institution: Prada, Jorge A.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, OH 45229 Timing: Fiscal Year 2001 Summary: Calcium requirements during pregnancy increase significantly to meet the needs of the mother and the developing fetus. This could result in the maternal loss of bone mineral density (up to 3.8% spinal BMD). This loss of BMD may be the combined result of dietary calcium intake falling short of the calcium requirements for pregnancy, and the increased urinary calcium excretion during pregnancy. From our preliminary study of 64 pregnant adolescents, the dietary recall of the previous 24 hours revealed a calculated dietary calcium intake of 978 +/- 532 mg/day, including the 250 mg/day of

48 Pregnancy

calcium present in the prenatal supplementation, which is below the RDA for pregnancy. Births from adolescent mothers are known to result in lower birth weight of the individual infants. However, it is not known whether it is associated with altered bone mineral status. The effect of maternal calcium depletion during adolescent pregnancy on the infant BMC has not been studied. The overall aim of this proposal is to determine the effects that the current maternal dietary calcium intake, and calcium supplementation in pregnancy, will have on the infant bone mineral content. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF PREGNANCY ON ADOLESCENT GROWTH AND HEALTH Principal Investigator & Institution: Crawford, Patricia B.; Nutritional Scis & Toxicology; University of California Berkeley Berkeley, CA 94720 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2005 Summary: (provided by applicant): Adolescent obesity is a growing U.S. public health problem. Pregnancy during adolescence may contribute to accumulation of fat due to high levels of gestational gain and metabolic adaptations. In contrast to adult pregnant women, young adolescents continue to gain fat beyond the first half of gestation, have higher gestational gains, and retain more weight postpartum. Recommendations for higher gestational weight gain among adolescents have been based primarily on efforts to promote optimal growth and health of the fetus, but the future health risks to the mother have not been addressed. Although postpartum weight increase is higher among adolescents than adults, the increase relative to non-gravid adolescents of similar maturation stage is not known. Longitudinal studies of adolescents have not examined the effect of pregnancy on growth, body size, and blood lipid profiles since longitudinal data before, during and after pregnancy have not been available. Current knowledge is limited by the following: a) lack of appropriate comparison groups of non-parous adolescents to account for growth and secular trends, b) unavailability of measured weight, height, and metabolic indices before, during and after pregnancy, c) lack of longitudinal measures of dietary intake and physical activity, and d) scarcity of comprehensive data on subjects' race, SES, age at menarche, reproductive history, alcohol use, smoking, hormonal contraceptive use, and other lifestyle characteristics. This study will assess the effects of adolescent reproductive status on: 1) incidence of obesity and 2) changes in growth and health parameters from menarche through adolescence, and will determine whether the effects are comparable for Black and White females. This study will also describe changes in body weight and size among primiparous adolescents according to age at menarche and age at first birth to examine the influence of gestational gain on measures of growth and health, and will determine whether the changes are comparable for Blacks and Whites. This study will combine the existing National Heart Lung and Blood Institute Growth and Health Study (NGHS) longitudinal anthropometric, blood lipid, and health data for a cohort of adolescent females with information that we will abstract from their pregnancy medical records (gestational age and weight gain, maternal and infant health outcomes, and pregnancy complications). We will provide the most accurate estimates to date of the effect of pregnancy on changes in stature, body size and adiposity, and blood lipid profiles relative to non-parous Black and White adolescents controlling for a wide variety of potential confounders. The findings will be examined specifically in relation to gestational gain and provide a scientific basis for pregnancy weight gain recommendations for adolescents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 49

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Project Title: ENDOTHELIUM DERIVED VASODILATORS IN PREGNANCY Principal Investigator & Institution: Magness, Ronald R.; Professor; Obstetrics and Gynecology; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2001; Project Start 01-JUL-1993; Project End 30-JUN-2003 Summary: Normal cardiovascular adaptations in pregnancy include generalized vasodilatation and reduced uterine and systemic vasoconstrictor responses to infused angiotensin II (ANG II). The specific physiologic, biochemical, and molecular mechanism(s) by which pregnancy alters uterine and systemic flows remain unknown, although it clearly results from both vasodilatation as well as growth/neovascularization. Uteroplacental vasodilation and angiogenesis are associated with increased secretion of basic Fibroblast Growth Factor (bFGF), Epidermal Growth Factor (EGF), and Vascular Endothelial Growth Factor (VEGF) as well as placental derived estrogen and progesterone during the second and third trimesters of pregnancy, at a time when fetal growth and uteroplacental blood flows increase dramatically. This increase in blood flow contributes to dramatic increases in shear stress on the lumenal surface of the vasculature. The uteroplacental vasculature in pregnancy exhibits very prominent production of Nitric Oxide (NO) and Prostacyclin (PGI2) from the endothelium due to increased expression (protein and mRNA) of endothelial NO synthase (eNOS) and cyclooxygenase-1 (COX-1), respectively. The overall hypothesis of this project is that uterine artery endothelium-derived NO and PGI2 productions are increased in normal pregnancy because these vessels are exposed to angiogenic growth factors (e.g. bFGF, EGF, and VEGF), placental steroids (Estrogen and Progesterone), and shear stress. We will examine these specific aims; AIM I Determination of the physiologic factors during the second and third trimester of ovine pregnancy controlling uterine blood flow (UBF) and the in vivo expression of eNOS, COX-1 and PG12 synthase (PGIS) by evaluating the local effects of: (Exp. 1) unilateral uterine arterial infusion of the estrogen receptor antagonist ICI 182780; and (Exp. 2) unilateral reductions in shear stress by occluding UBF. AIM II Determination of the factors which modulate the cellular and molecular (protein and mRNA) expressions of eNOS, COX-1, and PGIS in an established uterine artery endothelial cell (UAEC) culture model derived from pregnant and nonpregnant sheep. We propose to evaluate the effects of the following treatments on NO2/NO3 and PGI2 production as well as the expression of eNOS, COX-1, and PGIS in pregnant and nonpregnant UAEC cultures: (Exp. 1) Angiogenic Growth Factors (bFGF, EGF, and VEGF); (Exp. 2) Estrogen q ICI 182,780 and Progesterone q ZK299 (i.e. q receptor antagonists); (Exp. 3) comparing static cultures vs laminar shear stress and; (Exp. 4) interactions of laminar shear stress and responses to growth factors, estrogen and progesterone. Completion of these studies will provide the framework for understanding the local control of and interactions between growth factors, placental steroids and shear stress on controlling vasodilatation and blood flow to the uteroplacental vasculature. These vasodilatory mechanisms may be reduced in pregnancies complicated by hypertension and/or fetal growth retardation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ENVIRONMENTAL NEURODEVELOPMENT

LEAD,

THYROID

FUNCTION

&

Principal Investigator & Institution: Factor-Litvak, Pam R.; Associate Professor; Epidemiology; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2004

50 Pregnancy

Summary: Severe deficiency of thyroid hormone during the prenatal and neonatal periods is associated with adverse neurodevelopmental outcomes in infancy and childhood. Maternal iodine deficiency during pregnancy leads to a lowered production of activated (i.e., iodinated) thyroid hormone (T3) and an increased risk of cretinism (with associated severe mental retardation) in the child. Congenital hypothyroidism and transient hypothyroidism of prematurity are associated with deficits in cognition during early life. In light of these observations, it is appropriate to ask whether sub-optimal maternal thyroid function, particularly during the first half of pregnancy when maternal contribution to fetal thyroid hormone is maximal, is associated with neurodevelopment of the child. Recent data suggest that children of mothers with 'low-normal' thyroid function are at risk for small deficits in cognition and increased reports of behavior problems. The overall goal of this project is to assess whether mild deficiencies in maternal thyroid function are associated with adverse neurodevelopment in the child, and, if so, to elucidate possible biologic mechanism. One possible mechanism is through damage to the choroid plexus, the site of production of the brain-specific transport protein for thyroid hormone. Animal studies suggest that the choroid plexus is damaged by exposure to environmental lead, raising the possibility that associations between lead exposure and cognition in the child arise through an effect of lead on transport of thyroid hormone to the brain. The proposed study draws on data from a prospective study designed to examine the associations between pre- and post-natal lead exposure and childhood development. The cohort comprises approximately 300 children, born in 1984-1985 in two towns in Kosovo, Yugoslavia who were followed through age 12. Sera are available to measure thyroid function in the mothers at midpregnancy and in the children at ages 4, 7 and 12. Outcomes, including cognition, motor function, behavior problems and anthropometric measurements, were measured repeatedly during infancy and childhood. This project will expand the findings of the Yugoslavia study to examine first, whether maternal thyroid function in the first half of pregnancy is associated with cognitive, behavioral and growth outcomes and second, whether the associations between Pb and these outcomes are mediated by exposure to thyroid hormone. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF GALLBLADDER SLUDGE & STONES IN PREGNANCY Principal Investigator & Institution: Lee, Sum P.; Professor and Chief; Medicine; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 01-APR-1996; Project End 31-MAR-2002 Summary: (Adapted from Investigator's Abstract) Without exception, cholesterol gallstone is more common among women than men in every population studied. This consistent and conspicuous gender difference starts during puberty, continues throughout the childbearing years, but fades alter menopause. Biliary sludge, a newly described ultrasonographic diagnosis, is a mixture of cholesterol monohydrate crystals and other precipitates within the gallbladder, and it is regarded as a precursor form of gallstones. Sludge is frequently found in pregnant women, although the risk factors for the development of gallbladder sludge and stones during pregnancy have not been clearly defined. The investigators propose a prospective investigation of gallstones and biliary sludge that develop during pregnancy to accomplish several specific aims. First, they will determine the incidence rate of biliary sludge and gallstones during pregnancy and compare this rate to a nonpregnant control sample. Second, they will look for factors predictive of the development of biliary sludge gallstones during pregnancy,

Studies 51

including obesity, age, hyperinsulinemia, hyperlipidemia and serum estradiol and progesterone levels. Lastly, they will examine predictors of persistent gallstones and biliary sludge disease in the postpartum period by following women until one year after delivery. They aim to include as many as 7,280 women in this study. They will be recruited from the prenatal and genealogy clinics of Madigan Army Hospital. Development of gallstones and biliary sludge will be defined by ultrasonographic examination of the gallbladder contents performed at pre-specified intervals during gestation and postpartum, and at an equivalent time in the non-pregnant control group. A variety of analytic methods will be used to achieve these specific aims of this study. Gallstone and biliary sludge are common in women and represent major causes of morbidity. The investigators state that this study will add new and important insight into the risk factors leading to these outcomes and affecting their natural history. They further note that this information, in turn, may lead to effective strategies for treatment and prevention of these conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF INFANT LEUKEMIA Principal Investigator & Institution: Ross, Julie A.; Associate Professor; None; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, MN 554552070 Timing: Fiscal Year 2001; Project Start 09-FEB-1999; Project End 31-DEC-2002 Summary: Several exposures and experiences have been associated with younger age childhood leukemias, typically in children diagnosed less than 2 years of age. These include maternal alcohol consumption during pregnancy, maternal pesticide and solvent exposure during pregnancy, and infant birthweight in excess of 4000 grams. However, a diagnosis of less than 2 years of age is an inadequate characterization of infant leukemia. There are marked differences in clinical behavior and frequency of a specific genetic abnormality in cases diagnosed less than 1 year of age compared to cases diagnosed at older ages. Approximately 60 percent of infants with acute myeloid leukemia (AML) and 80 percent of infants with acute lymphoblastic leukemia (ALL) have a molecular abnormality in their leukemia cells involving the gene, MLL, at chromosome band 11q23; the frequency of this abnormality drops precipitously after 1 year of age. There is substantial evidence that these MLL abnormalities occur during pregnancy. Thus, infants with leukemia may be a highly informative subgroup for the identification of possible environmental exposures in utero that act as initiators. This case-control study will include infants with ALL and AML and randomly selected, individually-matched controls. This study is designed to explore the following in this unique patient population (1) maternal exposure to DNA topoisomerase II inhibitors during pregnancy is associated with infant AML that manifests MLL abnormalities; (2) mothers of infant cases are more likely to have exposures to pesticides and solvents during pregnancy; (3) in utero exposure to alcohol is associated with an increased risk of infant AML; (4) mothers of female cases are more likely to have a reproductive history that included fetal loss prior to the pregnancy of the index child; (5) infant cases, particularly ALL, will weigh more than infant controls; and (6) there will be a higher frequency of MLL abnormalities among female infants with leukemia compared with male infants with leukemia. This study will utilize the unique resources available through the Children's Cancer Group, and include ascertainment of cases over a six-year period (Jan 1, 1996-Dec 31, 2001). Included in this study will be the integration of molecular data documenting the presence or absence of an MLL abnormality. The overall sample size includes 250 matched sets (2 controls per case), which will provide sufficient statistical power to address the hypothesis being investigated.

52 Pregnancy


Project Title: EPILEPSY AND CHILDBIRTH: PK/PD MODELING OF AEDS Principal Investigator & Institution: Pennell, Page; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Approximately 1.1 million women with epilepsy are of childbearing age in the United States and give birth to over 20,000 babies each year. Pregnancy in women with epilepsy is accompanied by increased adverse neonatal outcomes, and approximately 28% of women will experience increased seizures. Serum concentrations of most of the AEDs decline during pregnancy, but findings from previous studies are too inconsistent to provide guidelines for management of AEDs during pregnancy. The primary objectives of Project 1 are: 1) pharmacokinetic/pharmacodynamic (PK/PD) modeling of antiepileptic drugs (AEDs) during pregnancy and lactation in women with epilepsy to define fetal/neonatal exposure; 2) identifying the predictors of seizure worsening during pregnancy and postpartum. Given that both AEDs and maternal seizures have been identified as having deleterious effects on the developing fetus and neonate, the PK/PD modeling combined with the course and predictors of illness will provide the foundation to propose guidelines to reduce exposure to both seizure activity and medication. PK/PD modeling of each of the AEDs encountered will be performed in Core A. Both a traditional, two-stage approach and population PK modeling will be employed. The influence of gestational age and other demographic, genetic, and environmental factors (covariates) will be analyzed. Frequency of seizures by type will be documented throughout pregnancy and first postpartum year and compared to each woman's preconception baseline. Worsening of seizure frequency will be correlated with potential predictors, including change in serum AED concentrations, hormonal status, stress, and altered sleep patterns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ETHANOL EFFECTS ON BONE FORMATION IN PREGNANCY Principal Investigator & Institution: Ronis, Martin Jj.; Professor; Arkansas Children's Hospital Res Inst Research Institute Little Rock, AR 72202 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 30-APR-2007 Summary: (provided by applicant): It is well known that women are more susceptible to the adverse effects of alcohol than men. An estimated 5-20 percent of American women consume alcohol during pregnancy. Yet, almost no research has examined the effects of ethanol on pregnant and lactating women. We have developed a total enteral nutrition (TEN) -model that supports the additional nutritional demands of pregnancy. Using the TEN system we have made several important observations: First, with constant infusion of ethanol, blood and urine ethanol concentrations of male and non-pregnant female rats cycle between almost zero and over 500 mg/dl with a frequency of one pulse every 5-7 days. Second, the amplitude of these ethanol pulses is markedly reduced (80 percent) in pregnant female rats suggesting that ethanol metabolism is significantly increased in pregnancy. This would be protective since the rate of ethanol metabolism, at a given ethanol intake, determines the maternal blood ethanol concentrations and toxicity. Third, we have observed that undernutrition during pregnancy significantly elevates the amplitude of pulsatile ethanol concentrations to higher levels. This would be expected to increase maternal toxicity. Fourth, chronic ethanol infusion results in reduced bone formation and strength in non-pregnant animals. This effect is reversed by

Studies 53

TNFa and IL-1f3 blockers. Fifth ethanol treatment during pregnancy results in significant reductions in trabecular and cortical bone mineral density at the end of gestation, over and above the effects of pregnancy itself Osteoporosis is an area of significant health care and concern. Normally there is no increased risk of osteoporosis with parity. However, we hypothesize that ethanol will inhibit bone formation during the period of high bone turnover in the latter part of pregnancy, increase bone loss during lactation and inhibit the anabolic phase of bone rebuilding which occurs postpartum in the absence of breast feeding or post-weaning in lactating mothers. This may result in permanent deficits in bone mineralization and strength. These effects may be exacerbated by undernutrition. The TEN system will used to determine the effects of ethanol/nutritional interactions on maternal bone in pregnancy and lactation and on skeletal rebuilding post-partum. The role of CYP2E1 and free radicals in the skeletal toxicity of ethanol during these periods will also be studied. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATION OF VITAMIN D REQUIREMENTS DURING PREGNANCY Principal Investigator & Institution: Hollis, Bruce W.; Professor; Pediatrics; Medical University of South Carolina 171 Ashley Ave Charleston, SC 29425 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The prevalence of hypovitaminosis D in reproductive age African-American women occurs at a rate of >40%. Two factors have contributed to this public health problem: an inadequate DRI for vitamin D and avoidance of sun exposure/use of sunscreen. This startling rate of hypovitaminosis D requires that the DRI for vitamin D in pregnancy be evaluated in a detailed manner. The Cochrane Library (2002) released a report stating that there is insufficient data to evaluate the effects of vitamin D supplementation during pregnancy. Recently, the safety of prolonged supplementation with up to 25x's DRI (10,000 IU/day) was demonstrated in nonpregnant adults. It is essential to determine what dose of vitamin D is required to eliminate hypovitaminosis D during pregnancy and provide the fetus/neonate with adequate vitamin D stores during development and growth, particularly in darkly pigmented individuals. The aim of this research proposal, then, is to determine the efficacy, effectiveness, and safety of maternal vitamin D supplementation (as a function of ethnicity and UV exposure) in the prevention of hypovitaminosis D in the pregnant mother and her fetus/neonate. We hypothesize that darkly pigmented mothers will require substantially higher oral supplementation with vitamin D to eliminate hypovitaminosis D as compared to their Caucasian counterparts. We propose a comprehensive clinical trial to test our hypothesis. Mothers at 12 weeks' gestation will be randomized to one of three vitamin D treatment groups: (1) Control, 400-, (2) 2,000-, or (3) 4,000 IU/day to be continued throughout pregnancy. Calcium and vitamin D homeostasis and skeletal remodeling in mother will be monitored closely throughout pregnancy. Bone density of mother will be measured at 12 weeks' gestation and one-month postpartum. Follow-up growth and skeletal integrity assessments of the infant will be performed at birth, 1, 6 and 12 months stratified by infant feeding regime. Through these proposed studies, the prevalence of hypovitaminosis D among mothers, their developing fetuses and neonates, and the utility of maternal therapeutic intervention with vitamin D for both mother and fetus/infant will be assessed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

54 Pregnancy

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Project Title: EXERCISE PREECLAMPSIA

INTERVENTION

TO

REDUCE

RECURRENT

Principal Investigator & Institution: Patrick, Thelma E.; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, PA 15213 Timing: Fiscal Year 2001; Project Start 05-SEP-2000; Project End 31-MAY-2005 Summary: Exercise has positive effects on the cardiovascular, metabolic, endocrine, and immune systems. Preeclampsia, a hypertensive disorder of pregnancy, has many common risk factors, and a common pathway, namely endothelial activation, with cardiovascular disease. For women who experience preeclampsia in more than one pregnancy, there is an increased risk of cardiovascular disease in later life. Similarities in cardiovascular disease and preeclampsia led to the conclusion that exercise would be an effective intervention in reducing the recurrence of preeclampsia. Reduction in recurrence of preeclampsia is the primary outcome of this study. The secondary aims are to examine the effect of a moderate intensity exercise intervention on markers of the metabolic syndrome in sedentary pregnant women, and to explore the usual health behaviors, self-efficacy, and differences in health behaviors adopted during pregnancy. To test these hypotheses, we propose a randomized clinical trial to examine the effects of a moderate intensity exercise during pregnancy. Multiparous women who had preeclampsia in a previous pregnancy will be enrolled and randomized to one of two groups. The control group will receive usual care, and the intervention group will receive an exercise intervention. The exercise intervention will consist of 30 minutes of moderate intensity physical activity performed on 5 days per week, and short bouts of exercise (3-10 minute episodes of walking) will be encouraged. Projection of sample size, 160 women per group, was based on the dichotomous primary outcome, a reduction of recurrence from 20 percent to 10 percent and accounts for 10 percent attrition. Juried diagnosis by a panel of clinical experts based on stringent clinical criteria for preeclampsia will be used to determine pregnancy outcome. Fasting serum and plasma samples will be obtained at baseline (first trimester), and at two subsequent times (once in the second and third trimester). Subjects will complete an interview to recall physical activity over the past 7 days, and will respond to questionnaires about health promoting lifestyle activities and exercise self-efficacy. This study will contribute to a program of research directed at health promoting lifestyle behaviors in women who are at risk for high-risk pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAILURE TO MODULATE T & NK CELL ZETA EXPRESSION IN RSA Principal Investigator & Institution: Taylor, Douglas D.; Associate Professor; Obstetrics and Gynecology; University of Louisville University of Louisville Louisville, KY 40292 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Escape of the fetus from the maternal immune system is essential for fetal development and successful pregnancy. Evidence has accumulated suggesting that the deletion or selective inactivation of reactive lymphocytes or the production of suppressor factors by cells of fetal origin may contribute to maternal immune dysfunction. Impairment to complete failure to induce NK and T cell dysfunction in some pregnant women could be for poor pregnancy outcomes from pre-term labor to fetal death. Understanding the mechanisms of pregnancy-associated T and NK cell dysfunction will provide the greatest impact on clinical improvements in the prevention of negative pregnancy outcomes. Recent evidence indicates that the loss of signal-transducing zeta chain, associated with CD3

Studies 55

and CD16, represents one of the mechanisms responsible for T and NK cell dysfunction. The absence of zeta chain results in defects in the assembly and function of the antigen reactive receptors and the affected leukocytes exhibit diminished proliferation and production of specific cytokines. We have demonstrated reduced expression of CD3 and CD 16-zeta chain in peripheral blood T and NK cells, respectively, of women developing normal pregnancies. Our recent studies have demonstrated that the sera from women with normal term pregnancies suppressed the level of zeta chain expression in T and NK cells, while sera from women with histories of recurrent pregnancy loss failed to significantly inhibit CD3 and CD16-zeta chain expression. Subsequently, we have isolated a 14kappaD protein from the plasma of a normal pregnant woman at 34 weeks gestation. A similar inhibitory protein could be demonstrated in the sera of five other normal term pregnant women. However, this factor could not be demonstrated in the sera obtained from pregnant women who spontaneously aborted. This protein specifically suppresses zeta chain levels; however, it does not modulate the levels of the kinases, lck and zeta-associated protein (ZAP)-70. This proposal will address the biochemical, molecular, and functional characterization of the pregnancy-derived 14kappaD zeta-inhibiting protein (ZIP). Initially, this investigation will identify differences in the l4kD proteins associated with uncomplicated pregnancies and recurrent aborters. We will further isolate and characterize its gene to define ZIP's expression during normal pregnancy and RSA. Using proteomic analysis, we will identify cellular events associated with T and NK cell activation that are altered by ZIP from normal and RSA pregnancies, using multiple activation pathways and timing of ZIP exposure to determine the specific events affected. Since the loss of T-cell zeta chain has been correlated with successful pregnancy, while impairments in this normal suppression of CD3 and CD16-zeta appear to be associated with recurrent spontaneous abortions, we will develop an ELISA for ZIP to define its biologic and clinical importance by correlating its level in patients' sera experiencing recurrent pregnancy loss. The inability to effectively modulate CD3 and CD 16-zeta chain during pregnancy might allow the generation of an effective cellular response against the fetus, directly resulting in spontaneous abortions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEMALE REPRODUCTIVE ORGANS AND THEIR INNERVATION Principal Investigator & Institution: Papka, Raymond E.; Neurobiology and Pharmacology; Northeastern Ohio Universities Coll Med P.O. Box 95 Rootstown, OH 44272 Timing: Fiscal Year 2001; Project Start 15-SEP-1988; Project End 30-APR-2003 Summary: Long termgoals of this research seek tounderstand the morphological and functional substrates of the uterine innervation, the response of uterine nerves to steroid sex hormones and how these may play a role in such conditions as preterm labor, protracted labor, autonomic dysreflexia and pregnancy-induced hypertension. The current proposal investigates the autonomic and sensory neural substrate for integration of uterine information and relates these substrates to the altered physical & steroid hormone environment of pregnancy and parturition. Distinct subpopulations of autonomic and sensory neurons innervate the uterus. This specificity of neural organization led to the hypothesis: first, that uterine neurons in autonomic and sensory ganglia provide part of the substrate, which involves estrogen-receptive neurons, to integrate uterine information and secondly, that this substrate plays a role in pregnancy, parturition and viscerovisceral reflexes. A specific role for estrogen in these pathways is hypothesized because estrogen modulates neurochemical systems in the CNS and

56 Pregnancy

influences sensitivity of primary afferent nerves. Specific aims will: 1) characterize sympathetic and vagal inputs to the uterus and determine if autonomic and sensory ganglionic uterine-related neurons contain estrogen receptors (ER), 2) determine if the content and distribution of ER or ER-containing, uterine-related autonomic and sensory neurons change with the altering hormonal milieu of pregnancy & parturition, 3) characterize neurotransmitters of ER-containing neurons in autonomic and sensory ganglia, 4) evaluate whether the input activity to autonomic uterine-related neurons increases during pregnancy and parturition and 5) determine whether some uterinerelated neurons influence the cervical ripening of parturition through release of transmitters that act in neurogenic inflammation. These studies will utilize retrograde tracing, in situ hybridization histochemistry, immunohistochemistry, nerve transections, parturition-induced activation of ganglionic neurons, and radioligand binding for ER. Health benefits from understanding involvement of neural mechanisms in the uterus include an increased basic understanding of neuroendocrine coordination of gestational events including pregnancy and parturition and the possibility of remediating problems such as preterm labor, protracted labor, autonomic dysreflexia and pregnancy-induced hypertension. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTION OF THE DECIDUAL TISSUE Principal Investigator & Institution: Gibori, Geula; Professor; Physiology and Biophysics; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2003; Project Start 01-DEC-1978; Project End 31-JAN-2008 Summary: (provided by applicant): The establishment and maintenance of pregnancy requires the coordinate activity of a specialized maternal tissue, the decidua. Extensive investigation from our and other laboratories has established that decidual cells are able to produce hormones and cytokines, and to express steroidogenic enzymes. The overall objective of our research is to understand the involvement of these decidua-derived factors in the maintenance of the proper milieu for fetal development. Gene knockout strategies have revealed a crucial role for prolactin (PRL), Interleukin-11 (IL-11) and for decidual steroidogenic enzymes, 5alpha-reductase type 1 (5alphaR1) and 20ahydroxysteroid dehydrogenase (20alphaHSD), in the normal progress of pregnancy in rodents. The focus of this grant application is to define the role, regulation and interaction of these decidua-derived factors. The first specific aim centers on the role of decidual-PRL in the inhibition of IL-6 and caspase-3, genes involved in inflammation and cell death respectively. Using both PRL and IL-6 knockouts as well as primary decidual cells and cell lines, we propose to examine whether it is indeed IL-6 expression that leads to fetal death in the PRL (-/-) mice, whether pregnancy can be salvaged by generating double knockout mice for PRL and IL-6, and by preventing IL-6 production in the PRL null mice. We will also determine the molecular mechanism by which PRL silences the decidual expression of the IL-6 gene. Another objective of this specific aim is based on our findings that dPRL acts as a survival factor preventing the expression and activation of the cell death inducer, caspase-3, in the decidua. We will examine the mechanism by which dPRL prevents the activity of this executioner caspase, and determine whether PRL inhibition of caspase 3 is at the transcriptional level and involves the Akt/forkhead pathway. The second aim will focus on the role of decidual IL-11 in the normal progress of pregnancy and more specifically on the reason why IL11Ralpha gene deletion leads to small decidua and to uncontrolled trophoblast invasion. Finally, in the third aim, we will examine the regulation and the role of decidual steroidogenic enzymes in the maintenance of pregnancy. We will examine the

Studies 57

mechanism by which PRL prevents decidual 20alphaHSD expression and whether PGF2a stimulates its expression at the end of pregnancy. We will also examine whether 5alphaR1 is not expressed in the IL-11Ralpha null mice causing high levels of circulating estradiol and precipitating fetal death. We will also test the hypothesis that fetal death in 5alphaReductase type 1 null mice is due to the inhibition of IL-11 signaling in the decidua by high levels of estradiol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONS OF PREGNANCY SPECIFIC GLYCOPROTEINS Principal Investigator & Institution: Dveksler, Gabriela S.; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, MD 20852 Timing: Fiscal Year 2001; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: Pregnancy specific glycoproteins (PSGs) are a family of secreted proteins produced by the placenta. These proteins belong to the immunoglobulin gene super family and are essential for a successful pregnancy. Expression of PSGs has been observed in many species including humans and mice. Our long-range goal is to define the roles and mechanisms of action of pregnancy specific glycoproteins in normal and abnormal pregnancy. The objective of this application is to characterize the initial interaction of PSGs with receptor-bearing target cells to clone their receptor, to clone their receptor, and to evaluate their ability to regulate the production of cytokines and other mediators of inflammation. The central hypothesis of the application is that PSGs bind to a specific cellular receptor on target cells and that this interaction contributes to the regulation of immune and inflammatory mediators which are essential for a normal pregnancy outcome. The rationale behind the proposed research is that PSGs are involved, through binding to a specific cellular receptor on mononuclear phagocytes in modulating mediators of the immune response, such as IL-10, thereby preventing the feto-placental damage that could ensue from local inflammation. The future development of therapeutic interventions, aimed at manipulation of immunomodulatory effects of PSGs during pregnancy, will depend on careful definition of specific PSG functions. To accomplish the objectives of this application, we will pursue two specific aims: (1) Clone and characterize the cDNA encoding the cellular receptor for murine PSGs on murine macrophages; (2) Characterize the roles of murine PSG2, PSG3, and PSG4 and human PSG6 as immunomodulators in vitro. We expect that the results obtained will aid in the definition of the roles of this glycoprotein family in maintaining normal pregnancy and that this knowledge will result in the development of new therapeutic strategies related to the management of complicated pregnancies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENITAL TRACT MUCOSAL IMMUNE FACTORS IN PREGNANCY Principal Investigator & Institution: Goepfert, Alice R.; Obstetrics and Gynecology; University of Alabama at Birmingham Uab Station Birmingham, AL 35294 Timing: Fiscal Year 2001; Project Start 28-AUG-2000; Project End 30-JUN-2002 Summary: (Adapted from applicant's description): Pregnancy is associated with substantial hormonal and anatomical changes primarily for the support and protection of the developing fetus. In fact, the leading cause of infant morbidity and mortality in the U.S. today, preterm birth, has been associated with upper genital tract infection which presumably ascends from the lower genital tract. However, no studies in the current literature have evaluated the mucosal immune system during pregnancy. In order to characterize mucosal immune factors of the lower genital tract in pregnancy,

58 Pregnancy

have propose the following specific aims: 1) To determine if there are longitudinal changes in the mucosal immune system of the lower genital tract (cervix and vagina) in pregnant women when followed in each trimester during pregnancy, 2) To determine if differences exist in mucosal immune factors of the lower genital tract in pregnant women at each trimester of pregnancy with and without selected risk factors (such as bacterial vaginosis, other pelvic infections, black race) for certain pregnancy complications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GLUCOSE AND AMINO ACID METABOLISM IN PREGNANCY Principal Investigator & Institution: Kalhan, Satish C.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, OH 44106 Timing: Fiscal Year 2001 Summary: The objectives of the proposed studies are to quantify longitudinally maternal metabolic responses to progressions of pregnancy and growth of the fetus. Specifically, the impact of pregnancy and alterations in fetal growth, e.g. in diabetes, upon whole body amino acid and glucose metabolism will be quantified using stable isotope tracer method. Data from our previous studies in human pregnancy have shown that while changes in energy delivering substrates, e.g. glucose and fatty acids, during pregnancy occur parallel with the energy requirements of the mother and growing conceptus, adaptive responses in protein/nitrogen metabolism appear in anticipation of the fetal needs. In addition, preliminary data suggest that (a) liver/splanchnic tissue may be an important organ system involved in the pregnancy related adaptation, and (b) amino acid transamination may be an important component of nitrogen conservation and accretion. The proposed studies are aimed at testing these two hypotheses. Multiple isotope tracers will be used simultaneously to quantify splanchnic extraction and metabolism of essential amino acids. Whole body kinetics of glutamine, a major nitrogen source for urea and for the fetus and its nitrogen source will be quantified. Since fetal macrosomia has continued to be a persistent problem in gestational diabetes despite rigorous intervention strategies, this clinical model of abnormal fetal growth will be evaluated for the changes in gluconeogenesis and amino acid metabolism. A recently developed novel method employing labeling of body water which has already been applied to normal pregnancy will be used to quantify gluconeogenesis in gestational diabetes. These studies will quantify kinetics of key nutrients and substrates in the whole body (mother and fetus) which can impact fetal growth. It is anticipated that these data will permit the development of intervention strategies for amelioration of aberrant fetal growth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HEPATIC DRUG ELIMINATION IN PREGNANCY Principal Investigator & Institution: Vore, Mary E.; Professor and Director; Toxicology; University of Kentucky 109 Kinkead Hall Lexington, KY 40506 Timing: Fiscal Year 2002; Project Start 30-SEP-1979; Project End 31-MAY-2006 Summary: (provided by applicant): This proposal focuses on the effects of estradiol and its metabolites on the function and expression of Mrp2 (ABCC2), the ABC transporter that mediates the biliary excretion of glucuronide and glutathione conjugates from the hepatocyte into bile. The proposal builds on our findings that 1) Mrp2-mediated transport of estradiol-17Beta-(Beta-D-glucuronide) (E217G) is essential for its cholestatic activity, 2) E217G causes endocytic retrieval of Mrp2 from the canalicular membrane

Studies 59

that coincides with decreased bile flow, and 3) expression of Mrp2 protein, but not Mrp2 mRNA, is decreased in pregnancy. Aim 1 will test the hypothesis that transport of cholestatic E217G and the choleretic estradiol-3-glucuronide (E23G) by rat Mrp2 and human MRP2 is mediated by overlapping but non-identical substrate binding sites. We will use an Mrp2/MRP2 baculovirus expression system in Sf9 cells and probe the substrate binding sites of E217G vs E23G. We will also determine if women with intrahepatic cholestasis of pregnancy have polymorphisms in MRP2 that alter their transport of E217G vs E23G. Aim 2 will test the hypotheses that A) E217G causes endocytic retrieval of Mrp2 and other transporters critical to bile formation from the canalicular membrane leading to inhibition of flow, and B) agents that protect against cholestasis do so by either inhibiting Mrp2 transport of E217G or prevention of transporter retrieval. We will use confocal immunomicroscopy to monitor endocytic retrieval of transporters from and their exocytic insertion into the canalicular membrane. Aim 3 will characterize the changes in Mrp2 expression in pregnancy and test the hypotheses that A) estrogens mediate the decreased hepatic Mrp2 expression in pregnancy, B) Mrp2 is subject to transcript-specific translational control conferred by regulatory elements in the 5' or 3' untranslated regions of Mrp2 mRNA and C) pregnancy and estrogens increase the degradation of Mpr2 protein. We will use polysomal distribution analysis of Mrp2 mRNA, translation assays in HepG2 cells and determine the degradation half-life of Mrp2 protein in control, pregnant, and estrogentreated rats. Significance: Characterization of the mechanisms by which estrogens decrease Mrp2/MRP2 function and expression can lead to 1) improved drug therapy for women in pregnancy, 2) development of therapeutic measures to increase MRP2 function in cholestatic liver disease, and 3) methods to screen for cholestatic toxicity in drugs under development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEPATIC/INTESTINAL P-GLYCOPROTEIN PREGNANCY

AND

CYP3A

IN

Principal Investigator & Institution: Unadkat, Jashvant D.; Professor; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: Pregnant women and their fetuses are therapeutic "orphans." Drugs are administered to pregnant women, and therefore their fetuses, without the necessary clinical data about the pharmacokinetics, dose, safety, or efficacy of the drugs in these vulnerable populations. To determine the correct dose of a drug to administer to the pregnant woman, it is important to know if the pharmacokinetics of the drug are different in pregnant women when compared with men or non-pregnant women. Many drugs administered to pregnant women are substrates of P-glycoprotein (P-gp) or cytochrome P450 3A enzymes (CYPCA4/5) or both, such as antivirals (e.g., anti-HIV protease inhibitors, antibiotics (e.g., clarithromycin), antihistamines (e.g., fexofenadine), and anti-epileptics (e.g, carbamazepine). P-gp and CYP3A4/5 enzymes are strategically located in the intestine, liver and kidneys?organs important for absorption, metabolism, and excretion of drugs. We have recently obtained evidence from perinatal Phase I clinical trial on indinavir, an anti-HIV protease inhibitor, that the oral clearance of this drug is increased approximately 3-fold during pregnancy. Since the disposition of indinavir is determined by P-gp and CYP3A4/5 enzymes in the intestine and liver, we hypothesized that P-gp and CYP3A4/5 expression and activity in these tissues are enhanced during pregnancy. The Specific Aims listed below are designed to test this hypothesis. Hypothesis Hepatic and Intestinal P-glycoprotein and CYP3A4/5

60 Pregnancy

expression and activity is enhanced during pregnancy Specific Aims 1. To determine, both antenatal and postpartum, in vivo intestinal and hepatic P-glycoprotein and CYP3A4/5 activities in pregnant women by oral administration of selective substrates of P-gp (digoxin) and CYP3A4/5 (midazolam). 2. To determine, in vivo (or ex vivo), both antenatal and postpartum, intestinal and hepatic P-glycoprotein and CYP3A4/5 activities (or expression) following oral and IV administration of protease inhibitors to a representative animal model, the pregnant M. nemestrina. 3. To determine if activity and expression of P-gp in lymphocytes is elevated during pregnancy in women and M. nemestrina. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HORMONAL REPRODUCTION

REGULATION

AND

ROLES

OF

CSF-1

IN

Principal Investigator & Institution: Pollard, Jeffrey W.; Professor; Developmtl & Molecular Biology; Yeshiva University 500 W 185Th St New York, NY 10033 Timing: Fiscal Year 2001; Project Start 01-AUG-1994; Project End 31-MAY-2003 Summary: The last few years have documented the expression of many different cytokines/growth factors in the female reproductive tract. In many cases their synthesis is regulated by the polypeptide and sex steroid hormones known to exert overall control of reproduction, suggesting that these growth factors are the local mediators of hormone action. This has been confirmed using null mutants in the cytokine/growth factor genes. Amongst the first growth factors to be studied was the mononuclear phagocytic growth factor, colony stimulating factor-1 (CSF-1), whose expression pattern, together with that of its receptor, in the ovary and uterus suggested roles in reproduction, in addition to those in regulating mononuclear phagocytic function. Our analysis of the CSF-1 nullizygous mice has confirmed these roles for CSF-1 in reproduction with major effects being on neuroendocrine function, ovulation and mammary gland development. Because in all null mouse mutants the gene product is ablated from conception, the effects of its absence in one cell type can have pleiotropic effects on other cell types. An important challenge therefore, is to identify unequivocally the effector cells for each individual phenotype. In this application we will use transgenic technology to spatially and temporally restore, or ablate, CSF-1 signaling to fully define the cell type specific mechanisms of CSF-1 action in female reproduction. Many of the growth factors/cytokines found in the female reproductive tract were originally characterized as hematopoietic cytokines. CSF-1 is one of these, being originally isolated as a macrophage growth factor. A significant gap in immunological knowledge is how infection is controlled at the utero-placental interface, while at the same time an immune reaction is not mounted against the allogenic fetus. The CSF-1 receptor is not only expressed in macrophages but also in trophoblast. Based upon our observations of acute susceptibility of CSF-1 nullizygous mice to placental infection with Listeria monocytogenes, we hypothesize that CSF-1 has an important immunological role during reproduction through the regulation of immune cytokine synthesis by the trophoblast. Our studies aim to identify the important cytokines and to restore CSF-1 signaling in trophoblast independently of other cell types and examine the effect of this on the immune response to L. monocytogenes in order to test this hypothesis. Furthermore, we will identify CSF-1 regulated cytokines in the placenta and use genetic means to ablate them to confirm their importance in controlling this infection. Since L. monocytogenes causes significant fetal morbidity and mortality during pregnancy in humans, such studies might also point to areas for therapeutic intervention in this infection during pregnancy.

Studies 61


Project Title: HUMAN FETOPLACENTAL VASCULATURE AND CGRP Principal Investigator & Institution: Dong, Yuan-Lin; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, TX 77555 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): The maintenance of adequate blood flow to the placenta is essential for a successful pregnancy. Increased fetoplacental vascular resistance and reduced blood flow seen in intrauterine growth restriction (IUGR) and/or preeclampsia is associated with increased fetal and neonatal morbidity and mortality. Calcitonin gene-related peptide (CGRP) has been demonstrated to be involved in the regulation of blood pressure and myometrial contractility during pregnancy via its potent smooth muscle relaxant property, but its role as a vasodilator in physiological and pathological fetoplacental circulation is poorly understood. We have new evidence that CGRP receptors are present in the rat placenta and progressively increase as gestation advances. In addition, CGRP peptide is present in fetal plasma at a higher concentration than that in maternal circulation in late pregnancies. CGRP mRNA is abundantly expressed in the fetal dorsal root ganglia (DRG) and progressively enhanced at term. In humans, CGRP relaxes umbilical, chorionic, and stem villous arteries in a dose-dependent fashion indicating that endogenous CGRP may help maintain low fetoplacental vascular tone during pregnancy. To assess the role of CGRP in the control of human fetoplacental vascular tone, we have proposed the following Specific Aims: Specific Aim 1: To characterize CGRP receptors in the human fetoplacental vasculature. We will identify the cellular location and distribution of CGRP receptor component CRLR and RAMP1 in fetoplacental vessels, and assess radio ligand CGRP binding affinities and capacities. Specific Aim 2: To assess the vasodilatory effects of CGRP on fetoplacental vessels, and determine if they are altered with advancing gestation and modulated by steroid hormones. Specific Aim 3: To determine the post-receptor signaling pathway of CGRPinduced fetoplacental vascular relaxation. Specific Aim 4: To determine the role of CGRP in altered fetoplacental vascular reactivity in IUGR and/or preeclampsia, and evaluate whether insufficient CGRP-related vasodilator mechanisms were involved in the pathophysiology of IUGR and/or preeclampsia. Our long-term goal is to define the role of CGRP in the regulation of fetoplacental circulation and vascular adaptation during pregnancy. This proposal will have important basic science and clinical implications. Our results may indicate that CGRP has vasodilatory effects on human fetoplacental vasculature and is regulated by sex steroid hormones, as well as elucidate the role of CGRP in IUGR and/or preeclampsia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: HYPERGLYCEMIA AND ADVERSE PREGNANCY OUTCOME Principal Investigator & Institution: Metzger, Boyd E.; Professor; Medicine; Northwestern University 633 Clark St Evanston, IL 60208 Timing: Fiscal Year 2001; Project Start 04-MAY-1999; Project End 31-MAR-2004 Summary: There is a consensus that overt diabetes mellitus (DM), whether or not accompanied by symptoms or signs of metabolic decompensation, is associated with a significant risk of adverse pregnancy outcome. On the other hand, the risk of adverse outcome associated with degrees of glucose intolerance less severe than overt DM is controversial. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study is a

62 Pregnancy

basic epidemiologic investigation aiming to clarify unanswered questions on the association of various levels of glucose intolerance during the third trimester of pregnancy and risk of adverse outcomes. Its General Aim, by means of an international cooperative study involving 16 field centers and approximately 25,000 pregnant women, is to achieve a major advance in knowledge on levels of glucose during pregnancy that place the mother, fetus, and neonate at increased risk. The primary hypothesis is that hyperglycemia, less severe than overt DM, is associated with increased risk of adverse maternal, fetal, and neonatal outcome that is independently related to the degree of metabolic disturbance. Specific Aims of HAPO are: 1. To examine glucose tolerance in a large, heterogeneous, multinational, multicultural, ethnically diverse cohort of women in the third trimester of gestation with medical caregivers "blinded" to status of glucose tolerance (except in those instances where fasting and/or two hour OGTT plasma glucose concentration exceeds a predefined cutoff value); and 2. To provide data that can be used to derive internationally acceptable criteria for the diagnosis and classification of gestational diabetes mellitus (GDM) based on the identification of pregnancies at risk for specific adverse outcomes. The study is to be accomplished with high quality standardized data collection on the women during the third trimester of gestation (including the OGTT) and at time of delivery for assessment of adverse outcomes, including fetal hyperinsulinism, fetal obesity (macrosomia), operative delivery (caesarian section), and neonatal morbidity (hypoglycemia). HAPO is to include field centers and regional centers where the participants will be studied, a Clinical Coordinating Center and Data Coordinating Center, both located at the Northwestern University Medical School in Chicago, as well as a Central Laboratory located in Belfast, Northern Ireland. This application requests support for the Clinical Coordinating Center, the field and regional centers and Central Laboratory. Cost effectiveness for the HAPO study is enhanced through cost sharing by colleagues in non-U.S. centers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREECLAMPSIA

HYPERHOMOCYSTEINEMIA

IN

PREGNANCY

AND

Principal Investigator & Institution: Roberts, James M.; Director, Magee-Womens Research Institut; Magee-Women's Hospital of Upmc 300 Halket St Pittsburgh, PA 15213 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2002 Summary: Preeclampsia, the leading cause of maternal mortality in developed nations, increases perinatal mortality five fold. The primary defect in the disorder is reduced placental perfusion. Recent data supports reduced placental perfusion translating to a multisystemic disease by actions to alter endothelial function. It is also evident that maternal constitutional factors such as prepregnancy obesity and insulin resistance interact with placental factors to increase the risk of preeclampsia. Many risk factors for preeclampsia (obesity, hypertension etc.) are similar to those for atherosclerosis, which also has vascular endothelium as a primary target. In addition to the role of endothelial dysfunction in the two disorders there are many other similarities including lipid alterations and evidence of oxidative stress. Hyperhomocysteinemia is a risk factor for atherosclerosis and recent data also indicate increased prevalence of hyperhomocysteinemia in preeclamptic women. Hyperhomocysteinemia can be caused by nutritional deficiency (folate, vitamin B6 and B12) as well as metabolic disorders such as renal disease. In addition, genetically determined deficits of homocysteine metabolism elevate plasma concentrations. We will determine the prevalence of hyperhomocysteinemia in nulliparous and recurrent preeclamptic patients and examine

Studies 63

mechanisms by which homocysteine might be increased (nutritional, metabolic and genetic). We will also probe how homocysteine might facilitate the development of preeclampsia; examining lipid changes and markers of oxidative stress and endothelial dysfunction. The confirmation of hyperhomocysteinemia as a risk factor for preeclampsia is especially important since elevated homocysteine can be reduced by administration of folate, vitamin B6 or B12 in patients with dietary deficiency and in larger doses can at least partially overcome genetically determined enzyme deficiencies. Finally, we will probe whether there is a unique sensitivity to homocysteine during pregnancy. Preeclampsia is completely reversible with delivery despite persistence of elevated homocysteine concentrations, yet these hyperhomocysteinemic women will have increased risk for atherosclerosis in later life. We will examine mice with hyperhomocysteinemia induced acutely by diet and a transgenic mouse deficient in a homocysteine metabolizing enzyme to determine if pregnancy presents unique risk for vascular and metabolic dysfunction. These studies could provide insight into what appears to be a unique sensitivity to endothelial dysfunction during pregnancy and whether acute (during pregnancy) insults are as important as life long exposure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPERTENSIVE DISORDERS OF PREGNANCY Principal Investigator & Institution: Thadhani, Ravi; Brigham and Women's Hospital 75 Francis Street Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: (Adapted from applicants' abstract) Candidate: Ravi I. Thadhani received his M.D. in 1991 from the University of Pennsylvania. He then completed his internal medicine residency and served as Chief Medical Resident at the Massachusetts General Hospital. In 1995 he entered the Harvard School of Public Health and will complete the Masters' Program in Clinical Effectiveness by June 1997. He is interested in an academic research career studying modifiable risk factors of hypertensive disorders of pregnancy. Sponsor and Environment: Meir J. Stampfer, M.D., D.PH. has trained numerous investigators in the field of cardiovascular and nutritional epidemiology, areas in which he has published extensively. He is co-investigator of the Nurses' Health Study I and Nurses' Health Study II, which are based at Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School. Dr. Stampfer is quite familiar with the research methods proposed in this project, and as a Professor of Epidemiology at the Harvard School of Public Health, he will also oversee Dr. Thadhani's formal education. Research: The applicant plans to examine prospectively the association between preand early-pregnancy risk factors and the subsequent development of transient hypertension of pregnancy or preeclampsia in two large cohorts: Nurses' Health Study II and the North Dakota WIC program. The following dietary hypotheses will be tested: pre- and early-pregnancy high intake of omega-3 fatty acids, antioxidants, and calcium reduces the risk of developing hypertensive disorders of pregnancy. Two non-dietary hypotheses will be tested: elevated serum cholesterol prior to pregnancy increases the risk, and smoking, which has been associated with a reduced risk, may not be associated with a reduced risk after adjusting for potential confounders. Diet in both cohorts will be measured by validated semiquantitative food frequency questionnaires developed at the Channing Laboratory. All cases will be verified by review of medical records. We expect 650 incident cases in the Nurses' Health Study II cohort (from 1991-2001) and 800 incident cases in the North Dakota WIC cohort (from 1995-2002). Because both cohorts are part of ongoing efforts, performing this study will be very economical. Furthermore, approximately 16% of women in the North Dakota cohort are of Native-American

64 Pregnancy

background, thus allowing us to evaluate a relatively under-studied segment of the population. Known risk factors for hypertensive disorders of pregnancy are either difficult or impossible to alter. The goal will be to identify dietary and non-dietary risk factors that may be amenable to modification prior to or early in pregnancy. (End of Abstract) Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INSULIN SIGNALING IN GDM & PLACENTAL HORMONES Principal Investigator & Institution: Barbour, Linda A.; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, CO 800450508 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: As a candidate, I have a longstanding interdepartmental collaboration between the departments of Medicine and Obstetrics and Gynecology with a long-term goal to become an independent researcher in gestational diabetes (GDM) and placental hormone physiology. The K-23 Award would allow me to combined clinical research skills I have gained by attaining my MSPH degree and basic research skills I am obtaining through my endocrinology fellowship in order to become a productive clinical investigator. My proposed patient oriented research focuses on the mechanisms of abnormal insulin signaling in GDM and the role of placental hormones in causing the insulin resistance of pregnancy. This award would allow me to gain expertise in executing patient oriented research on the Adult GCRC. The goal of this proposed longitudinal research project is to define the underlying abnormalities in insulin signaling in women with gestational diabetes, determine whether these abnormalities persist in women with normalize their glucose tolerance postpartum versus those who do not, and determine the placental hormones responsible for causing the insulin resistance of pregnancy. Gestational diabetes (GDM) complicates 3-10% of all pregnancies and is increasing in incidence, yet little is known about the molecular mechanisms of the insulin resistance. It results in significant morbidity to both the mother and the fetus, including a 50% risk of developing Type 2 DM in the mother, and a high prevalence of childhood obesity and adult DM in the offspring. This research would examine mechanisms of insulin resistance in others with GDM compared to pregnant controls by studying abnormalities in insulin signaling in skeletal muscle in a longitudinal prospective manner. This would be achieved by obtaining muscle biopsies before and after an oral glucose load in these two groups of women at 24-32 weeks of pregnancy. In order to examine whether or not these abnormalities persist postpartum, repeat muscle biopsies will be taken at 8-12 weeks postpartum before and after the same glucose load. Women with history of GDM who normalize their glucose tolerance will be compared to those who continue to have impaired glucose tolerance postpartum. Lastly, the cause of the insulin resistance in pregnancy will be examined by exposing muscle fibers taken at elective abdominal surgeries in non- pregnant women to placental hormones, including human placental growth hormone and human placental lactogen. This will determine whether the in-vivo insulin signaling abnormalities can be recreated in vitro with placental hormones individuals or in combination. Identifying the abnormalities in insulin signaling in this high risk population as well as the role of placental hormones in mediating the insulin resistance of pregnancy is critical so that progress can ultimately be made towards the prevention of Type 2 diabetes in the mother as well obesity and glucose tolerance in her offspring. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 65

•


INTERVENTION

TO

REDUCE

HIV/STD

RISK

IN

TEEN

Principal Investigator & Institution: Ickovics, Jeannette R.; Epidemiology and Public Health; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2001; Project Start 24-APR-2001; Project End 31-MAR-2006 Summary: (adapted from the applicant's abstract): The long-term objective of this study is to reduce risk for HIV and other sexually transmitted diseases (STDs) during and after pregnancy among ethnically-diverse adolescents (aged 14-19) receiving prenatal care in public clinics in 2 cities: New Haven CT and Atlanta GA. Because women of all ages make numerous behavioral changes during pregnancy (e.g., improve diet; reduce/eliminate tobacco, alcohol and illicit drug use), we believe that pregnancy may also present an important window of opportunity to promote changes in high-risk sexual behavior. Behavior changes initiated in pregnancy could be maintained postpartum with an effective intervention. Integrating theories of diffusion of innovation, social learning theory, and theory of gender and power, specific aims of the proposed study are to: (1) Implement a unique group prenatal care intervention that focuses on risk assessment, educational/skills development, and social support to reduce health risk behaviors and promote health enhancing behaviors; (2) examine prospectively changes in behavior throughout the prenatal period and up to one year later, and to determine the effects of these behavioral changes on biological outcomes, including incidence of STDs and repeat pregnancy; and (3) Identify HIV risk-related psychosocial characteristics associated with biological and behavioral outcomes. As part of this randomized controlled trial, women entering prenatal care in the collaborating clinics will be randomly assigned to one of three treatment conditions: individual standard of prenatal care, standard Centering Pregnancy Program for group prenatal care, and enhanced Centering Pregnancy Program including HIV/STD skills development. The principal outcome will be subsequent chlamydial or gonorrheal infection, evaluated on an intent-to-treat basis by logistic regression analysis. The strengths of the proposed study include: its randomized, prospective longitudinal design; opportunity to maximize sexual risk reduction during and after teen pregnancy; integration of biological and behavioral outcomes; intervention implemented in two cities with high HIV/STD prevalence; change social norms regarding high-risk behavior during pregnancy/postpartum by conducting prenatal care in peer groups; and ability to sustain the intervention because prenatal care is covered by most standard reimbursement systems -- both public and private (i.e. ease of technology transfer). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON SUPPLEMENTS AND ZINC IN PREGNANCY AND LACTATION Principal Investigator & Institution: King, Janet C.; Professor of Nutrition; Nutrition; University of California Davis Sponsored Programs, 118 Everson Hall Davis, CA 95616 Timing: Fiscal Year 2001; Project Start 24-SEP-1999; Project End 31-MAR-2004 Summary: It is a common practice to give supplemental iron to all pregnant women world-wide. The dose can vary from 60 mg/d to as much as 240 mg/d. When therapeutic doses of iron are prescribed, it is rare to also prescribe supplemental zinc. Studies in experimental animals and humans show that supplemental iron interferes with zinc absorption. In a recent longitudinal study of zinc absorption during pregnancy done by us, four of the 14 women studied were prescribed supplemental iron by their physicians. Although zinc absorption increased during pregnancy reaching a

66 Pregnancy

significant change during lactation, this adjustment was not observed in the four women taking supplemental iron. The need for absorbed zinc increases by 0.7 mg/d during pregnancy and 1.4 mg/d during early lactation. Our study showed that this need is met by upregulating zinc absorption if supplemental iron is not given. Administration of supplemental iron may impair this change in zinc use during pregnancy and lactation. The purpose of this proposed study, therefore, is to define the effect of supplemental iron on the metabolic adjustments in zinc utilization in healthy women during pregnancy and lactation. We hypothesize that a daily supplement of 100 mg iron inhibits zinc absorption and reduces the net uptake of zinc from the gastro-intestinal tract during late pregnancy and early lactation when the additional need for zinc is the greatest. Two groups of 15 women each will be recruited in early pregnancy and will be studied at 12-14, 32-34 weeks of gestation, and at 4-6 weeks postpartum. One group will receive 100 mg supplemental iron daily; the other group will be unsupplemented. All women will be given a prenatal vitamin supplement plus 8 mg iron and 5 mg zinc to assure a stable basal intake of the micronutrients throughout the study. Using stable isotopes, iron and zinc absorption and zinc kinetics will be measured. Biochemical measures of iron and zinc status will also be determined. All women will reside in a metabolic unit for 6 days during each test. Results from this comprehensive, longitudinal study will provide new data on the effects of iron supplementation on zinc utilization during pregnancy and lactation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

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

Studies 67

•

Project Title: DIFFERENCES

K-OPIOID

SYSTEMS--SEX

AND

PREGNANCY

LINKED

Principal Investigator & Institution: Drake, Carrie T.; Neurology and Neuroscience; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2001; Project Start 01-SEP-1998; Project End 30-JUN-2003 Summary: Two lines of evidence from human and animal studies suggest that drugs activating kappa opioid receptors (KORs) may be uniquely analgesic in women. First, KOR agonists have recently been shown to relieve post- surgical pain better in women than in men, and KOR agonists are also more effective analgesics in female rats. Second, the well-documented increase in pain threshold during late pregnancy, i.e. the "analgesia of pregnancy", has been shown to involve KORs and their endogenous opioid ligand, dynorphin. These gender- and pregnancy-related variations in KOR responsiveness may be caused by differences in KOR distribution in pain-related neuronal circuits (e.g. in dorsal horn of the spinal cord, periaqueductal gray). The studies in this application are designed to test the hypotheses that (1) KORs are located on neurons critically involved in modulating pain transmission in the central nervous system (CNS); (2) the greater responsiveness of females to KOR agonists is correlated with higher levels of KORs in nociception-related regions of the CNS in females; and (3) increases in KORs in spinal cord occur during the endogenous opioid mediated "analgesia of pregnancy". The methods to be used include tract-tracing and single- and dual- labeling immunocytochemistry of brain and spinal cord, with quantitative light and electron microscopic analysis. Different aspects of these studies will be conducted in rats and guinea pigs. Rats have been better studied in behavioral nociception paradigms, and the results from experiments in rats will integrate well with a large literature on rat nociceptive systems. However, the distribution of KORs in guinea pig brain more closely resembles that of humans than does the rat, therefore the experiments in guinea pig may be more specifically related to the roles of KORs in humans. The results of these studies will be relevant to understanding gender differences in analgesia, and may aid in the development of analgesic drugs and their targeting to appropriate patient populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LEAD DOSE BIOMARKERS, REPRODUCTION, AND INFANT OUTCOMES Principal Investigator & Institution: Hu, Howard; Associate Professor; Brigham and Women's Hospital 75 Francis Street Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: Population-wide blood lead levels have been decreasing in the United States due to lead control measures begun in the 1970s. Nevertheless, in utero exposure may be continuing, or perhaps even increasing, due to the long half-life of contaminants in maternal bone during pregnancy. Furthermore, there is evidence that levels of lead in plasma, which reflect the available fraction of lead in blood, are not adequately represented by whole-blood lead levels and correlate more closely with bone lead levels. These possibilities deserve intensive investigation in light of the recent accumulation of research demonstrating a neurotoxic effect of lead at progressively low levels of exposure. The new project proposed builds on an on-going NIEHS/Superfundsupported study of lead kinetics during reproduction among women in Mexico. In the major component of this project, 5,700 newly pregnant women will be screened in their first trimester, who meet initial eligibility criteria; they will be followed through

68 Pregnancy

pregnancy and birth, measuring blood lead levels, hematocrit, weight, and bone resorption (measured by urinary levels of cross-linked N-telopeptide of type I collagen [NTX]); screening bone lead levels will be measured by K-x-ray fluorescence in postpartum women who meet additional eligibility criteria; a cohort of 900 postpartum women and their infant will be selected to ensure a broad distribution based on level of lead in maternal trabecular bone (the patella); the mother-infant pairs will be followed in a prospective cohort study of neurobehavioral outcomes among the infants. The following Hypotheses will be tested: 1)lead level in maternal trabecular bone (represented by the patella bone) is a predictor of adverse infant mental development after controlling for blood level at birth, infant blood lead levels, maternal IQ, maternal intake of iron, zinc, and calcium, and other potential confounders. The magnitude of this effect is greater in women with higher levels of bone resorption during pregnancy, as reflected by urinary levels of NTX. In the sub-study component of this project, we will screen bone lead levels in 120 women who are trying to become pregnant; select 30 of these women who subsequently become pregnant for a prospective study of plasma lead and whole blood analyses during each trimester and during lactation. Hypothesis 2a will also be tested: In comparison to women with low pre-pregnancy bone lead, women with high pre-pregnancy bone lead will experience a greater increase in plasma lead levels; and Hypothesis 2: The percent increase in plasma lead will be greater than the percent increase in whole blood lead. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LEAD MOBILIZATION DURING PREGNANCY AND LACTATION Principal Investigator & Institution: Moline, Jacqueline; Assistant Professor; Mount Sinai School of Medicine of Cuny New York, NY 10029 Timing: Fiscal Year 2001; Project Start 01-MAY-1995; Project End 31-MAR-2006 Summary: (Taken from application) Evidence from case reports and studies of lead isotope ratios suggest that lead stored in the skeleton is mobilized during pregnancy and lactation, placing the mother and, in particular, the developing fetus and infant at risk of lead poisoning. The placenta is fully permeable to lead, and lead is present in breast milk. Calcium intake may protect against lead absorption. To investigate the hypothesis that skeletal lead is mobilized during pregnancy, and perhaps more importantly during lactation, we propose an intervention study with repeated measures of blood and bone lead in a population of women in Morelos, Mexico with high environmental lead exposure. Women will be randomized to receive calcium and vitamin supplements, calcium without vitamin supplements, or vitamin supplements alone. We will simultaneously follow a control group of non-pregnant women. We hypothesize that as lead is mobilized during pregnancy and lactation, maternal, fetal and infant blood-lead levels will increase, and maternal bone-lead levels will decrease. We will compare bone- and whole blood-lead levels prior to pregnancy with measurements obtained from the same women at two weeks, six months and twelve months postpartum. Bone-lead levels will be measured by X-Ray Fluorescence. We will examine molecular biomarkers of bone turnover to assess whether concurrent bone remodeling and lead mobilization occurs. We hypothesize that bone-lead levels will decrease during pregnancy, and further during lactation as a result of bone-lead mobilization. The control group of non-pregnancy women will allow us to compare the natural history of bone-lead changes in the absence of pregnancy and lactation. Bloodlead levels obtained in each child at the same time as the mother s postpartum evaluations will provide information about maternal transfer of circulating lead to the child. To assess gene-environment interactions, we will examine whether

Studies 69

polymorphisms in ALA-D, the hemochromatosis gene and the Vitamin D receptor influence lead release from bone. We hypothesize that women receiving calcium supplements will have less lead mobilization and thus less transfer to their developing child. We will also assess whether calcium plus vitamin supplements is more protective than calcium alone. This study will be undertaken in Morelos, Mexico where the population has high environmental lead exposure, predominantly through the use of lead-glazed ceramics, and where women have high rates of breast-feeding. Thus we will be able to compare bone-lead mobilization during lactation with that which occurs during pregnancy. The investigation should provide important insights into the potential health effects of chronic environmental lead exposure to pregnant and lactating women, developing fetuses, and infants through breast feeding, as well as insights into approaches for prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LEPTIN PREECLAMPSIA

IN

PREGNANCY

METABOLIC

ADAPTATION

&

Principal Investigator & Institution: Teppa, Roberto; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001 Summary: In this project we tested the biological relevance of increased circulating leptin and whether pregnancy might permanently alter circulating leptin. We tested the following hypothesis; free leptin is increased in normal pregnancy, free leptin concentration returns to prepregnancy concentration after normal and preeclamptic pregnancy, free leptin concentrations are not different after pregnancy in women who have had normal or preeclamptic pregnancies. These hypothesis were tested by the following specific aims: We measured free and bound leptin in preeclamptic and normal pregnant patients during pregnancy. We measured leptin fractions in nulligravid patients to have a baseline to compare our data during the pregnancy period. Free leptin is increased in obese individuals and it is the fraction which is altered by perturbations (e.g., feeding and fasting) known to alter circulating leptin concentration. During human pregnancy the total concentration of many hormones in blood is increased with minimal changes in the free active hormone because of an increase in binding proteins. We determined that the increased plasma leptin of normal pregnancy and the further increase in preeclampsia are not simply due to this phenomenon. We compared serum leptin concentration in serum samples obtained from 18 nulligravid women. Two ml serum were loaded into a column packed with Sephadex G-100 at 4 C in order to separate free from bound leptin. Leptin concentration in the fractions were assayed by RIA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LIPID METABOLISM IN PREGNANCY AND WITH PREECLAMPSIA Principal Investigator & Institution: Kelly, David E.; Magee-Women's Hospital of Upmc 300 Halket St Pittsburgh, PA 15213 Timing: Fiscal Year 2001 Summary: The overall goal of this project is to examine lipid metabolism in women with healthy preeclamptic pregnancies. We will test the hypothesis that women who develop pre-eclampsia have an accentuation of hypertriglyceridemia, beyond the physiologic rise normally found in pregnancy. Hypertriglyceridemia has been associated with preeclampsia. Recent studies indicate that elevated triglyceride and FFA can be observed as

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early as 16 to 20 weeks of pregnancy in women who develop pre-eclampsia. Pregnancy has a pronounced effect on maternal lipid metabolism. The increase in plasma triglyceride during the 2nd and 3rd trimesters is especially striking, increasing approximately 3-fold over first trimester and non-pregnant values. Previous clinical investigations of lipid metabolism during pregnancy have focused on fasting lipid profiles. We propose to extend the study of lipid metabolism during pregnancy to include dynamic responses to meal ingestion. The first of the four protocols we propose will be a longitudinal study of postprandial lipid metabolism in 200 primigravida women at week 16 and again at week 32. Based on an incidence of pre-eclampsia of approximately 5 to 10 percent, we estimate that 10 20 women in this cohort will develop pre-eclampsia. The second protocol will be a study of postprandial lipid metabolism in pregnant women admitted to the "high risk" pregnancy service for pre-eclampsia. The third protocol will be a study of lipolysis, lipid oxidation and triglyceride clearance among postpartum women who had pre-eclamptic pregnancies. The fourth protocol will use insulin infusion/glucose clamp studies to examine insulin resistance in postpartum women who had pre-eclampsia. We will test the hypothesis that abnormalities of postprandial triglyceride metabolism precede and accompany preeclampsia, and are associated with enhanced lipolysis, decreased triglyceride catabolism and insulin resistance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LONGITUDINAL BREATHING/PREGNANCY

STUDY--SLEEP-DISORDERED

Principal Investigator & Institution: Pien, Grace W.; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2002; Project Start 20-JAN-2002; Project End 31-DEC-2006 Summary: (prepared by applicant): Candidate's Plans/Training: The patient-oriented research in sleep medicine and epidemiology. Training will include closely mentored completion of the research protocol, advanced epidemiological course work in patientoriented research advanced training in sleep medicine and respiratory neurobiology . Environment: The University of Pennsylvania is a uniquely suited environment for this training award. The Center for Sleep and Respiratory Neurobiology will provide a mentored experience in patient-oriented research. The Center for Clinical Epidemiology and Biostatistics will provide advanced didactic training. Research: During pregnancy, physiologic changes including gestational weight gain take place that may place women at increased risk for the development of sleep-disordered breathing (SDB). Snoring, which is a common symptom of SDB, is a frequent complaint among pregnant women, experienced on a habitual b y as many as 23 percent of women by the end of the final trimester of pregnancy. The possibility regnant women snorers may manifest sleepdisordered breathing has remained largely unexplored. In general population, baseline obesity and weight gain are both associated with an increased risk for sleep-disordered breathing. It is our central hypothesis that pregnancy is a time of accelerated development of sleep disordered breathing in women, in which the degree of increase is likely to be larger in women with elevated baseline body mass index (BMI) or greater gestational weight gain. This protocol examines whether the number of sleepdisordered breathing events increases in women over the course of pregnancy and how baseline weight status and weight gain during pregnancy impact the degree of SDB. The specific aims of the study proposal are: 1) to test the hypothesis that the respiratory disturbance index (RDI), a measure of the number of abnormal respiratory events hourly during sleep, increases over the course of pregnancy; and to determine whether

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the degree of increase is greater in obese women; and 2) to identify specific clinical characteristics that influence the risk for clinically significant increases in the severity of SDB. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

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

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Project Title: MATERNAL DEPRESSION: AN ADVERSE EVENT FOR INFANTS Principal Investigator & Institution: Goodman, Mark M.; Professor of Radiology; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001 Summary: It is now well established that the children of depressed mothers are at increased risk for depression and other psychiatric disorders. The present proposal, the second of the two clinical projects on the CCNMD proposal, takes advantage of these previous clinical observations and scrutinizes the children of mothers who suffer depression during pregnancy or in the puerpurium. We propose to conduct the first longitudinal study of children whose mothers experienced at least one episode of major depression prior to pregnancy, thus placing the children at risk for exposure to

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depression in pregnancy or during the postpartum period. We propose to obtain behavioral, neurophysiological, neuroendocrine, and neuroimaging measures. Specifically we will test whether fetal exposure to maternal neuroendocrine dysregulation associated with depression, e.g., elevated cortisol, alters infant behavioral and/or endocrine responsiveness. Maternal blood samples will be obtained throughout pregnancy and maternal and umbilical cord blood will be obtained at birth. Subsequent infant measures including salivary cortisol, EEG, heart rate variability, as well as measures of maternal-infant interaction will permit us to test the potential contribution of maternal depressed affect on infant development. The data collected will allow for testing of hypotheses related to maternal depression during pregnancy as an early prenatal stressor and depression postpartum as a neonatal stressor with the resultant novel data on critical periods, severity of maternal depression and its impact on the fetus, as well as the role of genetic factors (family history and genetic analyses). In addition, potential ethnic differences between African-Americans and European Americans will be assessed. Taken together, this study will provide novel behavioral and neuroendocrinological information of the impact of maternal depression in children from birth to one year of age. This project is complementary to the other clinical project (Project 7) on the effects of early life stress on psychiatric and HPA function in adult women, has specific links to the basic science aspects of the proposed Center- through Project 2 and the Functional Brain Imaging Core, and utilizes multiple resources available in the CCNMD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MATERNAL FETAL TRANSFER OF IRON DEFICIENCY Principal Investigator & Institution: Lubach, Gabriele R.; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2001 Summary: OBJECTIVE To establish the relationship between maternal and infant iron status, and its relationship to the onset of iron-deficiency anemia in infancy. RESULTS Females who were iron deficient prior to pregnancy gave birth to infants with low iron levels. Those infants were more likely to develop iron-deficiency anemia by 6 months of age. This suggests the need for close monitoring of iron status both prior to and during pregnancy to insure the hematological health of the infant. DISCUSSION Iron deficiency anemia is still prevalent in many parts of the world. It is the most common deficiency during pregnancy, and continues to affect 30-80% of infants worldwide. We have previously found a transient anemia in some infants in our studies. Therefore, we undertook a pilot study with 5 iron-deficient and 5 iron-sufficient multiparous females, to investigate the cause of the infant anemia. Iron status was monitored during pregnancy, and through 6 months postpartum. Infants were similarly assessed through 6 months of age. At parturition, serum ferritin levels were significantly different in the 2 groups of females. Infant ferritin and iron levels reflected the iron status of the mother. Six months later, iron-deficient mothers still had much lower iron stores. Infants with low ferritin at birth, had low ferritin at weaning. In addition, the hematological status of the infants over the first 6 months of life was a reflection of their iron stores at birth. Our data sugg est that infants born to mothers with low iron status are at a high risk for developing iron-deficiency anemia. FUTURE DIRECTIONS To continue this research on iron in the infants, and its relationship to cognitive and behavioral development. KEY WORDS anemia, iron deficiency, pregnancy, Macaca mulatta FUNDING NIMH MH41659-12 and NIH P51 RR00167-38 Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MATERNAL HEALTH STATUS AND ADVERSE BIRTH OUTCOMES Principal Investigator & Institution: Haas, Jennifer S.; Assistant Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2002 Summary: (Adapted from the applicant's abstract): The rates of maternal and neonatal mortality remain significantly above the objectives for the new millennium. The proposed research will examine whether a woman's pre-pregnancy health status explains, in part, the persistent racial disparities in adverse perinatal outcomes in the United States. A multi-ethnic cohort of 2,400 women in the San Francisco Bay Area will be followed throughout pregnancy until they are three months post-partum. We will recruit women who will deliver at one of three sites: an academic health center, a public hospital, and a large group model HMO. We will collect standardized, self-reported information on pre-pregnancy health status and objective clinical data from medical records to examine whether a legacy of chronic health problems and poor health status are related to an increased risk of adverse perinatal outcomes. Our research is based on the hypothesis that the prenatal period is too late to address the legacy of chronic health problems and poor health status of African-American and disadvantaged women. Cohort characteristics will be grouped into three broad categories: (1) race and other sociodemographic characteristics, (2) pre-pregnancy factors, and (3) current pregnancy factors. Data will be analyzed to examine whether disparities in adverse outcome are explained by pre-pregnancy maternal health status. We will examine two primary outcomes variables: (1) an aggregate indicator of adverse neonatal outcome, and (2) an aggregate indicator of adverse maternal outcome. These data could have significant health policy impact. While all states provide insurance coverage for prenatal care for poor pregnant women through Medicaid, only Hawaii extends coverage to eligible women regardless of pregnancy. These data may address whether more continuous coverage for reproductive age women is appropriate. The long-term goal of this investigation is to inform public policy so that discrete interventions can be designed and implemented to reduce the health risks of women prior to pregnancy. Such interventions should begin from the premise that improved maternal and infant outcomes can only come from improved maternal health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MATERNAL PERIODONTITIS AND ADVERSE PREGNANCY OUTCOMES Principal Investigator & Institution: Pitiphat, Waranuch; Postdoctoral Fellow; Oral Health Policy & Epidem; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2003 Summary: (provided by applicant) We propose to evaluate whether periodontitis is a risk factor for adverse pregnancy outcomes. The published studies evaluating these associations are few, small, mostly retrospective and show inconsistent results; although relative risks as high as 7.5 have been reported. We plan to add an oral component to the ongoing Project Viva, a prospective study of 6,000 pregnant women, to evaluate this association. Maternal infection during pregnancy has been demonstrated to play an important role in etiology of preterm delivery. Periodontal infection can serve as a reservoir of gram negative anaerobic organisms and their products, and proinflammatory mediators which could target the placental membranes via systemic circulation thus leading to preterm delivery or fetal growth restriction. The primary aim

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of this study is to examine the effect of maternal periodontitis on length of gestation and fetal growth. The secondary aim is to explore the association between periodontitis and serum levels of TNF-alpha. The proposed prospective nested case-control study will request pre-existing radiographs from Viva participants. Cases will be mothers who give birth to a preterm infant and mothers who give birth to a restricted fetal growth infant. Controls will be mothers with normal pregnancy outcome. We will enroll all cases and a random sample of controls in a 1:3 ratio, frequency matched by race, age and smoking status. Periodontal bone loss as a result of chronic periodontitis will be evaluated from the pre-existing radiographs. Viva participants who report having x-rays taken within last 5 years will be requested on the supplemental questionnaire after delivery to provide their existing dental radiographs or the name and address of the dentist who has these. We will then request the participants' dentists to provide existing bitewing radiographs. The radiographs will be interpreted by one well-calibrated dentist by using a visual categorization method. We will employ multivariate analyses to adjust for potential confounders. In addition, we will perform the analysis of TNFalpha using blood samples that were pre-collected at first prenatal visit in Project Viva's pilot study (Pregval Study) to evaluate one potential pathway relating periodontitis and adverse pregnancy outcomes. The proposed study will help us clarify the relationships between periodontal disease and adverse pregnancy outcomes. Since periodontal disease is a highly prevalent condition that can be controlled, understanding these relationships is of significant importance, both for individuals and for public health policy aiming to improve the well-being of mothers and infants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MATERNAL-FETAL IMMUNE INTERACTION AND PREGNANCY SUCCESS Principal Investigator & Institution: Bacon, Sarah J.; Biological Sciences; Mount Holyoke College 50 College St South Hadley, MA 01075 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2005 Summary: (Provided By Applicant) Maternal immune function during pregnancy can profoundly influence embryonic development. The prevalence of preterm births due to uterine infection, the transmission of infectious disease from mother to fetus, and the possibility of immunologically-based miscarriage in humans all highlight the importance of understanding how the maternal immune system influences fetal health and development. Recent progress has been made toward understanding the effect of maternal immune stimulation on pregnancy outcome, and mouse models offer some insight into how this influence may play out at the uterine interface between mother and fetus. Because the local interactions between mother and fetus in the uterus are inaccessible in humans, the choice of an appropnate model system is important. In an outbred rat model, it is possible to look directly at how the mother's immune system influences events in the uterus during embryo development and also assess how particular genetic differences between the mother and embryo may adjust the action of immune system. The specific aims of this research are threefold. First, we will characterize the effect of maternal immunostimulation on embryo and placental development in the rat. Second, we will develop a DNA-based technique to determine the Major Hisrocompatibility Complex (MHC) haplotype of outbred Sprague-Dawley rats. Third. we will use this technique to assess the role of MHC sharing between mother and embryo on pregnancy outcome and immune cell infiltration of the uterus during pregnancy. Together, the completion of these specific aims will clarify the role the maternal immune system plays in pregnancy and pregnancy loss in the rat, and

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illuminate some of the ways in which embryonic genotype may modify the mother's response. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS AND EFFECT OF DECREASED GLUCOSE INSULIN SENSITIVITY IN PREGNANT WOMEN Principal Investigator & Institution: Catalano, Patrick M.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, OH 44106 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2002 Summary: The long term objectives of this grant proposal are to investigate the mechanisms and effect of pregnancy on glucose insulin sensitivity in women with normal glucose tolerance (NGT) and gestational diabetes (GDM). The specific aims of this proposal are to: 1) determine the relationship between the changes in glucose insulin sensitivity and level of expression of post receptor insulin signaling intermediates in skeletal muscle in lean and obese women with NGT and GDM in late gestation and postpartum, 2) to determine the role of tumor necrosis factor alpha (TNFalpha) modulation of insulin receptor beta (IRbeta) and insulin receptor substrate I (IRS-1) in skeletal muscle in late pregnancy and 3) to characterize the effect of pregnancy on glucose metabolism, i.e. insulin sensitivity and pancreatic beta cell response postpartum in women with NGT and GDM. Specific aim #1 will evaluate longitudinally 12 women with NGT (6 lean and 6 obese) matched with 12 women with GDM (6 lean and 6 obese) at 30-36 weeks and 16 weeks postpartum. All subjects will be evaluated using the euglycemic clamp with infusion of [66/2/H2] glucose and have Bergstrom needle skeletal muscle biopsies. The specific methodology will allow us to estimate insulin sensitivity using Western blotting to measure changes in protein expression and competitive PCR to compare differences in mRNA expression during and after pregnancy. Specific aim #2 will evaluate 16 women at the time of elective cesarean delivery (8 NGT) and gynecologic surgery (8 CTL). All subjects will have densitometry and rectus muscle biopsies at the time of surgery. Skeletal muscle will be used to immunoprecipitate IRbeta and IRS-1. IRS-1 from pregnant NGT will be incubated with IRbeta from non pregnant CTL and insulin added to phosphorylate IRbeta. This will allow us to evaluate if the rise in TNF- alpha in late pregnancy induces serine phosphorylation of IRS-1 and converts IRS-1 to an inhibitor of IRbeta tyrosine kinase activity. Specific aim #3 will evaluate 24 women; 8 women (4 NGT and 4GDM) who do not plan to conceive (at yearly intervals), and 16 women (8 NGT and 8 GDM) planning to conceive (prior to conception, at 30-36 weeks and post partum. All subjects will be evaluated using densitometry, an intravenous glucose tolerance test, indirect calorimetry and the euglycemic clamp with infusion of [6-6/2H2] glucose. These data will allow us to evaluate the effect of pregnancy on pancreatic beta cell function and insulin sensitivity in women with NGT and GDM, in contrast to changes in thee measurements ascribed to time alone. The information obtained from these studies will allow us to begin to understand the mechanisms involved in the alterations in insulin sensitivity during pregnancy, and the potential genetic factors responsible for decreased glucose insulin sensitivity in women with GDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS OF UTERINE VASCULAR ADAPTATION IN PREGNANCY Principal Investigator & Institution: Gokina, Natalia I.; Obstetrics and Gynecology; University of Vermont & St Agric College 340 Waterman Building Burlington, VT 05405

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Timing: Fiscal Year 2003; Project Start 04-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Normal pregnancy is characterized by a remarkable enhancement of uterine blood flow due to vasodilation and growth and remodeling of uterine vasculature that is associated with an increased uterine reactivity to vasoconstrictors. The long-term goal of this proposal is to understand the causes and cellular mechanisms underlying the modulation of uterine vascular contractility during gestation, with a specific focus on the role of ion channels in endothelial and vascular smooth muscle cells. Our central hypothesis is that pregnancy down- regulates the delayed rectifier and Ca2+-activated potassium channels with a resultant increase in Ca 2+ influx and smooth muscle contractility. Enhanced Ca 2+ sensitization of contractile process is a synergistical mechanism. Pregnancy-induced up-regulation of PKC and RhoA is proposed as a common regulatory mechanism for enhanced Ca 2+ sensitization and inhibition of K+ channel function. These adaptive changes are counteracted by increased Ca2+-dependent production of endothelium-derived NO and EDHF. Furthermore, we suggest that the effects of pregnancy are highly localized by the side of placentation and are mediated by estrogen. Specific Aim 1 will determine the mechanisms that regulate a steady state global [Ca2+]_ in smooth muscle of uterine resistance arteries, and their modulation in pregnancy. The role of PKC and RhoA in regulation of Ca 2+ sensitization and ion channel function will be studied. Specific Aim 2 will explore the mechanisms by which NO and EDHF mediates the effects of pregnancy on uterine arterial contractility with a specific focus on the role of endothelial intracellular Ca 2+ and small conductance Ca 2+-activated potassium channels. Specific Aim 3 will test the role of local vs. systemic factors, and of estrogen in mediating the effects of pregnancy on uterine artery function. The three Specific aims will integrate the physiological function (regulation of arterial diameter) with intracellular (Ca 2+ signaling, Ca 2+ sensitivity and ion channel function) and molecular (PKC and RhoA) mechanisms and will be accomplished by direct measurements of arterial diameter, intracellular Ca, membrane potential, expression and distribution of PKC and RhoA, and ion currents in endothelial and smooth muscle cells. The proposed study will provide new insights into cellular and molecular mechanisms mediating the effects of pregnancy and estrogen on uterine blood flow and significantly deepen the understanding how these mechanisms are altered in pregnancy-induced hypertension and preeclampsia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS REGULATING NEUTROPHIL ACTIVATION IN PREGNANCY Principal Investigator & Institution: Petty, Howard R.; Professor; Biological Sciences; Wayne State University 656 W. Kirby Detroit, MI 48202 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 31-DEC-2002 Summary: (provided by applicant): This application is submitted in response to an RFA that requested applications to identify and characterize differences in the innate and adaptive immune response between genders, with a specific call for interdisciplinary clinical and basic research studies that may be important in the understanding and treatment of autoimmune diseases. Neutrophils are key cells in the development of homeostatic as well as pathologic inflammatory responses. These cells play a central role in the generation of tissue damage in autoimmune diseases (i.e., rheumatoid arthritis) as well as in infectious diseases, including sepsis. The studies outlined in this application are designed to study the differences in neutrophil function in non-pregnant women, pregnant women, and men. Studies conducted in our laboratory have established that

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neutrophils of normal pregnant women have a unique immunological state, which has not been previously recognized. This state exhibits the simultaneous expression of activated and inhibited neutrophil properties as reflected in cell calcium signaling, metabolism, and oxidant production. We have demonstrated that these properties reverse shortly after delivery and, thus, may account for the increase in postpartum disease activity in some autoimmune disorders. Our preliminary studies have identified biochemical bases for the changes in neutrophil physiology observed in normal pregnancy and implicated the hexose monophosphate shunt (HMS) and lipid rafts in the regulation of calcium signaling, metabolism and oxidant production. Strikingly, we have identified that trophoblast cells (which are in direct contact with maternal neutrophils in the intervillous space) have the capacity to reverse neutrophil activation upon contact. Using ultra-fast microscopy, we have been able to demonstrate interference with normal calcium signaling and reactive oxygen metabolite (ROM) production upon cell-to-cell contact. More importantly, we have determined that this property of trophoblasts resides in the glycocalyx and can be released in soluble form. This factor may account for the clinical improvement of some autoimmune diseases during pregnancy and their worsening after delivery. Moreover, our findings and proposed strategy may offer a unique opportunity for the identification of endogenous mechanisms affecting women's health. We propose that studying neutrophil biology during pregnancy will result in a mechanistic understanding of factors responsible for clinical improvement in certain autoimmune diseases during pregnancy and will also lead to the development of novel therapeutic approaches to control inflammation and autoimmunity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDIATORS OF VASCULAR DYSFUNCTION IN PREECLAMPSIA Principal Investigator & Institution: Gandley, Robin E.; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, PA 15213 Timing: Fiscal Year 2002; Project Start 14-JUN-2002; Project End 31-JAN-2007 Summary: The goal of this project is to investigate potential mechanisms underling the vascular dysfunction that occurs during and after preeclampsia. Inactivation of nitric oxide (NO) by reactive oxygen species, especially superoxide (O2-), is an important mechanism of vascular dysfunction in several diseases. In this context, important links exist between angiotensin II, vascular O2-production and impaired NO-dependent relaxation. Our data has implicated angiotensin AT-1 receptor signaling and increased vascular O2-generation in the increased myogenic response and loss of endotheliumdependent relaxation that results from exposure of resistance arteries to preeclampsia plasma in vitro. Vitamin C (abscorbate) is a key modulator of NO. Plasma ascorbate is decreased during preeclampsia. In a strain of rats unable to synthesize ascorbate, we have shown that subnormal ascorbate intake (30-40% plasma reduction) during pregnancy results in a striking increase in vascular 02- output and myogenic reactivity. Therefore, we hypothesize that two phenomena associated with preeclampsia, namely 1) plasma factors interacting with the AT1 receptor, and 2) suboptimal ascorbate reserves operate in tandem to increase the prevalence of oxidative reactions within the vasculature. In turn, this leads to effective deficiency of NO, through oxidative degradation of NO and/or impaired vascular response to NO. Accordingly, we will use our isolated artery bioassay system to examine plasma factors mediated altered NOdependent responsiveness (Aims 1 and 2). Aim 1 is to characterize the functional changes induced by exposure of mesenteric arteries to pregnancy and postpartum plasma and to evaluate the role of candidate factors operating through angiotensin

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receptor subtypes. Aim 2 is to determine the role and enzyme sources of O2-, effects of exogenous anti-oxidants and alterations in eNOS potentially impacting NO-dependent responsiveness in this model. We will also use our unique rat strain to further explore the role of ascorbate in the vascular adaptation to pregnancy (Aims 3 and 4). Aim 3 test the hypothesis that subnormal ascorbate results in an effective deficiency of NO that is accentuated during pregnancy. Aim 4 is to determine the oxidative mechanisms of decreased NO bioavailability in this model. Aim 4 is to determine the oxidative mechanisms of decreased NO bioavailability in this model. This integrated approach, in combination with Subproject by S. Schroff, will provide important information concerning oxidant/anti-oxidant mediators of vascular hyperresponsiveness during and after preeclampsia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MISOPROSTOL FOR ABNORMAL FIRST TRIMESTER Principal Investigator & Institution: Moalli, Pamela A.; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001 Summary: Patients who have a documented abnormal first trimester pregnancy will be randomly assigned to receive either misoprostol or placebo vaginally. Patients return two days later for a vaginal ultrasound and a second dose of the medication if the pregnancy has not passed. Those who receive a second dose will be followed two days later. Patients who have not passed the pregnancy after two doses of placebo will be referred for either surgical abortion or treatment with misoprostol as they prefer. Patients who pass the pregnancy under the study protocol will be followed two weeks later and then weekly until their HCG levels fall below 10. NCRR Clarification: research is on abnormal pregnancy/miscarriage Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MISOPROSTOL FOR MEDICAL MANAGEMENT OF ABNORMAL FIRST TRIMESTER PREGNANCY Principal Investigator & Institution: Nichols, Mark; Oregon Health & Science University Portland, OR 972393098 Timing: Fiscal Year 2001 Summary: Participants in this research study will include healthy women over the age of 18 who have an early pregnancy that is not normal and cannot become a normal pregnancy. Doctors usually suggest that the abnormal pregnancy be removed from the uterus (womb). This is usually done by a surgical procedure called a dilation and curettage (D&C). With a D&C, a small suction instrument would be put up into the uterus to take out the abnormal pregnancy. The purpose of this study is to test the safety and effectiveness of a medicine called misoprostol to remove this abnormal pregnancy tissue from the uterus without needing this surgical procedure. NCRR Clarification: research is on abnormal pregnancy/miscarriage Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MODULATION OF IMMUNE RESPONSES DURING PREGNANCY Principal Investigator & Institution: Caton, Andrew J.; Associate Professor; Wistar Institute Philadelphia, PA 191044268 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2004

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Summary: Pregnancy is associated with changes in immune function which may protect the fetus from harmful maternal immune responses, but which also increase maternal susceptibility to infections and can exacerbate or alleviate particular autoimmune diseases. This proposal will use the influenza virus A/PR/8/34 hemagglutinin (PR8 HA) as a well characterized model antigen with which to determine factors modulating the immune responses to viral, maternal and fetal antigens during murine pregnancy. The following specific questions will be addressed: 1) How do pregnancy-associated changes in immune function modulate maternal immune responses to influenza virus? The specific aspects of anti-viral immunity that are suppressed or enhanced during pregnancy will be determined by comparing pregnant and non-pregnant BALB/c mice for their abilities to generate influenza virus-specific immune responses. How pregnancy affects the capacity of influenza virus-specific T helper (Th) cells to differentiate into distinct phenotypes (e.g. Th1 versus Th2 cells) will be examined using transgenic (Tg) mice expressing HA-specific T cell receptors (TCR Tg mice). 2) Does pregnancy affect autoreactivity to influenza HA as a maternal self antigen? Whether pregnancy influences the magnitude of autoreactive HA-specific T and/or B cell responses will be examined in mice that express the HA as a neo-self antigen (HA Tg mice). In addition, the extent to which maternal anti-HA (self) Th responses in HA Tg mice are suppressed or modified (either systemically, or in lymph nodes draining the uterus) during pregnancy will be determined. 3) How does the maternal immune system perceive the HA as a fetal antigen? Female BALB/c mice will be mated with male HA Tg mice, and the ability of the fetal HA either to activate or to induce antigenspecific tolerance among maternal HA-specific T and/or B cells will be analyzed. Whether expression in different fetal cell types affects how the HA is perceived by the maternal immune system will be evaluated. How the induction of anti-viral immune responses can be harmful to fetal development will also be assessed. By defining mechanisms by which the maternal immune system accommodates the fetal allograft, these studies may provide clinical benefits in the areas of transplantation and autoimmunity. Determining the effects of pregnancy on immune responses to viral and self antigens, and the effects of maternal immunity on fetal development, may similarly benefit women's health and child development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODULATION OF THE RECEPTIVE ENDOMETRIUM BY CG Principal Investigator & Institution: Fazleabas, Asgerally T.; Professor; Obstetrics and Gynecology; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2007 Summary: (provided by applicant): The initiation of pregnancy requires a precisely timed synchrony between endometrial development and the implanting blastocyst. This "receptive window" is initially dependent on estrogen and progesterone. However, signals from the developing embryo further modify the receptive uterus. During the previous funding period we addressed this issue in a non-human primate model. We demonstrated that in addition to the specific changes that are induced by estrogen and progesterone during the window of receptivity, infusion of chorionic gonadotrophin (CG) in a manner that mimics blastocyst transit further modulates the uterine environment. Changes are evident in all three major cell types i.e., the luminal epithelium, glandular epithelium and stromal fibroblasts. The modulation of the cytoskeletal architecture in stromal fibroblasts and the increase in secretory activity in glandular epithelial cells are regulated by CG acting directly on the endometrium, independent of the ovary. Furthermore these responses are suppressed when the

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progesterone receptor is antagonized. Since our in vivo studies have clearly demonstrated a direct effect of CG on modulating uterine receptivity, we now propose a series of studies to determine the function of two gene products that are induced in stromal fibroblasts in response to CG stimulation. Stromal Cell Protein (SCP) and Notch1 are both expressed in stromal cells and their expression is regulated both in vivo and vitro by CG. The first Specific Aim is focused on determining the mechanisms by which SCP activates Recombination Activating Gene in immune cells, which in turn may be responsible for altering the phenotype of lymphocyte populations within the endometrium. We hypothesize that these regulating mechanisms play a central role in providing immune tolerance to the fetal allograft. In the second Specific Aim we propose to determine the role of Notch-1 to inhibit apoptosis in stromal fibroblasts. In addition, Notch-1 is also able to influence the commitment to phenotypic differentiation within the lymphoid lineage. Thus, these studies will provide insight into the mechanisms by which stromal fibroblasts play an important role during the establishment of pregnancy. Understanding the complex immune and cell differentiation mechanisms within the uterine environment during early pregnancy has direct relevance to our ability to identify causes of infertility, pregnancy failure and other possible causes of infertility in women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR BIOLOGY OF UTERINE FUNCTION DURING PREGNANCY Principal Investigator & Institution: Chien, Edward K.; Obstetrics and Gynecology; University of Chicago 5801 S Ellis Ave Chicago, IL 60637 Timing: Fiscal Year 2001; Project Start 01-MAR-1999; Project End 28-FEB-2002 Summary: Edward K.S. Chien, M.D., received a baccalaureate degree in chemical engineering in 1984 and a medical degree in 1988 from the University of Illinois. Following his residency in Obstetrics and Gynecology at the University of Michigan Medical Center he completed a clinical fellowship in Maternal Fetal Medicine under the direction of Mark Phillippe, M.D., at the University of Chicago. During his clinical fellowship he worked in the laboratory of Dr. Mark Phillippe and investigated signal transduction mechanisms of myometrial cells. Two years ago Dr. Chien applied and received a Reproductive Scientist Development Program award. During that period of time he identified gestational regulated genes in the myometrium using differential messenger RNA display under the guidance of Dr. Graeme I. Bell, PhD. From these preliminary studies Dr. Chien has developed an extensive list of candidate genes which appear to be gestationally-regulated. The sponsor in the present application, Dr. Graeme Bell, is an international authority on monogenic and polygenic forms of diabetes mellitus and identified a number of transcription factors associated with maturity onset diabetes of the young. He has worked closely with Dr. Chien on all aspects of the present project. The broad, long-term objectives of this proposal is to identify and confirm, myometrial specific, gestationally-regulated genes and to understand the mechanisms surrounding their regulation. More specifically, the myometrium undergoes marked changes during pregnancy with significant changes in gene expression. The molecular mechanism behind these changes are to be identified. The regulatory elements of myometrial specific genes undergoing differential expression during pregnancy will be identified. These elements will be evaluated to determine their role in the changes related to pregnancy. Understanding the mechanism regulating changes in myometrial function will permit the development of novel therapies to treat preterm labor and post term pregnancies. The methods used to identify gestationally-

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regulated genes include differential mRNA display, cDNA array hybridization, and proteome analysis. Genomic sequences will be obtained by bacteriophage library screening after confirming tissue specific regulation with Northern blots and semiquantitative reverse transcription-polymerase chain reaction. Regulatory regions are identified by cell transfection experiments with reporter gene constructs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR GENETIC STUDIES OF RECURRENT PREGNANCY LOSS Principal Investigator & Institution: Hoffman, Eric P.; Director; Children's Research Institute Washington, D.C., DC 20010 Timing: Fiscal Year 2001; Project Start 18-JAN-1999; Project End 31-DEC-2002 Summary: Recurrent spontaneous pregnancy loss is an important women's health issue. The frequency of clinically recognized spontaneous abortion in the general population has been estimated to range between 15 and 20 percent of all recognized conceptions. Approximately 50 percent of spontaneously aborted fetuses are karyotypically abnormal, and half have normal chromosome studies. Women who have unexplained recurrent spontaneous abortion are frequent, and an underlying genetic basis for recurrent pregnancy loss is frequently assumed. However, investigations into possible genetic causes of cytogenetically normal recurrent spontaneous abortion have been rare or non-existent, and no responsible genes or gene products identified. The lack of genetic studies is likely due to the high incidence of spontaneous abortion in the general population, and difficulty in establishing investigative protocols. Here we report a 53 member pedigree where many family members have recurrent spontaneous abortion in the absence of any other clinical symptoms or phenotype. We show a statistically significant association between the phenotype of recurrent spontaneous abortion and highly skewed X inactivation patterns, and have genetically mapped the locus responsible for this "molecular" phenotype to Xq28. Thus, we have identified the first genetic locus for recurrent spontaneous abortion, and have shown that the inheritance mechanism is "X-linked lethal". The hypothesis that our proposed research will test is that a subset of females that show recurrent spontaneous abortions are carriers for Xlinked lethal traits. Our first specific aim is to define the molecular basis of the phenotype in the Xq28-linked family through positional cloning techniques. The second specific aim is to ascertain and collect women with recurrent cytogenetically normal pregnancy loss, and two control groups. These women will be studied for X inactivation patterns to determine the extent of association between recurrent spontaneous abortion and the carrier state for X-linked lethal traits. While there are likely to be many different causes for recurrent pregnancy loss, the proposed research will begin to dissect the molecular basis for the subset that are genetically determined as mendelian traits. This proposal represents a synergistic collaboration between a laboratory well versed in molecular analysis of inherited traits, and clinicians and epidemiologists with considerable expertise in women's health issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR PATHWAYS OF HEART K CHANNEL REGULATION Principal Investigator & Institution: Stefani, Enrico; Professor & Vice Chair of Research; Anesthesiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006

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Summary: (provided by applicant): The long term goal is to unravel cellular and molecular mechanisms involved in cardiac-electrical and molecular-remodeling during functional hypertrophy in pregnancy, and recovery in postpartum; in particular, those related to K+ channel expression/function. I to K+ shapes the cardiac action potential duration in both rodents and humans. In failing hypertrophic hearts, I to-f molecular components, in particular Kv4.3 and Kv4.2 channels are downregulated increasing action potential duration and arrhythmogenesis. During pregnancy, there is an increased risk of arrhythmias, the heart develops functional hypertrophy, and hormone levels dramatically change; however, no studies are available on changes in K+ expression/function induced by sex hormones, that may explain the cardiac risks during pregnancy or their reversibility after delivery. Thus, the main hypothesis is that, during pregnancy and postpartum, sex hormones may regulate I to current components (e.g. Kvl.4, Kv4.2, Kv4.3, KChlP2, MiRP1, frequenin) in a genomic or non-genomic fashion. Preliminary Studies show that: (a) cardiac Kv4.3, Kvl.4 and KCh/P2, but not Kv4.2 channel transcripts, and Kv4.3 protein were reduced in late pregnancy; (b) as in pregnancy, 17-beta-estradiol (E2) treatment reduced cardiac Kv4.3 and Kvl.4 mRNA; (c) E2 reduced Kv4.3 protein expression in cultured adult myocytes; (d) E2 had dual effects on I to currents, at 100 nM (similar to late human pregnancy), it shortened the action potential and increased I to amplitude; whereas, an opposite effect was produced by 10 fM E2; (e) c-Src tyrosine kinase, which is activated by E2 and from the onset of hypertrophy, reduced expression of Kv4.3; and (f) tyrosine kinase activation produced action potential prolongation and I to current reduction. We will mainly use mice and multiple experimental approaches. The Specific Aims are to: (1) Investigate, during pregnancy and early postpartum, the remodeling of action potentials, and of I to fast (I to-f) and I to slow (I to-s) currents, and underlying molecular components. (2) Investigate the action of E2 on I to-f/I to-s currents and their molecular components, and if E2 stimulates Kv4.3 gene transcription through the c-Src/MAPK (ERK) axis. (3) Characterize and define the mechanism(s) of non-genomic regulation of I to-f and Kv4.3 channels by E2. (4) Investigate short- and long-term actions of c-Src-dependent tyrosine phosphorylation on I to currents and Kv4 isoforms. (5) Determine the motifs in Kv4.3 involved in its regulation by c-Src. These studies should provide new information on the cellular and molecular mechanisms leading to the remodeling of cardiac K+ channels in the early stages of hypertrophy, and help in the design of new strategies for preventive Medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOTHERHOOD, GANGS, AND ALCOHOL: A QUALITIATIVE STUDY Principal Investigator & Institution: Hunt, Geoffrey P.; Senior Scientist; Scientific Analysis Corporation 390 4Th St, 1St Flr San Francisco, CA 94107 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 30-JUN-2004 Summary: (provided by applicant): The focus of this proposed 36-month qualitative continuation project is to investigate the influence of motherhood on the lifestyles of female gang members, who are either pregnant or mothers. Our aim is to widen and extend our on-going research on homegirls (female gang members) and alcohol consumption (NIAAA R01 AA11971). We will examine the influences of the process of motherhood (from pregnancy to parenthood) by focusing on: 1) their involvement and membership in the gang; 2) their alcohol consumption and drinking practices; and 3) other related high-risk behaviors, including drug use, violence and gang related criminal activities. In spite of extensive research on teenage pregnancy and motherhood,

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research on homegirls who are either pregnant or have children is comparatively sparse. Using primarily qualitative and ethnographic research methods, we plan to locate and interview 180 homegirls, who are either pregnant or have children, from each of the three major ethnic groups -- African-American, Hispanic and Asian-American. By utilizing: 1) a pre-coded descriptive data form, 2) a pregnancy and motherhood time line, and 3) a life history, family gang and motherhood semi-structured interview schedule, we will examine the influence of pregnancy and motherhood on the lives of homegirls and especially the possible effects on their alcohol consumption. This project is important for two reasons: First, given the special circumstances of this group of high risk young women, including the high prevalence of pregnancy and heavy use of alcohol coupled with the high risk nature of the environments in which they operate, this population is a particularly important group of high risk adolescent girls on which to conduct research. Second, it will highlight the extent to which adolescent homegirls modify their alcohol consumption during each trimester during pregnancy and once they become mothers. Information from this project will provide important data in assisting community based organizations design counseling, prenatal, parenting and prevention programs specifically suited for the needs of this high risk group of adolescents and their children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOTOR-MATERNAL ORAL THERAPY TO REDUCE OBSTETRIC RISK Principal Investigator & Institution: Offenbacher, Steven; Professor; Dental Research Center; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2003; Project Start 05-JUN-2003; Project End 30-MAY-2008 Summary: (provided by applicant): Recent studies have confirmed that there is an association between maternal periodontal disease and pregnancy complications that result in premature delivery [e.g. gestational age (GA)1000 women to be followed through pregnancy. In the postpartum subjects are recruited for a nested case control study to assess the influence of lactation on maternal bone density, maternal blood lead and breast milk lead. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00011726

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Safety and Effectiveness of Ritonavir Plus Lamivudine Plus Zidovudine in HIVInfected Pregnant Women and Their Babies Condition(s): HIV Infections; Pregnancy Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: The purpose of this study is to see if it is safe and effective to give ritonavir (RTV) plus lamivudine (3TC) plus zidovudine (ZDV) to HIV-infected pregnant women during pregnancy and to their babies after birth. Pregnant women who are HIV-positive are at risk of giving HIV to their babies during pregnancy or delivery. It is important to learn how to prevent HIV-positive pregnant women from giving HIV to their babies. RTV and ZDV have been shown to be safe and effective against HIV in adults. The combination of 3 anti-HIV drugs (RTV, 3TC, and ZDV) may help prevent HIV infection from mother to infant but studies are needed to determine whether they are safe and effective during pregnancy. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000888

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A Phase I Study of Safety and Pharmacokinetics of Nevirapine in HIV-1 Infected Pregnant Women and Neonates Born to HIV-1 Infected Mothers Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To determine the bioavailability, pharmacokinetics, and short-term safety and tolerance of nevirapine in HIV-1 infected pregnant women and their

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newborns when nevirapine is given to the mother during active labor, and when their neonates are dosed during the first week of life. To determine the short-term safety profile of mothers receiving zidovudine (AZT) who received nevirapine during active labor, and their neonates who received no dose, a single dose, or multiple doses of nevirapine and who are receiving AZT during the first 6 weeks of life. Treatment of HIV-1 infected pregnant women during active labor may result in therapeutic levels of nevirapine in the neonate at the time of exposure to HIV-1 during parturition, decreasing the neonate's risk of infection. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000808 •

A Phase I Study of the Safety and Pharmacokinetics of Recombinant CD4 Immunoglobulin G (rCD4-IgG) in HIV-1 Seropositive Women During the Last Trimester of Pregnancy and Their Newborns Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); Genentech Purpose - Excerpt: Part 1: To determine both the safety, tolerance, and pharmacokinetic profile (blood levels) of recombinant CD4 immunoglobulin G (rCD4-IgG) by intravenous bolus administration (given through the vein) in women with HIV infection who are in their third trimester (last three months of pregnancy). To determine the safety of maternal/fetal transfer of rCD4-IgG in infants born to mothers entered into the study. To obtain a preliminary indication of the antiviral and immunologic effects of rCD4-IgG in HIV seropositive pregnant women and their newborns. AMENDED: Part 2: To determine the safety profile of rCD4-IgG in HIV-1-infected women at the onset of labor and in their newborns. To determine the extent of placental transfer of rCD4-IgG when administered to the mother at onset of labor. To determine the pharmacokinetics of rCD4-IgG in newborns. To obtain preliminary evidence of the ability of rCD4-IgG to prevent intrapartum transmission of HIV-1 from mother to fetus. An agent that can prevent HIV infection is desirable for those at risk of infection as well as in the pregnant female and newborn populations. Such an agent may help prevent the progression of the disease in infants and children in early stages of infections. In theory, rCD4-IgG has antiviral effects. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000642

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A Study of Zidovudine in HIV-Infected Pregnant Women and Their Children Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID)

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Purpose - Excerpt: AMENDED: To evaluate the pharmacokinetics of intravenously administered AZT to HIV-1 infected pregnant women in labor; to evaluate the pharmacokinetics and urinary excretion of AZT and its metabolites in newborns of HIV1 infected mothers who receive IV AZT only during labor; to evaluate the safety of IV AZT administered by continuous infusion to HIV-1 infected laboring women and their infants. Original design: To determine the distribution and elimination of zidovudine (AZT) in the body as well as its safety in the treatment of pregnant women and their unborn children. The information derived from this study is required in order to design a future study that will assess the efficacy of AZT in reducing the transmission rate of HIV-1 from seropositive women to their fetus by treating them during the third trimester of pregnancy. An estimated 30 percent to 40 percent infected pregnant women risk transmission of HIV-1 to their infants, whether they be symptomatic or asymptomatic. Zidovudine (AZT) has previously demonstrated its effectiveness as a potent inhibitor of HIV replication in vitro and in adult patients; benefits of treatment include decreased mortality rate, decreased incidence of opportunistic infections, and increased number of CD4 cells. Phase I AZT studies in children, however, have resulted in uncontrolled information regarding clinical efficacy. The present study, therefore, will investigate the safety and pharmacokinetics of intravenous (IV) and oral AZT administration to HIV-1 infected pregnant women in the 3rd trimester, as well as the safety and efficacy of such treatment in their newborns. It is hoped that the results will be instrumental in designing future studies to assess the efficacy of AZT in reducing the transmission risk of HIV-1. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001106 •

Active Immunization of HIV-1 Infected, Pregnant Women With CD4 Lymphocyte Counts >= 400/mm3: A Phase I Study of Safety and Immunogenicity of MN rgp120/HIV-1 Vaccine (NOTE: Some Patients Receive Placebo) Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To evaluate the safety of rgp120/HIV-1MN vaccine in HIV-1 infected pregnant women with CD4 counts >= 400 cells/mm3. To evaluate the immunogenicity of this vaccine in pregnant women and the passive acquisition of vaccine-specific antibody in their infants. To evaluate the induction or augmentation by rgp120/HIV1MN vaccine of mucosal immune response in the gastrointestinal and reproductive tracts during pregnancy. To isolate and genetically characterize the HIV-1 present in cervicovaginal fluid specimens of pregnant women and compare it to that present in their peripheral blood mononuclear cells and to that of their infected infants. Evidence suggests that an advanced stage of disease with high plasma viremia is associated with increased transmission of HIV-1 to the fetus. Slowing the progression of disease, reducing the titer of virus in plasma, and increasing the titer of epitope-specific antibody are potentially attainable goals through active immunization of the mother during pregnancy. Phase(s): Phase I Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001041 •

Active Immunization of HIV-1 Infected, Pregnant Women With CD4 Lymphocyte Counts >= 400/mm3: A Phase I Study of Safety and Immunogenicity of VaxSyn Recombinant gp160 (NOTE: Some Patients Receive Placebo) Condition(s): HIV Infections; Pregnancy; HIV Seronegativity Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To evaluate the safety of gp160 vaccine (VaxSyn) in HIV-1 infected pregnant women with CD4 counts >= 400 cells/mm3. To evaluate the immunogenicity of this vaccine in pregnant women and the passive acquisition of vaccine-specific antibody in their infants. Evidence suggests that an advanced stage of disease with high plasma viremia is associated with increased transmission of HIV-1 to the fetus. Slowing the progression of disease, reducing the titer of virus in plasma, and increasing the titer of epitope-specific antibody are potentially attainable goals through active immunization of the mother during pregnancy. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000777

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Active Immunization of HIV-Infected Pregnant Women: A Phase I Study of Safety and Immunogenicity of a rgp120/HIV-1 Vaccine (NOTE: Some Patients Receive Placebo) Condition(s): HIV Infections; Pregnancy; HIV Seronegativity Study Status: This study is terminated. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: PRIMARY: To evaluate the short-term safety of rgp120/HIV-1SF2 vaccine versus MF59 placebo administered to HIV-infected pregnant women. SECONDARY: To evaluate the immunogenicity and long-term safety of rgp120/HIV1SF2 in HIV-infected pregnant women who received the vaccine during pregnancy only or during pregnancy and postpartum. To evaluate immunogenicity and safety in the infant through 18 months of age following maternal immunization with the vaccine during pregnancy. Active immunization of HIV-infected women during pregnancy may slow the progression of maternal disease, reduce the titer of virus in maternal plasma, and increase the titer of epitope-specific antibody. Also, active immunization has the potential to induce primary immunity in the fetus and to boost both T-cell and humoral immune responses to HIV in the mothers. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001046

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Calcium for Pre-Eclampsia Prevention (CPEP) Condition(s): Cardiovascular Diseases; Eclampsia; Heart Diseases; HELLP Syndrome; Hypertension; Pre-Eclampsia; Pregnancy Toxemias; Vascular Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI); National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: To evaluate the efficacy of 2 grams per day of oral calcium supplementation in reducing the combined incidence of hypertensive disorders of pregnancy: pre-eclampsia, eclampsia, and the HELLP Syndrome (hypertension, thrombocytopenia, hemolysis, and abnormal liver function). The National Institute of Child Health and Human Development (NICHD) initiated the trial in 1991, with joint funding provided by the National Heart, Lung, and Blood Institute in fiscal years 1992, 1993, and 1995. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000534

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Effect of Pregnancy on Uveitis Condition(s): Postpartum Period; Pregnancy; Uveitis Study Status: This study is completed. Sponsor(s): National Eye Institute (NEI) Purpose - Excerpt: The purpose of this study is to gain information about the course of uveitis (a type of eye inflammation) during pregnancy and the postpartum period (six months after delivery). Some reports have indicated the condition may improve or disappear without treatment during pregnancy and recur postpartum, requiring treatment. No systematic studies have been done, however, to examine a link between pregnancy and disease suppression. All medicines for uveitis have side effectsparticularly for pregnant women, their unborn babies, and breast-feeding mothers. The information gained may help guide treatment decisions for these patients in the future. Women who are between 2 and 20 weeks pregnant and have had uveitis within 2 years of becoming pregnant will be followed monthly with an eye examination and blood tests until six months after giving birth. The eye examination will include dilation of the pupils to look at the back of the eye. Photos of the eye will be taken to record changes that occur due to uveitis. The blood tests will assess immune function and try to determine whether levels of hormones and cytokines are related to uveitis disease activity. Patients who develop an inflammation and significant vision loss may require treatment, possibly with eye drops or injections near the eye. Treatment will be decided in consultation with the patient's obstetrician. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001867

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Emergency Contraception (ECP): Reducing Unintended Pregnancies Condition(s): Contraception; Pregnancy

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Study Status: This study is completed. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: Emergency contraception is a method of birth control that can be used up to three days after sexual intercourse. Emergency contraceptive pills (ECPs) can be given to a woman before she needs them (advance provision) or when she needs them (emergency provision). This study will compare these two methods of providing ECPs. Phase(s): Phase IV; MEDLINEplus consumer health information Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00067509 •

Fortovase (Saquinavir) Given with Low-Dose Ritonavir, Zidovudine, and Lamivudine to HIV-Positive Pregnant Women During and After Pregnancy and to Their Newborns Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: The purpose of this study is to see if it is safe to give saquinavir-SGC (SQV) combined with low-dose ritonavir (RTV) plus zidovudine (ZDV) and lamivudine (3TC) to HIV-positive pregnant women and to see if it is safe to give 3TC and ZDV to their newborns. Another purpose is to see what levels of SQV, low-dose RTV, ZDV, and 3TC are found in mothers and what levels of ZDV and 3TC are seen in newborns. Another purpose of this study is to see whether SQV passes from mother to newborn and if it passes at a level that is safe for the newborn. Although ZDV has been able to reduce the rate of transmission of HIV from mother to child, it may be possible to reduce it further by using a combination of anti-HIV drugs. This study adds SQV (a protease inhibitor [PI]) with RTV (another PI) and 3TC (a reverse transcriptase inhibitor) to the mother's ZDV regimen. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000920

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Hypertensive and Normal Pregnancy--Calcium Metabolism and Renin-Angiotensin SCOR in Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Eclampsia; PreEclampsia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To study calcium metabolism and the renin-angiotensin system in hypertensive and normal pregnancy. Study Type: Observational

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NHLBI/NICHD Collaborative Studies of Asthma in Pregnancy Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI); National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: To conduct a collaborative program of research on asthma and pregnancy consisting of two studies: the Asthma in Pregnancy Study (APS) is an observational study to evaluate relationships between asthma severity and treatment programs and perinatal outcome, and the Asthma Therapy in Pregnancy Trial (ATPT) is a randomized clinical trial of inhaled beclomethasone versus theophylline in the treatment of moderate asthma during pregnancy. Both studies are conducted in the Maternal-Fetal Medicine Unit (MFMU) Network, an ongoing group of participating obstetric centers supported by the National Institute of Child Health and Human Development. Studies are co-funded by the NHLBI. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000578

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Oral Calcium in Pregnant Women with Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Pre-Eclampsia; Pregnancy Toxemias; Vascular Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine of providing calcium supplementation to women with pre-existing hypertension reduces the level of blood pressure, requirement for antihypertensive drugs, and incidence of pre-eclampsia. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000543

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Regulation of Placental Vascular Reactivity in Pregnancy-induced Hypertension Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Pregnancy Toxemias Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To elucidate the role of an imbalance in vasodilator prostacyclin (PGI2) and vasoconstrictor thromboxane (TxA2) in pregnancy-induced hypertension Study Type: Observational

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Renin and Prorenin in Pregnancy Condition(s): Cardiovascular Diseases; Heart Diseases; Hypertension; Pregnancy Toxemias; Pre-Eclampsia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the role of the prorenin-renin-angiotensin-aldosterone system (RAAS) in normal and hypertensive pregnancy. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005207

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Steroid Hormones, TH1/TH2 Cytokines and Reproductive Status Condition(s): Arthritis, Rheumatoid; Healthy; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study is designed to evaluate blood Th1 and Th2 immunoregulatory cytokine production and hormonal levels associated with the third trimester of pregnancy and the postpartum state. Cytokine and hormone levels will be assessed in blood specimens obtained from healthy pregnant and postpartum females and compared to levels from premenopausal non-pregnant and non-postpartum females. Blood samples obtained at 30-36 weeks of gestation and 2-6 weeks postpartum will be the primary study points. Samples will also be obtained from pregnant, postpartum, and non-pregnant, non-postpartum, premenopausal female patients with rheumatoid arthritis. Additional data will be generated from samples from normal males, which will be compared with data from females. We expect to find that pregnancy is associated with enhanced Th2 cytokine expression and that the postpartum state is associated with enhanced Th1 cytokine expression. We expect to see differences in cytokine expression between males and females as well. We seek to gather data supporting the view that distinct hormonal environments regulate these contrasting immunological states. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001376

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Study of a Phenylalanine Restricted Diet During Pregnancy to Prevent Symptoms in Offspring of Patients With Phenylketonuria Condition(s): Phenylketonuria Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); University of Texas

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Purpose - Excerpt: Objectives: I. Assess the impact of a phenylalanine restricted diet during pregnancy on symptoms in offspring of patients with phenylketonuria. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006142 •

Study of Metabolic Effects of Pregnancy in Women With Cystic Fibrosis Condition(s): Cystic Fibrosis Study Status: This study is terminated. Sponsor(s): National Center for Research Resources (NCRR); University of Utah Purpose - Excerpt: Objectives: I. Compare the clinical status of pregnant vs nonpregnant women with cystic fibrosis. II. Determine glucose tolerance during each trimester of pregnancy in these women. III. Evaluate peripheral insulin sensitivity in these women. IV. Evaluate whole body protein turnover and hepatic glucose production in these women. V. Determine resting energy expenditure in these women. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00014768

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Study of Perinatal Transmission of Zidovudine-Resistant HIV Among Pregnant Women Treated with Zidovudine Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: To identify patterns of zidovudine ( AZT ) susceptibility among mother/infant pairs with perinatal HIV transmission. Most HIV-infected infants acquire their disease via perinatal transmission. Since transmission of HIV-resistant strains to infants could alter the course of disease and response to currently recommended treatment, a study to assess the patterns of AZT susceptibility among mother/infant pairs with perinatal transmission is essential to delineate future therapeutic strategies. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000828

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Study of the Experiences and Needs of Parents Continuing a Pregnancy Following a Prenatal Diagnosis of Holopresencephaly Condition(s): Holoprosencephaly Study Status: This study is completed. Sponsor(s): National Human Genome Research Institute (NHGRI) Purpose - Excerpt: This study will examine the experiences of parents who decided to continue a pregnancy after receiving a prenatal diagnosis of holopresencephaly (HPE). HPE results from a genetic defect that can cause facial abnormalities such as cleft lip and cleft palate, learning disabilities, muscle weakness, problems with digestion, sleep and

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muscle control, and other disabilities. The severity of symptoms varies greatly among affected children. Parents whose child was diagnosed before birth with HPE may be eligible for this study. It involves a one-time interview that takes from about 45 to 60 minutes. The interview is conducted either in person or by telephone and consists of three parts, as follows: 1. The experience of receiving the diagnosis of HPE during the pregnancy < includes general questions such as when and how HPE was diagnosed, what kind of information the parent received, the parent's reaction to the diagnosis, what genetic counseling, if any, the parents received, and so forth. 2. Emotional and informational needs < includes questions about the parent's specific emotional and informational needs from the time of diagnosis until the baby's birth, and the parent's reactions to support that was given. 3. Questionnaire < includes questions about the parent and his or her child, such as the parent's age, gender, marital status, and religious background, the child's age, gender, medical problems, and so forth. The questionnaire will be completed verbally for telephone interviews and in writing for in-person interviews. The interview will be tape-recorded and will be kept confidential. Information from this study will provide health professionals, including genetic counselors, more effective strategies for helping other parents who face similar prenatal diagnoses. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005016 •

The Safety and Effectiveness of Zidovudine in HIV-Infected Pregnant Women and Their Infants Condition(s): HIV Infections; Pregnancy Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); Glaxo Wellcome Purpose - Excerpt: To determine whether the rate of HIV transmission from mother to infant can be reduced by continuous oral zidovudine (AZT) treatment to HIV infected pregnant women, intravenous AZT during childbirth, and oral AZT treatment of the newborn infant from birth to six weeks of age. The study is also designed to evaluate the safety of AZT for both the pregnant woman and the newborn infant. No method exists to prevent transmission of HIV from an infected mother to her newborn infant. Giving an antiviral agent (such as AZT) to the mother and to the newborn could in theory decrease the risk of infection to the newborn by reducing the exposure of the fetus to maternal virus, or by preventive treatment of the fetus before exposure. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000960

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “pregnancy” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON PREGNANCY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 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 “pregnancy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on pregnancy, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Pregnancy By performing a patent search focusing on pregnancy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

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

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

Antigen for early pregnancy test and contraceptive vaccine Inventor(s): Bahl; Om P. (Williamsville, NY) Assignee(s): Research Corporation (New York, NY) Patent Number: 4,256,629 Date filed: April 17, 1979 Abstract: Antisera suitable for detecting the presence of human chorionic gonadotropin in body fluids by immunoassay are prepared by administering to a host animal an antigen comprising the.beta.-subunit of human chorionic gonadotropin which has been modified by cleaving and optionally conjugating the thus modified.beta.-subunit with a protein or hapten capable of enhancing the immunogenetic potency of the antigen. The antigens are also useful for the contraceptive purposes to terminate pregnancy. Excerpt(s): This invention relates to antisera produced by novel antigens, which are useful in testing for pregnancy in humans and more particularly to antisera having an immunological reaction with human chorionic gonadotropin, wherein the immunological cross-reactivity with human luteinizing hormone is reduced or eliminated. This further relates to the production of antigens to prepare said antisera, and which may also be used for contraceptive purposes to terminate human pregnancy. Human chorionic gonadotropin is a hormone produced by the placenta during pregnancy. Presence of the hormone in the serum and urine therefore serves as an indication of pregnancy. The presence of this hormone has been detected by its effect on the ovaries of animals and, more recently, by immunoassay. However, because the tests used hitherto do not sufficiently distinguish between hCG and other hormones which are present, such as luteinizing hormone, the presence of hCG cannot be unambiguously detected until several weeks after conception, by which time the levels of hCG are high enough so that it can be detected even in the presence of interfering substances. Web site: http://www.delphion.com/details?pn=US04256629__

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Antigestagens, glucocorticoids and prostaglandins for induction of labor or for termination of pregnancy Inventor(s): Elger; Walter (Berlin, DE), Beier; Sybille (Berlin, DE) Assignee(s): Schering Aktiengesellschaft (Berlin and Bergkamen, DE) Patent Number: 5,095,010 Date filed: November 13, 1990 Abstract: Combination products containing an antigestagen, a glucocorticoid and a prostaglandin are suitable for combined use in inducing labor or terminating pregnancy. Excerpt(s): This invention relates to a combination product for combined use in induction of labor or termination of pregnancy. To avert danger to mother and/or child, it is sometimes necessary to induce birth artificially or prematurely terminate pregnancy. Surgical techniques and pharmacological methods are available for this purpose. A good pharmacological method is vaginal or intramuscular application of prostaglandins. This is used if pregnancy is terminated in the 1st or 2nd trimester of the

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pregnancy (Contraception 1983, Vol. 27, 51-60, and Int. J. Gynaecol. Obstet. 1982, Vol. 20, 383-386). The advantages of prostaglandins include the ease of application and the ability to use them over a long period of pregnancy. The disadvantages of prostaglandins include acute side effects such as pains and nausea; moreover, the success rate in the case of termination of pregnancy in advanced phases of pregnancy is not more than 90%, even after lengthy treatment with prostaglandins. Web site: http://www.delphion.com/details?pn=US05095010__ •

Assays and devices for distinguishing between normal and abnormal pregnancy Inventor(s): Pronovost; Allan D. (San Diego, CA), Lee; Theodore T. (San Diego, CA) Assignee(s): Quidel Corporation (San Diego, CA) Patent Number: 5,786,220 Date filed: April 28, 1995 Abstract: Methods and devices for distinguishing between normal and abnormal pregnancies are provided. The methods rely on determining the concentration of progesterone or progesterone metabolite in a patient sample, where a concentration above a threshold value is indicative of a normal pregnancy. Preferably, the concentration of hCG is determined simultaneously, where an hCG concentration above a threshold value provides confirmation that the individual being tested is pregnant. An exemplary test device comprises a lateral flow membrane having zones for capturing label in response to the progesterone and hCG concentrations, respectively. Visible label is accumulated when the hCG concentration exceeds the threshold value but is absent when the progesterone concentration exceeds the threshold value. Excerpt(s): The present invention relates generally to met hods and devices for distinguishing between normal and abnormal pregnancies in pregnant human females. More particular y, the present invention relates to methods and devices for determining progesterone or progesterone metabolite concentrations optionally in combination with human chorionic gonadotropin concentrations and relating said concentration(s) to pregnancy status. Pregnancy in human females can be terminated by unfortunate circumstances, including spontaneous abortion and ectopic pregnancy. While the latter event cannot be treated to preserve the pregnancy, spontaneous abortion can be avoided in many cases by taking proper corrective actions. In booth cases, and in all other types of abnormal pregnancies, it is desirable to determine the abnormal status of the pregnancy at as early a date as possible. Much research has been done to show the relationship between progesterone levels and ectopic pregnancy or spontaneous abortion. Generally, it has been found that drops in serum progesterone levels correlate in a predictable manner with both ectopic pregnancy and spontaneous abortion. Progesterone metabolite levels in urine also correlate with both ectopic pregnancy and spontaneous abortion, but are generally less well studied. Elevated or continually doubling serum human chorionic gonadotropin (hCG) levels are also known to correlate with normal pregnancy. Web site: http://www.delphion.com/details?pn=US05786220__

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Chemical reagent indicator for the in vitro diagnosis of pregnancy Inventor(s): de Gracia; Maria R. (6 Avenue Dapples, Lausanne (Vaud) Assignee(s): none reported Patent Number: 4,433,057 Date filed: February 5, 1982 Abstract: A chemical reagent for the in vitro diagnosis of pregnancy in a female mammal; said reagent to be added to a urine sample and containing(a) a buffer solution having a pH of 5.2 to 6.6;(b) a dye colorimetrically responsive to HCG; and(c) a chemical component for adjusting and stabilizing the pH of the urine sample to 4-5. Excerpt(s): The present invention relates to a chemical reagent indicator for the in vitro diagnosis of pregnancy in a female mammal, and also to the method of preparing and the method of utilizing such indicator. It is well known to rely on the presence of human chorionic gonadotropin (H.C.G.) in the urine or serum of expectant mothers beyond the 24th day of pregnancy, with a maximum concentration between the 40th and the 60th day, for diagnosing the state of pregnancy. Initially, biological lab tests have been carried out by using animals such as rats and rabbits. Web site: http://www.delphion.com/details?pn=US04433057__

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Chicken GNRH analogs and uses thereof in regulation of fertility and pregnancy Inventor(s): Siler-Khodr; Theresa (13 Mayborough La., San Antonio, TX 78257) Assignee(s): none reported Patent Number: 6,323,179 Date filed: October 15, 1999 Abstract: Specially designed non-mammalian GnRH analog decapeptides resistant to degradation by the placental enzyme, C-ase-1, or a post-proline peptidase, are disclosed. The GnRH analogs are further defined as analogs of Chicken II GnRH or Salmon GnRH. These non-mammalian analogs incorporate D-arginine, D-leucine, D-tBu-Serine or DTrp at position 6 and ethylamide or aza-Gly-amide at position 10. The D-Arg (6)Chicken II GnRH-ethylamide, D-Arg (6)-Chicken II GnRH-aza-Gly (10)-amide, the DArg (6)-Salmon GnRH ethylamide, and D-Arg (6)-Salmon GnRH-aza-Gly (10)-amide analogs are also provided, and demonstrate preferential binding to chorionic GnRH receptor that is greater relative to the biding of these analogs to pituitary GnRH receptor. These non-mammalian GnRH analogs may be used in pharmaceutical preparation, and specifically in various treatment methods as a contraceptive or postcoital contraceptive agent. The non-mammalian GnRH analogs are also provided in pharmaceutical preparations that may be used clinically for maintaining pregnancy when used in very low doses and administered in pulsatile fashion. In another aspect, the non-mammalian GnRH analogs may be used a luteolytic agents. The aza-Gly (10) amide non-mammalian analogs are yet other embodiments of the non-mammalian GnRH analogs provided as a part of the invention. Excerpt(s): The present invention relates generally to the field of regulating fertility and parturition. More particularly, it concerns the use of unique non-mammalian peptide hormone analogs of GnRH designed to be useful in fertility regulation, post-coital contraception and as a menses-inducing agent. Before the chemical characterization of the mammalian hypothalamic GnRH, it was realized that hypothalamic substances

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regulated production of pituitary LH and FSH. Burgus R., Guillemim R 1970 Hypothalamic releasing factors Ann Rev Biochem 39:499-526. Current contraceptive methods are centered on the existing knowledge of GnRH-gonadotropin-ovarian physiology. The delineation of mammalian GnRH made possible the ability to create methods to detect and quantify this molecule. The human placenta and the chorionic membranes have also been observed to contain a GnRH-like substance. Gibbons J M, Mitnick M, Chieffo V 1975 In vitro biosynthesis, of TSH- and LH-releasing factors by the human placenta. Am J Obstet Gynecol 121:127-131. The present investigator has recently localized, quantified and demonstrated the synthesis of a GnRH-like substance by the human placenta. Siler-Khodr T M, Khodr G S 1978 Luteinizing hormone releasing factor content of the human placenta. Am J Obstet Gynecol 130:216-219; Khodr G S, SilerKhodr T M 1978 Localization of luteinizing hormone releasing factor (LRF) in the human placenta. Fert Steril 29:523-526; Siler-Khodr T M, Khodr G S 1979 Extrahypothalamic luteinizing hormone releasing factor (LRF): Release of immunoreactive LRF by the human placenta in vitro. Fert Steril 22:294-296; Khodr G S, Siler-Khodr T M 1980 Placental LRF and its synthesis. Science 207:315-317. Web site: http://www.delphion.com/details?pn=US06323179__ •

Chorionic gonadotropin derived antigen for early pregnancy test and contraceptive vaccine Inventor(s): Bahl; Om P. (Williamsville, NY) Assignee(s): Research Corporation (New York, NY) Patent Number: 4,268,435 Date filed: April 17, 1979 Abstract: Antisera suitable for detecting the presence of human chorionic gonadotropin in body fluids by immunoassay are prepared by administering to a host animal an antigen comprising the.beta.-subunit of human chorionic gonadotropin which has been modified by cleaving and optionally conjugating the thus modified.beta.-subunit with a protein or hapten capable of enhancing the immunogenetic potency of the antigen. The antigens are also useful for the contraceptive purposes to terminate pregnancy. Excerpt(s): This invention relates to antisera produced by novel antigens, which are useful in testing for pregnancy in humans and more particularly to antisera having an immunological reaction with human chorionic gonadotropin, wherein the immunological cross-reactivity with human luteinizing hormone is reduced or eliminated. This further relates to the production of antigens to prepare said antisera, and which may also be used for contraceptive purposes to terminate human pregnancy. Human chorionic gonadotropin is a hormone produced by the placenta during pregnancy. Presence of the hormone in the serum and urine therefore serves as in indication of pregnancy. The presence of this hormone has been detected by its effect on the ovaries of animals and, more recently, by immunoassay. However, because the tests used hitherto do not sufficiently distinguish between hCG and other hormones which are present, such as luteinizing hormone, the presence of hCG cannot be unambiguously detected until several weeks after conception, by which time the levels of hCG are high enough so that it can be detected even in the presence of interfering substances. Web site: http://www.delphion.com/details?pn=US04268435__

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Clothing adaptor for early term pregnancy Inventor(s): Dawson; Marisa (601 Northwest 22nd St., Wilton Manors, FL 33304) Assignee(s): none reported Patent Number: 4,803,740 Date filed: May 4, 1987 Abstract: Disclosed is a method of adapting a lower body garment for use during early term pregnancy. The method includes the steps of co-linearly securing to each side of the vertical zipper area, strips of a velcro-like fabric. Thereafter, there is provided an adaptor in the nature of an inverted triangle, formed of flexible fabric. Velcro-like strips are placed along both diagonal sides of the inverted triangle. There is further provided several buttons along the horizontal base of the adaptor at a first vertex thereof. There is also provided a buttonhole at the opposite horizontal vertex from the several buttons. The velcro-like strips co-linear with the zipper are press-fitted against the velcro-like elements upon the diagonals of the inverted triangle of the adaptor means. Thereafter a selected one of the several buttons is fastened to the original buttonhole of the lower body garment. The selected button of the several buttons will depend upon the point within the early term of pregnancy of the wearer. Thereafter, the buttonhole of said adaptor is fastened to the original button of the lower body garment. Excerpt(s): The present invention relates to a removable insert intended to render regular clothing adaptable for wear during early term pregnancy and, after the period of pregnancy, to permit the return of the clothing to its original shape and utility. U.S. Pat. No. 2,606,322 (1952) to Vraciu, entitled Maternity Girdle, discloses a girdle having an insert which permits the usage of the girdle during different stages of pregnancy. The disclosure of Vraciu does not relate to any method for adapting ordinary clothing for use during the early stages of pregnancy. U.S. Pat. No. 2,747,197 (1956) to Bailey, entitled Skirt with Removable Insert. This reference is not related to the maternity area; however, it discloses the use of an insert panel primarily for decorative purposes to an otherwise conventional skirt. Web site: http://www.delphion.com/details?pn=US04803740__

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Composition and method for determination of pregnancy Inventor(s): Grundman; Lea (Jerusalem, IL) Assignee(s): Rafa Laboratories Ltd. (IL) Patent Number: 4,088,749 Date filed: April 26, 1976 Abstract: Composition for the determining of whether or not a female is pregnant are provided. The composition consists essentially of a neutral and inert particle on which.gamma.-globulin is adsorbed, said.gamma.-globulin being coupled to a bifunctional coupling agent, the two functional groups thereof possessing different reactivities, the other functional group of said coupling agent being coupled to HCG. The body fluid of the female suspected of being pregnant is mixed with the above composition and permitted to stand. Agglutination indicates non-pregnancy whereas failure of agglutination indicates pregnancy. Excerpt(s): The present invention relates to a serodiagnostic composition for a method for the determination of pregnancy. There are known various methods for the

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determination of pregnancy. Some methods (biological methods) require the use of a specific animal, e.g., rabbits, mice, frogs, etc. These biological tests have serious drawbacks, e.g., they require the availability and housing of many animals meeting specific requirements, which make the method complicated and expensive. Moreover, these methods require special laboratory performances and are usually time consuming, i.e., the results can be obtained only after some days. It has thus been desirable to develop some methods for the determination of pregnancy which overcome the above drawbacks, i.e., do not require animals, not require any specific laboratory techniques, i.e., can be performed in a physician's office and yield the results in a relatively short time. Web site: http://www.delphion.com/details?pn=US04088749__ •

Determining pregnancy induced hypertension and eclampsia by immunoassay of cellular fibronectin Inventor(s): Teng; Nelson N. H. (Hillsborough, CA), Senyei; Andrew E. (Santa Ana, CA) Assignee(s): Adeza Biomedical Corporation (Sunnyvale, CA) Patent Number: 5,079,171 Date filed: January 27, 1989 Abstract: Preeclampisa, pregnancy induced hypertension (PIH) and eclampsia are determined by identifying the presence of an endothelial cell marker in a sample of blood, plasma or serum of a pregnant woman using a sandwich or competition immunoassay. Cellular fibronectin marker in a sample is determined by binding with an anti-(cellular fibronectin) antibody. Reagents for these methods are also an aspect of the invention. Excerpt(s): This invention relates to methods, reagents and kits for detection of pregnancy induced hypertension (PIH) or preeclampsia during pregnancy. In particular, this invention is directed to the determination of PIH or preeclampsia by testing whole blood, serum or plasma samples for the presence of a marker for endothelial cell injury, for example cellular fibronectin. Preeclampsia, eclampsia and pregnancy induced hypertension (PIH) are characterized by elevated blood pressure, proteinuria, and edema. The cause and nature of these disorders is only partially understood. Preeclampsia and PIH are often used to designate the same disorders. The term "preeclampsia" is used hereinafter, for purposes of clarity of explanation, not by way of limitation, to broadly include preeclampsia, pregnancy induced hypertension, and eclampsia. Although considered to be relatively rare in the United States, preeclampsia occurs worldwide in from 2 to 35 percent of pregnancies, depending on diagnostic criteria and study population. Deaths from preeclampsia are nearly equal to those from eclampsia in a recent report by Redman, C. Brit.Med.J. 296:1209-1210 (April, 1988). However, tests for these conditions are often ambiguous, and diagnosis of these conditions have often not been possible until the condition had progressed. A reliable test for early diagnosis of this condition is critically needed. A review of the role of prostaglandins in preeclampsia was published by Friedman, S. Obstet.Gynecol.71:122137 (1988). Examination of maternal fluids for metabolic markers for PIH and preeclampsia has revealed that urine levels of 2,3-dinor-6-keto PG F.sub.1.alpha. increase during this condition, Ob/Gyn Topics, 2:5 (1987). Levels of other substances in the blood have also been studied. Web site: http://www.delphion.com/details?pn=US05079171__

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Device and method for pregnancy detection Inventor(s): Carta; Emanuela (Milan, IT), Rovelli; Cesare (Milan, IT), Piro; Paola (Milan, IT), Lamponi; Sandro (Milan, IT), Corti; Angelo (Milan, IT), Morgese; Nicola (Milan, IT), Tognella; Sergio (Milan, IT), Rurali; Carlo (Milan, IT), Bassi; Rosangela (Milan, IT) Assignee(s): Boehringer Biochemia Robin S.p.A. (Milan, IT) Patent Number: 5,145,789 Date filed: October 5, 1989 Abstract: A device to determine human chorionic gonadotropin (hCG) in urine is described. It includes:a) a first area, consisting of a material able to draw urine by capillarity, on which an hCG bioselective colored agent is absorbed, an end of said first area, to be dipped in urine, while the other end contacts with the following b) area;b) a reading area which contacts the previous one and an area of a material able to assure the capillary flow of urine, on which there is bound:1) a protein able to selectively bind hCG and possibly;2( hCG (positive reagent control) and3) an inert protein (negative reagent control) disposed so as to form, after the reaction with the bioselective colored reagent present in a), two different figures which can be visually detected according to the positivity of the analysis:c) a further area, an end of which contacts the previous one, of a material able to assure the capillary flow of urine towards the other end containing an indicator revealing the occurred passage of urine through the A device.According to the invention, pregnancy analysis becomes easier because the a device is dipped just once in the sample to be tested and because the results are simple to read. Excerpt(s): The present invention relates to a device and a method for the detection of human chorionic gonadotropin (hCG) in urine for early pregnancy diagnosis. Human chorionic gonadotropin (hCG) is a glycoprotein hormone synthesized by the placenta and released in blood and urine soon after the implantation of a fertilized ovum in the chorionic tissue. Concentration of hCG in urine increases from undetectable levels to 50 International Units/1 2-3 weeks after conception and up to 100.000 IU/l after 10 weeks (Speroff L., Glass R. H., Kase N. G. In "Clinical Gynecologic Endocrinology and Infertility", 3rd ed., Williams and Wilkins Co., Baltimore, 1983:555). For this reason urinary hCG is generally considered a specific marker of pregnancy. Web site: http://www.delphion.com/details?pn=US05145789__

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Device for preventing and treating toxemia in pregnant women Inventor(s): Abitbol; M. Maurice (41 Allenwood Road, Great Neck, NY 11023) Assignee(s): none reported Patent Number: 3,988,793 Date filed: September 16, 1975 Abstract: A mattress device designed for treating a pregnant woman by releasing the pressure ordinarily produced by the pregnant uterus and the abdominal wall on the abdominal aorta, thereby helping to prevent complications of pregnancy, such as toxemia and fetal distress. The device comprises a thick mattress-like member having an inflated ring extending through the mattress with a chamber formed on the central portion of the ring. The chamber is open at the top for receiving the pregnant uterus of a woman lying in the prone position, with her abdominal wall floating freely in the

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chamber. The inflated ring is filled to an air pressure which provides a body support that compensates for the heavier weight around the midsection. The combination of the variable air pressure of the ring and different sizes and shapes of such ring permit a mattress support well adapted to the varied sizes and shapes of the pregnant uterus while also enabling the abdominal wall to float freely in the chamber. The bottom of the chamber is closed by a wall in air-tight relation with the side walls of the ring. The top, outside surface of the ring is made of a rubber-like or plastic material that can form an air-tight seal with the skin of the woman around the area adjacent the pregnant uterus. In this fashion, an enclosed chamber is formed which is connected in fluid communication with a vacuum pump. The negative pressure in the chamber further relieves the pressure of the pregnant uterus and the abdominal wall on the abdominal aorta. Excerpt(s): The present invention relates to the treatment of pregnant women and more particularly to a mattress device for treating a pregnant woman lying in the ventral position. In the past, there have been proposed mattresses having a cavity located in the central portion and adapted to accommodate the enlarged abdomen of an expectant mother sleeping or resting in a face-down position. In U.S. Pat. No. 3,378,862 issued on Apr. 23, 1968 to J. P. Skinner, there is disclosed a foam rubber mattress having a cavity shaped to accommodate the expanded abdomen of a woman in full term pregnancy, with a stretchable panel covering the top of the cavity so as to support the expanded abdomen. The panel thereby is designed to serve as a continuing support for the expanded abdomen during the progressive stages of pregnancy since it provides a resistance or tension on the abdominal wall. In U.S. Pat. No. 3,118,152 issued on Jan. 21, 1964 to R. B. Talley, Jr., there is disclosed a maternity mattress pad made up of sections around a central opening. Also, in U.S. Pat. No. 3,287,747 issued on Nov. 29, 1966 to Ellsworth, there is disclosed a maternity mattress abdominal cushion having an elliptical shape in plan contour. Generally, the known attempts to place pregnant women in the ventral or prone position were intended primarily for comfort reasons and to satisfy the habit of those patients that sleep on their stomachs. The prior art mattress devices have cavities or depressions for accommodating the pregnant uterus, but only in a minimal degree or in no manner do such mattresses relieve the pressure caused by the pregnant uterus or by the abdominal wall on the abdominal aorta. Such mattresses or cushions generally produce a pressure on the abdominal wall through the bottom or sides of the cavity walls or the cushion. Web site: http://www.delphion.com/details?pn=US03988793__ •

Direct agglutination test for pregnancy Inventor(s): Hoff; Gail (Millington, NJ), Prevorsek; Metka (Morristown, NJ) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 4,003,988 Date filed: June 1, 1976 Abstract: Direct agglutination reagent for pregnancy testing which comprises the use of suspensions of polystyrene latex particles sensitized with a globulin fraction of antiserum to human chorionic gonadotropin (HCG). When mixed with urine or blood serum samples containing HCG, this reagent agglutinates indicating a positive test for pregnancy.

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Excerpt(s): Direct agglutination tests which form the basis of the present invention are well known as to the theory by which they work. U.S. Pat. No. 3,171,783 to Fisk describes such diagnostic tests but states that they are not suggested for use because of a lack of sensitivity. The present invention has solved many of the difficulties described in the prior art. When the test for pregnancy by direct agglutination is performed using the methods and materials set forth, it results in the realization of the simplicity and accuracy suggested by classic agglutination methods. Furthermore, the test of this invention, when used with the reagent and method disclosed, is 100 to 600% more sensitive than the direct agglutination tests of the prior art which are commercially available. Also, by utilizing the specific buffering system disclosed as part of the reagent system, it was unexpectedly found that false positive reactions would be minimized. It has been found that the determination of pregnancy can be quickly and accurately made with the simplest equipment by means of the present invention. Web site: http://www.delphion.com/details?pn=US04003988__ •

Early pregnancy detection by detecting enhanced blood platelet activation Inventor(s): O'Neill; Christopher (Flat 1, 83 St. Johns Rd., Glebe 2037, N.S.W., AU) Assignee(s): none reported Patent Number: 4,543,339 Date filed: March 15, 1983 Abstract: A method and reagent system for detecting pregnancy in a mammal at an early stage by detecting enhanced activation of blood platelets. Excerpt(s): The present invention relates to the detection of pregnancy in mammals (particularly agricultural and domestic animals) at a very early stage. The invention is based on the monitoring of changes in the haemostatic system (i.e. the blood coagulation system). Traditionally, the diagnosis of pregnancy is based on missed menstrual periods (human) or a failure to return to oestrus (animal species). Depending on the mammal species, this may take from several days to several weeks. For humans, the most commonly used experimental test for detecting pregnancy is based upon the immunological detection of human chorionic gonadotrophin (HCG). HCG is a glycoprotein hormone produced by the placenta during pregnancy, and may be found in blood and urine samples of pregnant women. The latex particle test for HCG is well known and well established for use with humans. However, the HCG hormone does not appear in conveniently measurable amounts until about 2 or 3 weeks following a missed period. By this time pregnancy, if it exists, can no longer be terminated by menstrual regulation and abortion, if required, must be brought about by more complicated techniques. Web site: http://www.delphion.com/details?pn=US04543339__

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Ectopic pregnancy test Inventor(s): Teng; Nelson N. H. (Hillsborough, CA), Senyei; Andrew E. (Santa Ana, CA) Assignee(s): Adeza Biomedical Corporation (Sunnyvale, CA) Patent Number: 5,236,846 Date filed: July 18, 1991

Patents 345

Abstract: A method for determining ectopic pregnancy in pregnant persons comprises obtaining a test sample; and determining the absence of a fetal restricted antigen in the sample. The sample is obtained from the vaginal cavity in the vicinity of the cervical canal or the cervical os. One fetal restricted antigen is fetal fibronectin. In one embodiment of this invention, the sample is contacted with an insoluble support to which anti-(fetal restricted antigen) antibody is adhered, and the fetal restricted antigen binding to the support is determined. Alternatively, a class of substances of which the fetal restricted antigen is a member is captured with a general binding antibody such as an anti-(fibronectin) antibody; an anti-(fetal restricted antigen) antibody such as anti(fetal fibronectin) antibody is bound to the support; and the absence of binding with fetal restricted antigen is determined. Competition or sandwich assay procedures can be used. Reagents and reagent kits are also included. Excerpt(s): This invention relates to methods, reagents and kits for detecting ectopic pregnancy in a patient who has pregnancy indicating levels of pregnancy antigen in the blood or urine. A wide variety of tests have been developed for the determination of pregnancy. These methods, in general, involve the testing of blood or urine for levels of pregnancy antigens or other compounds which are indicative of pregnancy. Ectopic pregnancies, however, are not reliably distinguished from normal pregnancies by these methods, and ectopic pregnancies remain a major cause of morbidity and mortality for women. Commercial early pregnancy determinations include the rabbit ovulation test of urine (5.5 wk), rat ovarian hyperemia test of urine (5.5 wk), hemagglutination inhibition latex particle test of urine (5.5 wk), RIA (radioimmunoassay) test of blood using competition with.sup.125 I labeled hCG for anti-(hCG) antibodies (3.5 wk), RIA test of blood using competition with.sup.125 I labeled hCG for anti-(.beta.-hCG) antibodies (3.5 wk), and RRA (radioreceptor assay) test of blood using competition with.sup.125 I labeled hCG for specific receptor sites. The RIA tests have been refined to provide qualitative results the same day but require an additional day to determine the exact titer of hCG or.beta.-hCG in the serum. The RRA assay is more rapid, but is currently less sensitive than the RIA test. Web site: http://www.delphion.com/details?pn=US05236846__ •

Enhanced maintenance of pregnancy using leukaemia inhibitory factor in embryo culturing Inventor(s): Fry; Richard C. (Altona North, AU), Parr; Ronald A. (Hoppers Crossing, AU) Assignee(s): Amrad Corporation Limited (AU) Patent Number: 5,366,888 Date filed: April 16, 1992 Abstract: The present invention relates to the use of leukemia inhibitory factor (LIF) in the enhancement of development and maintenance of mammalian embryos, particularly sheep embryos. It has been observed that following the introduction into foster mothers of embryos cultured in vitro in the presence of LIF, the maintenance of pregnancy is enhanced relative to that seen following introduction of embryos that had not been cultured with LIF prior to introduction into foster mothers. Excerpt(s): The present invention relates to the use of Leukemia Inhibitory Factor (LIF) in the enhancement of development and maintenance of animal or mammalian embryos and the use of same to enhance impregnation. 2. the ability to compete with a molecule

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having the defined sequence of murine LIF or human LIF (defined in International patent application Ser. No. PCT/AU88/00093) for binding to specific cellular receptors on M1 cells or murine or human macrophages. A major difficulty associated with present in vitro fertilisation (IVF) and embryo transfer (ET) programs, particularly in humans, is the tow success rate "achieved" on implantation of fertilised embryos. Currently, in human IVF programs, the implantation rate may be as low as 10%, leading to the present practice of using up to four fertilised embryos in each treatment which, in turn, leads occasionally to multiple births. Accordingly, there is a need to improve the implantation rate in human IVF programs. Similarly, in IVF and ET treatments in domestic animals such as sheep, cattle, pigs and goats, it is highly desirable for economic reasons to have as high an implantation rate as possible so as to reduce the numbers of fertilised embryos lost and unsuccessful treatment procedures performed. Furthermore, as with human IVF procedures, the practice of transferring more than one embryo to the recipient animal to ensure pregnancy can result in unwanted multiple births. Web site: http://www.delphion.com/details?pn=US05366888__ •

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

Patents 347

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

Fetal fibronectin pregnancy test Inventor(s): Teng; Nelson N. H. (Hillsborough, CA), Senyei; Andrew E. (Santa Ana, CA) Assignee(s): Adeza Biomedical Corporation (Sunnyvale, CA) Patent Number: 5,185,270 Date filed: December 12, 1988 Abstract: A method for determining normal intrauterine pregnancy during the first 20 weeks of pregnancy comprises obtaining a test sample; and determining the presence of a fetal restricted antigen in the sample. The test sample is removed the vaginal cavity in the vicinity of the cervical canal and/or the cervical os. One fetal restricted antigen is fetal fibronectin.In one embodiment of this invention, the test sample is contacted with an insoluble support to which anti-(fetal restricted antigen) antibody is adhered, and the fetal restricted antigen binding to the support is determined. Alternatively, the test sample is contacted with an insoluble support to which is adhered an antibody which binds a class of substances including the fetal restricted antigen; and the fetal restricted antigen binding to the support is determined. Reagents and reagent kits are also included. Excerpt(s): This invention relates to methods, reagents and kits for early determination of pregnancy. In particular, this invention is directed to the determination of normal pregnancy in the uterus during weeks 1 to 20 of pregnancy by testing a sample for the presence of a fetal restricted antigen. A wide variety of tests have been developed for the determination of pregnancy. Commercial early pregnancy determinations include the rabbit ovulation test of urine (5.5 wk), rat ovarian hyperemia test of urine (5.5 wk), hemagglutination inhibition latex particle test of urine (5.5 wk), RIA (radioimmunoassay) test of blood using competition with.sup.125 I labeled hCG for anti-(hCG) antibodies (3.5 wk), RIA test of blood using competition with.sup.125 I labeled hCG for anti-(.beta.-hCG) antibodies (3.5 wk), and RRA (radioreceptor assay) test of blood using competition with.sup.125 I labeled hCG for specific receptor sites. The RIA tests have been refined to provide qualitative results the same day but require an additional day to determine the exact titer of hCG or.beta.-hCG in the serum. The RRA assay is more rapid, but is currently less sensitive than the RIA test. Home pregnancy tests for hCG in urine include a variety of enzyme immunoassays,

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hemagglutination inhibition, and antibody-antigen agglutination tests which are effective to indicate pregnancy from 0 to 9 days after a missed period. Confirmation by physician is recommended, particularly to determine abnormal gestation such as ectopic pregnancy. Web site: http://www.delphion.com/details?pn=US05185270__ •

Garment for simulating the effects of pregnancy on the human body Inventor(s): Ware; Linda M. (3760 Onyx St., Eugene, OR 97405) Assignee(s): none reported Patent Number: 4,531,919 Date filed: July 12, 1984 Abstract: A garment for wear by those interested in experiencing the physical effects of full term pregnancy. A fluid filled, weighted body of several pounds overlies the wearer's stomach while a rib belt exerts a compressive force to alter lung capacity. A bladder pillow simulates the effect of a fetus on the bladder. Garment straps permit garment fitting to a wide range of physiques while weights may be added to weight the garment to the size and build of the wearer for a true simulation. Excerpt(s): The present invention pertains generally to garment construction and particularly to a garment which, when worn, simulates various physical aspects of pregnancy. In the education of those anticipating parenthood it is a difficult task to convey to the prospective parent the physical changes and, to some extent, hardships encountered during a pregnancy, This is especially so in the case of the father for obvious reasons. Reading or hearing a list of physiological changes associated with pregnancy do not provide a lasting insight into such changes. Accordingly, a husband or a woman who has not experienced pregnancy have no opportunity to physically sense changes to the body during a pregnancy. The present invention is embodied in a garment having components which affect certain portions of the body so as to simulate the effects of pregnancy and hence educate those who would otherwise have no opportunity to experience same. Web site: http://www.delphion.com/details?pn=US04531919__

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Gender-indicating colormetric test on pregnancy urine and test kit therefor Inventor(s): Weisberg; Kenneth (606 St. Andrews Rd., Hollywood, FL 33021) Assignee(s): none reported Patent Number: 4,840,914 Date filed: September 26, 1988 Abstract: A gender-indicating test of the unborn child is provided. It is a colorimetric test on the pregnancy urine performed on samples obtained after about the 20th week of the pregnancy. The gender-indicating composition for use in the test is a mixture of alkali hydroxide and metallic aluminum. The colored results of the exothermic reaction of the composition with the urine is evaluated--tan solutions indicate a female child and brown solutions indicate a male child. The invention includes the method, the compositions used in the method and a convenient kit containing the subdivided composition in test units for performing the gender-indicating test.

Patents 349

Excerpt(s): This invention relates to a method and a kit for determining the gender of the unborn fetus and more particularly to a test for ascertaining the gender of the baby in the womb based upon tests on the pregnancy urine. The fascination of guessing the sex of the unborn baby in the womb is deeply ingrained in all cultures. Various folklore techniques have been used. They have ranged from torque on suspended wedding rings to color reflections from flowers, coins held near the belly or colors transmitted through various unguents applied to the belly. The shape of the belly was also a sure indicator-round could be either a boy or a girl depending on the specific culture. Needless to say, the prognosticators were either right or wrong--usually about half the time. None of the methods were scientifically based. Recently some methods based on science have had favor based to some degree upon endocrinology. Acne-like complexion changes in the mother have been held to indicate a probable girl. These are based upon supposed excesses of female hormones. Improvement in the mother's complexion was suggestive of a probable boy. The reasoning was a supposed neutralization of any excessive female hormones by the male hormones from the boy fetus. Web site: http://www.delphion.com/details?pn=US04840914__ •

IGF-1 and related compounds in pregnancy Inventor(s): Breier; Bernhard H. (Hamilton, NZ), Ambler; Geoffrey R. (Auckland, NZ), Gluckman; Peter D. (Auckland, NZ) Assignee(s): Auckland Uniservices Limited (Auckland, NZ) Patent Number: 5,420,111 Date filed: February 10, 1993 Abstract: Fetal growth is promoted and fetal growth retardation is reduced in mammals by increasing in a maternal host during pregnancy the active concentration of IGF-1 and /or IGF-2 and/or analogues thereof. The active concentration of IGF-1 and/or IGF-2 and/or analogues thereof may be increased either by directly administering to the maternal host IGF-1 and/or IGF-2 and/or analogs thereof or by administering another compound which, upon being so administered, causes an increase in the active concentration of IGF-1 and/or IGF-2 and/or analogues thereof in the maternal host. Excerpt(s): This invention relates generally to a method and/or medicament for reducing fetal growth retardation and relates particularly though not necessarily solely to the use of maternally administered IGF-1, IGF-2 or analogues thereof or a combination of these compounds to promote fetal growth by reducing maternal constraint. Fetal growth retardation is a major cause of perinatal morbidity and mortality both in farm animals and in man. In man, intrauterine growth retardation is a major cause of perinatal death either due to late abortion, stillbirth or neonatal death particularly in prematurely delivered infants. No effective intrauterine therapy is known even though its diagnosis in utero by ultrasound for example is routine. The main therapy is bedrest. Growth retarded infants who survive have a far greater risk of asphyxial brain damage leading to sensory defects, cerebral palsy, learning disorders, epilepsy, or intellectual retardation. They also may exhibit severe and continuing growth failure. Web site: http://www.delphion.com/details?pn=US05420111__

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Implantation rates after in vitro fertilization, treatment of infertility and early pregnancy loss with a nitric oxide donor alone or in combination with progesterone, and a method for contraception with nitric oxide inhibitors Inventor(s): Chwalisz; Krzysztof (Berlin, DE), Garfield; Robert E. (Friendswood, TX) Assignee(s): Schering Aktiengesellschaft (Berlin, DE), The Board of Regents, Univ. of Texas System (Austin, TX) Patent Number: 6,040,340 Date filed: May 7, 1996 Abstract: A method is provided for the improvement of implantation rates and/or pregnancy rates in a female mammal, comprising administering to a female mammal in whom pregnancy is desired an effective amount of(a) a nitric oxide synthase substrate, a nitric oxide donor, or both, optionally in combination with(b) a progestin, and,(c) optionally, in further combination with an estrogen.A method is also provided for fertility control for a female mammal, comprising administering to a female mammal in whom pregnancy is not desired and at risk for becoming pregnant an effective amount of nitric oxide synthase inhibitor in combination with an antiprogestin. Pharmaceutical compositions are also provided. Excerpt(s): This invention relates to a method for the improvement of implantation rates after in vitro fertilization (IVF), for the treatment of infertility and for the treatment and prevention of early pregnancy loss in women with a nitric oxide synthase substrate (Larginine), a nitric oxide donor or both, alone or in combination with progesterone and/or estrogen. Human in vitro fertilization is surprisingly unsuccessful. The overall birth rate per IVF treatment cycle is approximately 14% in USA (Medical Research International Society for Assisted Reproductive Technology [SART], The American Fertility Society [1992]. Fertil Steril 5:15 ), and 12.5% in UK (The Human Fertilization and Embryology Authority. Annual Report, London 1992). Success is greater when more than one embryo is transferred simultaneously. However, simultaneous transfer of multiple embryos increases the incidence of multiple pregnancy and the possibility of miscarriage and prematurity. The reasons for the low pregnancy rates after IVF are still not completely understood. The quality of both the embryo and the uterine environment affects success. Generally, there is a high rate of spontaneous early abortion in fertile cycles in women. After natural conception, possibly as many as 50-60% of very early pregnancies are lost (Winston M L, Handyside A H [1993], New challenges in human in vitro fertilization. Science 260:932-935). This may be due to both conceptus abnormalities and dysynchrony between embryo and endometrium at the time of embryo transfer. Web site: http://www.delphion.com/details?pn=US06040340__

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Inflatable body support cushion, particularly to support a woman during pregnancy Inventor(s): Pettit; John E. (18219 46th Place South, Seattle, WA 98188), Pettit; Dorothy E. (18219 46th Place South, Seattle, WA 98188) Assignee(s): none reported Patent Number: 4,054,960 Date filed: June 25, 1976 Abstract: A continuously and adjustably inflatable cushion supports the entire body length of a prone, face down, expectant mother, and is shaped to accommodate and

Patents 351

conform to the enlarged contours of her body during pregnancy and immediately afterward. An essentially circular opening passes completely through the central portion of the supporting cushion, to surround and partially support the enlarged abdomen of the expectant mother. The depth and softness of this opening is varied during progressive stages of pregnancy through a valve mechanism, to add or release air.When deflated, the cushion is folded into a compact, lightweight configuration for economical packaging and storage. The inflatable cushion has the additional advantages of light weight and portability in either its collapsed or inflated configurations; continuous range of adjustment to accommodate the shape of a human body; and the cushion is preferably constructed from material which is non-flammable, odor free and easily cleaned.Additional accommodating openings in the cushion structure accommodate the breasts of the mother both during and after childbirth and a breathing opening is provided for the face down, reclining occupant. Internal reinforcing panels and heat seams in the cushion material are utilized to maintain the shape and increase the weight bearing strength of the cushion structure, and to subdivide the cushion into air tight compartments, which can be individually, adjustably inflated. A separable, inflatable plug is provided to fill the central cushion opening, adapting the cushion to use as a conventional air mattress after pregnancy. Excerpt(s): Modifications have been made to mattresses to adapt to the needs of child bearing women and to provide maximum comfort when she lies in a face down position. However, these mattresses are expensive and too bulky to be easily moved and cannot be taken on trips by the expectant mother. The inflatable body support cushion fills the need for an economic, portable device which can be used alone or with a conventional mattress and may be easily collapsed to a very light weight and compact configuration which will fit in the purse of an expactant mother. For example, the inventions of Mr. Milan, described in U.S. Pat. No. 1,548,728 and Mr. Skinner, U.S. Pat. No. 3,378,862 are both full sized mattresses which are bulky, difficult to clean, and flammable. Although Mr. Skinner's invention comforms somewhat to body contours by means of a stretchable support panel, it lacks the range and sensitivity of adjustment available in the present invention, by varying the inflation of a cushion which substantially surrounds and supports the expectant mother's abdomen. The invention of Mr. Talley, described in U.S. Pat. No. 3,118,152, is an abdomen accommodating pad which while more portable than a full mattress, still is much more bulky and lacks the adjustability of an inflatable device. Also, Mr. Talley's mattress pad does not support the full length of the reclining body, thus requiring the use of additional support. The present invention provides a great improvement over the prior art in that it greatly increases portability, economy and adjustability and is safer for use because it is nonflammable and sanitary. Web site: http://www.delphion.com/details?pn=US04054960__ •

Isoferritin as a marker for pathological pregnancy Inventor(s): Moroz; Chaya (40 Yehuda Hanasi St., Tel Aviv, IL) Assignee(s): none reported Patent Number: 5,871,735 Date filed: June 12, 1990 Abstract: The present invention relates to a method of diagnosis of pathological pregnancy which relies on an evaluation of the amount of placental isoferritin (PLF) in the serum or amniotic fluid of a pregnant woman. Diagnosis may also be achieved by

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observation of percentages of PLF-bearing lymphocytes in the pregnant female. Detection of PLF levels is achieved by immunoassay with a PLF-specific antibody. Also described is a method of treating or preventing pathological pregnancies and transplant or graft rejection by administration of effective amounts of PLF and/or a PLF-specific antibody in combination with immunization. Excerpt(s): There is currently a widespread need for simple yet accurate means of diagnosis for a number of conditions which affect pregnant women. It is often difficult, if not impossible, to determine in advance which pregnant women are at risk for certain conditions which may prevent carrying a child to term, and/or which may endanger the life of both mother and fetus. Early detection of problem pregnancies enables rapid implementation of necessary therapy or prophylactic measures. The present invention now provides a serum marker which may be used for the diagnosis and detection of several types of pathological pregnancies. The marker which is indicative in all these conditions is placental isoferritin (PLF; or oncofetal or embryonic ferritin). Accurate detection of the presence or absence of the marker is enabled by the discovery of a PLFspecific monoclonal antibody, as well as a broadly cross-reacting monoclonal antibody to isoferritin. The existence of these antibodies has made possible the construction of immunoassays which can accurately and rapidly facilitate diagnosis of the aforementioned disease states. Iron is known to be an essential element of the makeup of every living organism, but may also become toxic at physiological pH values by virtue of its tending to oxidize, hydrolyze and precipitate as insoluble ferric oxide polymers. The protein ferritin, found in all living cells, is the body's means for ensuring that iron toxicity does not occur. Ferritin functions by storing iron in the cells in a soluble and readily available form. The iron stored in cells may then be mobilized whenever needed by the body, for example, for erythropoiesis. The name "ferritin" actually encompasses a number of individual isomeric forms which are characteristic of different tissue types. Each isoferritin has 24 subunits of two distinct types, namely light subunits (L) and heavy subunits (H). These subunits differ in molecular weight, the light subunit being about 18 kDa, and the heavy subunit about 19-21 kDa. The isoferritins extracted from different tissues or organs typically exhibit different isoelectric points, with the isoelectric focusing pattern of human tissues forming a continuous spectrum; those tissues associated with high iron storage have ferritins at the basic end of the spectrum (e.g. spleen and liver), while iron poor tissues, (e.g. heart and placenta) and malignant cells have acidic ferritins. (Drysdale, Ciba Found. Symp. 51:41, 1977). The difference in isoelectric point appears to be related to the different distribution of light and heavy subunits in each type. Specifically, heavy subunit-rich ferritins are relatively acidic, and light chain rich ferritins are relatively basic (Cosell, et al., in Ferritins and Isoferritins as Biochemical Markers, p. 49-65, 1984, Elsevier). Current studies indicate that the H and L subunits are encoded by a complex group of genes, therefore suggesting that there is an even greater heterogeneity of ferritin molecules than had previously been expected. Web site: http://www.delphion.com/details?pn=US05871735__ •

Maternal immune responsiveness as a predictor of pregnancy outcome Inventor(s): Bermas; Bonnie L. (Newton, MA), Hill; Joseph A. (Brookline, MA) Assignee(s): Brigham and Women's Hospital (Boston, MA) Patent Number: 6,182,665 Date filed: May 29, 1998

Patents 353

Abstract: A method for predicting whether a pregnant woman will be able to carry a fetus to viability by determining her immunological responsiveness to recall antigens. Women, particularly women with a history of recurrent spontaneous abortion, who have a responsiveness that is no higher than the responsiveness of women known to have had a successful pregnancy, have a high probability of maintaining gestation until viability. Excerpt(s): The present invention is directed to a method for determining whether a pregnant woman will successfully complete gestation based upon her immunological responsiveness to recall antigens. Recurrent spontaneous abortion, defined as three or more unexplained pregnancy losses prior to 20 weeks of gestation, occurs in approximately 0.3% of couples who desire children (Stirrat, Lancet 336:728-733 (1990)). Among the factors identified as causing this disorder are: genetic or chromosomal abnormalities (3-5% of cases); endocrine etiologies (17%); infections (5%); and mularian anomalies (10%). The etiology of the remaining 50-60% of miscarriages is uncertain, but there are reasons to suspect that immunological factors may play a role. Pregnancy is accompanied by a decline in the reactivity of maternal T-cells to HLA antigens (Tafuri, et al., Science 270:630-633 (1995)) and by a diminished immunological responsiveness of the mother (see e.g., Brunham et al., J. Clin. Invest. 72:1629-1638 (1983); Muchmore et al., J. Immunol. 138:2547-2553 (1987); and Tartof, Clin. Exp. Immunol. 57:502-510 (1984)). This suggests that maternal immunological changes may help provide an environment conducive to fetal development. Web site: http://www.delphion.com/details?pn=US06182665__ •

Maternity dress for a doll which simulates pregnancy Inventor(s): Fogarty; Bonnie R. (39 Sandy Hook Rd., Sarasota, FL 34242), Fogarty; A. Edward (39 Sandy Hook Rd., Sarasota, FL 34242) Assignee(s): none reported Patent Number: 5,207,728 Date filed: March 30, 1992 Abstract: A removable maternity dress for a doll which simulates pregnancy and child delivery and which may be easily adapted to a conventional doll. The invention includes a doll dress preferably made of non-stretchable flexible fabric having a concealed upright front pocket connected thereto. The pocket is sized to receive a baby doll insertable therein through a flapped lower opening at the bottom of the pocket. Removal of the baby doll from the pocket downwardly through the lower opening simulates child birth. A front opening in the dress adjacent the pocket coverable by an apron-like fabric sheet may also be provided. A layer of flexible latex or the like connected to and extending across the front opening simulates the appearance of the pregnant mid section of the doll. A liquid or gel-filled bladder attached between the front of the dress and the pocket affords a more realistic sensation of touch of the baby doll within the pocket. A lenticular screen positioned over an image of the baby doll and having a transducer-like extension therefrom affords simulated kicking movement of the baby doll as found on an ultrasound machine. Excerpt(s): This invention relates generally to dolls, and more particularly to a removable maternity dress for a conventional doll which simulates pregnancy and birth. A number of prior art devices are known which in some fashion simulate pregnancy and birth of a doll or toy animal. However, elements of social unacceptability have

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rendered many of these prior art devices unmarketable. One such device is disclosed in U.S. Pat. No. 4,883,442 invented by Kaplan. However, this device utilizes an elastic stretchable pouch on the mother doll to impart a realistic pregnant look and which, after removal of the baby doll, conforms to the unpregnant shape of the doll. An early patent to Overholt in U.S. Pat. No. 1,431,482 discloses a doll capable of carrying a baby doll across its chest held there by snaps. The disclosures in U.S. Pat. Nos. 2,551,433 and 2,551,560 teach the use of manikins for mid-wifery instruction and which include an abdominal cavity into which a baby doll may be placed. However, a rigid cap or cover is utilized to cover the pregnancy appearance. Web site: http://www.delphion.com/details?pn=US05207728__ •

Means for testing for pregnancy Inventor(s): Saxena; Brij B. (Englewood, NJ) Assignee(s): Cornell Research Foundation, Inc. (Ithaca, NY) Patent Number: 4,094,963 Date filed: May 20, 1976 Abstract: Disclosed is a method for the determination of the hormone human chorionic gonadotropin (HCG), luteinizing hormone (LH), prolactin (PRL) and HCG-like material in an aqueous sample comprising contacting a highly specific receptor for these hormones with an aqueous sample to be tested, providing a means of indicating whether binding has taken place between the receptor and hormone possibly contained the sample and observing the indicating means to determine the presence of the hormone in the sample. PRL may be determined separately or simultaneously with the HCG and LH. The receptor is a plasma membrane extract from the corpus luteum of an animal which possesses the receptor for HCG, LH, PRL and HCG-like material. Radioassay indicating means are preferred, according to which competitive protein binding between radioisotopically labeled hormone and hormone present in the sample is radiologically determined. The method has particular application to the determination to pregnancy in the human female. Excerpt(s): The present invention relates to a method and means for the determination of the hormones human chorionic gonadotropin (HCG), luteinizing hormone (LH) and prolactin (PRL) and more especially to a fundamentally new method and means for detection of pregnancy in the human female. Tests for the detection of pregnancy are generally based on the determination of hormones which are produced by the developing placenta, such as gonadotropic hormones similar to those produced by the anterior pituitary gland and steroid hormones similar to those of the ovary and adrenal gland. Pregnancy tests in use today are nearly exclusively based upon an essay for the placental hormone, human chorionic gonadotropin (HCG). This hormone is found in body fluids (blood serum and urine) only during pregnancy, with the exception of several other very rare hormone-producing conditions of the body. The International Unit (I.U.) of HCG was adopted in 1938 and is defined as the specific gonadotropic activity of 0.1 mg. of a dried standard kept at the National Institutes of Health, London, England. The earliest tests for pregnancy were based upon biological in vivo methods for determining the presence of HCG. For example, the earliest test, the AschheimZondek test was based upon the ability of HCG injected subcutaneously in mice to produce corpora lutea. The Friedman test is another biological test in which a urine sample of the suspected pregnancy is injected into the ear vein of a mature female rabbit which has been isolated 3 to 4 weeks, and 48 hours after injection the ovaries are

Patents 355

examined for ruptured hemorrhagicfollicles, which indicate a positive reaction. A lesser known test developed by Kupperman in 1943 involves the injection of the patients's urine into a female rat with subsequent inspection of the ovary for signs of hyperemia. While the 2 hours necessary for conducting this test is considerably shorter than the 48 hours required for the Friedman test and the nearly five days required for the Aschheim-Zondek test, this test is not as reliable since it requires a skilled technician to differentiate a slightly pink negative ovary from a reddened positive ovary to attain a high degree of accuracy. A test developed by Gaili and Mainini in the late 1940's also requires only approximately two hours to conduct the test; however, this test involves the injection of the patient's urine into frogs with the subsequent observation for ejection of sperms, and these animals are relatively insensitive compared with rabbits, mice and rats. Web site: http://www.delphion.com/details?pn=US04094963__ •

Medical timing system for use during pregnancy and method of using same Inventor(s): Forbath; Frank P. (2880 Club House Rd., Costa Mesa, CA 92626) Assignee(s): none reported Patent Number: 4,493,043 Date filed: November 25, 1981 Abstract: A medical timing system has a programmed computer controlled display and audible buzzer, with inputs from a timing switch and a readout button which are connected together so that pregnancy labor pains may be timed, contraction patterns may be rehearsed by an expectant mother, and fetus movements may be counted. The medical timing system is preferably hand-held and compact so that the timing switch and readout button may be easily actuated and so that accurate and reliable timing measurements may be made and recorded through use of the system. Excerpt(s): This medical timing system for use during pregnancy is related to the field of diagnostic medical instruments and is more particularly related to electronic digital computer programmed devices for monitoring the occurence of biomedical events relating to childbirth and allowing the practice of procedures for natural childbirth. The timing of the interval between contractions during pregnancy labor has been used in the past in order to allow and expectant mother to determine when to call a doctor or go to a hospital. Such timing has been used by doctors and nurses in determining the proximity of birth. Thus, data on the time sequence of contractions--their duration and the interval between the successive start of each contraction--is an aid to the medical staff in determining the progress of labor and is a clue to when the expectant mother should go to the doctor's office for an examination or to the hospital for delivery. The measured durations and intervals aid in accurate determination of the apparent progress of labor. Additional clues--not used herein--to the medical staff on the progress of labor are the intensity of the contraction and the dilation of the cervix. In preparation for pregnancy labor, rehearsal techniques have been used (such as the Lamaze method) by expectant mothers and their coaches (typically the expectant fathers) in which a sequence of breathing exercises, message maneuvers, etc. of predetermined durations are performed in order to simulate the procedures for prepared childbirth. It is also known that the occurence of movements by the fetus indicates the health and state of development of the fetus. A method for keeping track of labor contractions used in the past involved observing an ordinary wristwatch or stopwatch and manually writing down (as on pencil and paper) the times when contractions occurred. Often a coach would assist the

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expectant mother by observing the timepiece and writing down the times, since the expectant mother may be experiencing pain, loss of sleep, or may otherwise be incapable of making reliable measurements. However, the measuring ability of a coach who is fatigued or has lost sleep (which is often the case) may also be unreliable. This prior method has disadvantages in that manual subtraction computations are required (if an ordinary wristwatch is used) and the writing down of times requires light to see by (a disadvantage in the dark of night). Another inconvenience with this prior method is that a pencil, paper, and timepiece must be available at all times in order to measure and record the occurence of contractions. Web site: http://www.delphion.com/details?pn=US04493043__ •

Method and apparatus for estimating and displaying fetal development data during pregnancy Inventor(s): Laros, Jr. Russell K. (21 Marsh Rd., Tiburon, CA 94920-2541) Assignee(s): none reported Patent Number: 5,928,168 Date filed: August 27, 1996 Abstract: A method and apparatus for determining and displaying fetal development data during pregnancy which allows a user to instantly view the current status of fetal development based on user defined pregnancy reference data. Pregnancy reference data, including a pregnancy reference date such as the expected due date, is entered by the user and stored in a storage device. Thereafter, whenever the user requests the information concerning the fetus, the apparatus estimates the current status of fetal development using the pregnancy reference data and a look-up table containing various parameters. The apparatus then provides a convenient display of the current status of fetal development. The display may be in the form of current gestation measurements or expected current fetal measurements, such as the expected size and weight of the fetus. Excerpt(s): This invention is broadly directed to a method and apparatus to store and display pregnancy related data. The invention is directed to the health care field and the fields of data storage, calculation, and display. More particularly, the invention relates to the storage and processing of pregnancy related data, and display of up-to-date information concerning fetal development. A woman's peace of mind regarding her pregnancy helps maintain her health and the health of the unborn child. Peace of mind can be increased by informing the expectant woman of factual information concerning her current stage of pregnancy and informing her of recent developments of her fetus. Web site: http://www.delphion.com/details?pn=US05928168__

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Method and kit for pregnancy detection Inventor(s): Sulitzeanu; Bernard (Jerusalem, IL) Assignee(s): Teva Pharmaceutical Industries Ltd. (IL) Patent Number: 4,508,829 Date filed: August 18, 1982 Abstract: Method and kit for pregnancy detection adapted for self-performance. Urine to be tested is contacted with a lectin substrate being lectin bound to a solid support and

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capable of binding HCG. After separation of the lectin substrate from the urine the substrate is contacted with a liquid color reagent comprising a colored carrier material and anti-HCG antibodies bound thereto. If after separation of the colored reagent from the substrate the latter remains colored, the subject is pregnant, while lack of color indicates non-pregnancy. A preferred color reagent comprises killed and stained Staphylococci bacteria. There is also provided a kit for self-performance of the method comprising at least one column packed with a lectin substrate and adapted for the controlled passage of liquid therethrough, and a color reagent. Excerpt(s): The present invention concerns a method and a kit for early pregnancy detection. Pregnant women secrete soon after the implantation of a fertilized ovum in the chorionic tissues an increasing amount of human chorionic gonadotropin (HCG) some of which is excreted in the urine. Most presently available pregnancy detection methods are based on the detection of HCG in the urine. One group of known methods for the detection of HCG in the urine is based on radioimmunoassay. While these methods are very reliable and sensitive they require highly sophisticated laboratory equipment and such tests cannot be carried out by the subjects themselves. Web site: http://www.delphion.com/details?pn=US04508829__ •

Method and means for determination of pregnancy Inventor(s): Cappel; Leona R. (Norco, CA) Assignee(s): Cooper Laboratories, Inc. (Palo Alto, CA) Patent Number: 4,348,207 Date filed: January 29, 1981 Abstract: A diagnostic means and method of testing for pregnancy in humans and a test kit incorporating such diagnostic means and ancillary materials. A sample of a patient's first morning urine is added to a test tube containing a known lyophilized reagent. The tube is capped, shaken to mix the contents, and placed upright for one to two hours. The tube is then inverted and compared with positive and negative standard vials to show either agglutination of particles, such as red blood cells, contained therein, in which case the subject is not pregnant, or a failure to agglutinate, in which event the patient is pregnant. The test tube is of sufficient dimension to support capillary action and is formed from, or has its interior surface coated with, a material which is non-wettable to the liquid contained therein. Excerpt(s): The invention relates to a novel diagnostic means and method of testing for pregnancy in humans, and to a test kit incorporating such diagnostic means and ancillary materials. It has been known for some time that the presence of human chorionic gonadotropin (HCG) of placenta origin in the urine constitutes one of the early indications of pregnancy. Originally, in vivo methods for determining the presence of such HCG were developed, and while consistently accurate they have proved to be unwieldy because of the difficulty of maintaining a large supply of animals of the required age, the need for multiple, time-lapse, injections of test serums, and the attendant delay in obtaining results. More recently a number of diagnostic methods for determining pregnancy by in vitro determination of HCG in the urine have developed. In general, these tests involve the interaction of a sample of urine to be tested with a reagent resulting in the formation or inhibition of a precipitate or a sedimentation pattern in the test vial, thus providing a qualitative indication of the presence or absence of the telltale HCG.

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Web site: http://www.delphion.com/details?pn=US04348207__ •

Method and system for the pregnancy condition protocol of an emergency medical dispatch system Inventor(s): Clawson; Jeffrey J. (4649 Farm Meadow La., Salt Lake City, UT) Assignee(s): none reported Patent Number: 6,076,065 Date filed: March 28, 1997 Abstract: A method and system for receiving, processing and responding to emergency medical calls for patients with pregnancy related medical problems is described. A consistent, standard and systematic process is provided which in combination with adequate training, supervision and quality assurance serves to provide a method for gathering emergency medical information regarding a patients pregnancy problems, categorizing such information into various determinant levels for appropriate response, and for giving qualified emergency medical information to callers thereby permitting "zero time" response by those at the scene. By using this invention properly a dispatcher is guided through the interrogation of callers concerned with pregnancy, childbirth or miscarriage medical problems, gathering critical information and giving the appropriate guidance to the caller. This invention specifically guides the dispatcher through the steps of the pregnancy/childbirth/miscarriage protocol, thereby identifying the degree of urgency of such complaints and appropriately dispatching emergency medical responders. Excerpt(s): This invention relates to methods and systems for processing and responding to emergency medical inquiries. Specifically, this invention relates to the process or method of managing the dispatch of emergency medical care to callers or patients with pregnancy, childbirth or miscarriage problem complaints. Providing adequate emergency medical care presents several critical challenges to medical care providers. These challenges include: the proximity to the care provider, the time required for help to arrive, the identification of the criticality of the emergency, the appropriate level of care provided, the variances in training of emergency medical dispatcher personnel, and limited nature of emergency care resources. This invention addresses these challenges by providing a consistent and proven system for: First, gathering necessary medical complaint information from emergency medical inquiry callers and providing emergency verbal instructions to individuals at the scene. Second, prioritizing the complaint to determine the criticality of the emergency. Third, assisting dispatched responders to be prepared for each emergency situation. Fourth, advising those on the way to provide care at the scene of specific problems or potential hazards. When used correctly this invention decreases the effective response time, while increasing the professionalism and control of emergency medical dispatchers, increases the accuracy and appropriateness of patient interrogation and well as the quality of gathered information, reduces the number of multiple unit responses thereby reducing the risk of emergency medical vehicular collisions, improves patient care, reduces burnout and stress of dispatchers by improving their quality of training, decreases the risk of responder injury or mistake by providing responders with improved knowledge of the situation, and provides an means for continuously improving the quality of emergency patient care. While being included within a greater invention that addresses all of the above issues, this invention specifically addresses the pregnancy/childbirth/miscarriage problem protocol or procedure. Pregnancy problems

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constitute some of the most common, urgent and critical of emergency medical calls. Accurate, efficient and systematic responses to these calls can and does make the difference in the successful resolution of pregnancy problems. This invention specifically addresses these types of problems. It is desirable to provide a systematic and standardized method for responding to emergency medical requests. Although in the related art some attempt has been made to address the problem of medical care assessment, the related art does not address the specific problems of emergency dispatcher response to pregnancy, childbirth or miscarriage problem calls. Rather related art approaches describe the following. A process of helping patients assess their health, select appropriate health care, and guide such patients to an appropriate level and type of care. An automated medical history taking system and a technique wherein selected branch paths through a question repertory are provided. A method and apparatus for coordinating the actions of two or more medical teams, especially for instructional purposes. An expert system for providing suggested treatments for a patient with physical trauma. A medical payment system that incorporates computer technology in the storage, retrieval and processing of patient data and insurance claims. A knowledge base containing medical/pathological information on various diseases. A hospital computerized system for entering information pertinent to a patient's stay in the hospital. An expert computer system for processing medical claims. An interactive computerized apparatus and method for presenting medical information for diagnosis and study of disease. An automated and interactive positive motivation system to send a series of motivational messages and/or questions to a client to change or reinforce a specific behavioral problem. An artificial intelligent expert system. A rapid response health care communications system for providing rapid and reliable health services to patients located within or outside a health care facility. Web site: http://www.delphion.com/details?pn=US06076065__ •

Method for differentiating vaginal secretory fluid or cervical mucus of pregnant woman suffering from threatened premature delivery Inventor(s): Saito; Shigeru (Habikino, JP), Nozawa; Masayuki (Tokyo, JP), Ichijo; Motohiko (Nara, JP), Maeda; Makiko (Tokyo, JP) Assignee(s): Daiichi Pure Chemicals Co., Ltd. (Tokyo, JP) Patent Number: 6,027,908 Date filed: October 7, 1996 Abstract: Described is a method for differentiating the vaginal secretory fluid or cervical mucus of a pregnant woman suffering from threatened premature delivery, which comprises measuring an amount of Interleukin-8 in the vaginal secretory fluid or cervical mucus. The above method makes it possible to differentiate the vaginal secretory fluid or the like of the pregnant woman suffering from threatened premature delivery with good sensitivity and therefore is useful for the detection, treatment or the like of premature delivery. Excerpt(s): The present invention relates to a method for differentiating the vaginal secretory fluid or cervical mucus of a pregnant woman suffering from threatened premature delivery, which method is useful for the detection of premature delivery. Premature delivery is one of the abnormalities which occur accompanied with pregnancy. It is caused by various reasons but ascendens infection, intrauterine infection and abruption of placenta are considered as main reasons. In the case where the premature delivery occurs because of an infectious disease or chorionic amnionitis, the

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concentration of C-reactive protein (CRP) and the leukocyte count both in the blood of the mother's body show an increase so that premature delivery is checked by measuring these values. Web site: http://www.delphion.com/details?pn=US06027908__ •

Method for obtaining estrogens from pregnant mare urine by solid phase extraction on a semi-polar adsorber resin Inventor(s): Ban; Ivan (Hanover, DE), Heinemann; Henning (Lehzte-Aligee, DE), Rasche; Heinz-Helmer (Burgdorf, DE), Mechtold; Gerhard (Hanover, DE) Assignee(s): Sovlay Deutschland GmbH (Hanover, DE) Patent Number: 5,723,454 Date filed: November 26, 1996 Abstract: A method for obtaining an extract containing the natural mixture of conjugated estrogens from mare urine by solid-phase extraction of the mixture of conjugated estrogens from the urine of pregnant mares on non-ionic semi-polar polymeric adsorber resins. Excerpt(s): The present invention relates to obtaining a natural mixture of conjugated estrogens from the urine of pregnant mares. Estrogens are used in medicine for hormone replacement therapy. In particular, estrogen mixtures are used for the treatment and prophylaxis of the disorders of the climacteric period which occur in women after natural or artificial menopause. In this case, natural mixtures of conjugated estrogens such as are found in the urine of pregnant mares have proved particularly effective and well tolerated. The dissolved solids content in the urine of pregnant mares (=pregnant mare urine or "PMU") may naturally vary within wide ranges, and may generally lie in a range of 40-90 g dry matter per liter. In addition to urea and other usual urine contents, phenolic constituents are contained in the solids content of the PMU in quantities of about 2-5% by weight relative to dry matter. These phenolic constituents include cresols and dihydro-3,4-bis›(3-hydroxyphenyl)methyl!-2(3H)furanone, known as HPMF. These may be present in free or conjugated form. The PMU contains a natural mixture of estrogens which is largely present in conjugated form, e.g. as sulfuric acid semi-ester sodium salt (referred to hereinafter as "sulfate salt"). The content of conjugated estrogens (calculated as estrogen sulfate salt) may be between 0.3 and 1% by weight relative to dry matter. Web site: http://www.delphion.com/details?pn=US05723454__

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Method for terminating pregnancy Inventor(s): Revici; Emanuel (New York, NY) Assignee(s): Avram; Elena (New York, NY) Patent Number: 4,609,552 Date filed: April 12, 1985 Abstract: A method for terminating pregnancy which comprises internally administering to the body a sufficient amount of a bivalent negative sulfur composition to induce menstruation.

Patents 361

Excerpt(s): This invention relates to a method for terminating pregnancy by administering to the body an amount of elemental sulfur or a non-toxic bivalent negative sulfur composition sufficient to terminate the pregnancy by inducing menstruation. Examples of non-toxic bivalent negative sulfur compositions that can be used according to the invention include the reaction products of allylic unsaturated fatty acids or esters and sulfur. As disclosed in U.S. Pat. No. 4,368,206, such reaction products are produced by oxidizing a liquid composition containing a fatty acid or fatty ester, structurally characterized by allylic unsaturation, for example, by bubbling air through the reaction mixture. The fatty acid or ester advantageously includes elemental sulfur and/or a conventional free radical initiator such as tertiary-butyl peroxide during the heating step. The allylically unsaturated compound is preferably a naturally occurring oil containing polyunsatuarated fatty esters, such as an animal, vegetable, or fish oil, and, particularly, polyunsaturated vegetable oils. Sesame oil, a vegetable oil consisting largely of triglycerides, is the most advantageous composition found to date in the practice of this invention. Web site: http://www.delphion.com/details?pn=US04609552__ •

Method for testing for pregnancy Inventor(s): Saxena; Brij B. (Englewood, NJ) Assignee(s): Cornell Research Foundation, Inc. (Ithaca, NY) Patent Number: 4,016,250 Date filed: November 11, 1974 Abstract: Method for the determination of the hormone human chorionic gonadotropin (HCG), luteinizing hormone (LH), prolactin (PRL) and HCG-like material in an aqueous sample comprising contacting a highly specific receptor for these hormones with an aqueous sample to be tested, providing a means of indicating whether binding has taken place between the receptor and hormone possibly contained in the sample and observing the indicating means to determine the presence of the hormone in the sample. PRL may be determined separately or simultaneously with the HCG and LH. The receptor is a plasma membrane extract from the corpus luteum of an animal which possesses the receptor for HCG, LH, PRL and HCG-like material. Radioassay indicating means are preferred, according to which competitive protein binding between radioisotopically labeled hormone and hormone present in the sample is radiologically determined. The method has particular application to the determination to pregnancy in the human female. Excerpt(s): The present invention relates to a method and means for the determination of the hormones human chlorionic gonadotropin (HCG), luteinizing hormone (LH) and prolactin (PRL) and more especially to a fundamentally new method and means for detection of pregnancy in the human female. Tests for the detection of pregnancy are generally based on the determination of hormones which are produced by the developing placenta, such as gonadotropic hormones similar to those produced by the anterior pituitary gland and steroid hormones similar to those of the ovary and adrenal gland. Pregnancy tests in use today are nearly exclusively based upon an assay for the placental hormone, human chorionic gonadotropin (HCG). This hormone is found in body fluids (blood serum and urine) only during pregnancy, with the exception of several other very rare hormone-producing conditions of the body. The International Unit (I.U.) of HCG was adopted in 1938 and is defined as the specific gonadotropic activity of 0.1 mg. of a dried standard kept at the National Institutes of Health, London,

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England. The earliest tests for pregnancy were based upon biological in vivo methods for determining the presence of HCG. For example, the earliest test, the AschheimZondek test was based upon the ability of HCG injected subcutaneously in mice to produce corpora lutea. The Friedman test is another biological test in which a urine sample of the suspected pregnancy is injected into the ear vein of a mature female rabbit which has been isolated 3 to 4 weeks, and 48 hours after injection the ovaries are examined for ruptured hemorrhagicfollicles, which indicate a positive reaction. A lesser known test developed by Kupperman in 1943 involves the injection of the patient's urine into a female rat with subsequent inspection of the ovary for signs of hyperemia. While the two hours necessary for conducting this test is considerably shorter than the 48 hours required for the Friedman test and the nearly five days required for the Aschheim-Zondek test, this test is not as reliable since it requires a skilled technician to differentiate a slightly pink negative ovary from a reddened positive ovary to attain a high degree of accuracy. A test developed by Galli and Mainini in the late 1940's also requires only approximately two hours to conduct the test; however, this test involves the injection of the patient's urine into frogs with the subsequent observation for ejection of sperms, and these animals are relatively insensitive compared with rabbits, mice and rats. Web site: http://www.delphion.com/details?pn=US04016250__ •

Method for the detection of pregnancy disorders Inventor(s): Silberman; Michael (P.O. Box 9697, Haifa 31096, IL) Assignee(s): Technion Research & Development Foundation Ltd. (Haifa, IL), Silberman; Michael (Haifa, IL) Patent Number: 5,198,366 Date filed: August 16, 1991 Abstract: The present invention relates to a method for an early stage detection of three specific pregnancy-related disorders: preeclampsia, intrauterine growth retardation and preterm delivery. According to the method, an antigen consisting of a specific humanderived placental soluble protein, known as PP-13, is determined by radioimmunoassay or ELISA. In the radioimmunoassay method, the PP-13 is labelled by a radioactive iodine and the bounded iodine is counted and correlated with standard curves. The best results are obtained when the protein to be labelled by radioactive iodine is present at a concentration of above 0.71 mg/ml. In case of the ELISA method, the quantitative determination of PP-13 is carried out with an alkaline phosphatase substrate and measured at an optical density of 405 nm. Excerpt(s): The present invention relates to a new method for the detection of pregnancy-related disorders. More particularly, the invention relates to a new method for the detection of three specific pregnancy-associated disorders: severe preeclampsia, Intra-Uterine Growth Retardation (IUGR) and preterm delivery, at a relatively early stage of pregnancy. As known, high risk pregnancies constitute about 10 to 25% of pregnancies. Among the high risk pregnancy disorders the following can be mentioned: diabetes, kidney diseases (such as chronic pyelonephritis, chronic pyelonephritis and renal insufficiency), heart diseases (such as primary pulmonary and hypertension).The known methods for controlling the progress of pregnancy, have the disadvantage of detecting the status of pregnancy disorders at a relatively late stage, when the clinical signs and symptoms are already apparent. There are several hormone assays suggested to give an indication whether placental function is normal or to predict impending fetal

Patents 363

death. The tests most widely used are: urine estriol, urine total estrogens, serum unconjugated estriol and serum placental lactogen. As known, estriol is an estrogenic compound produced by the placental from precursors derived from fetal adrenal cortex and fetal liver. The conjugated form of estriol is excreted into the maternal urine. Serum estriol can be measured either as total estriol or as unconjugated estriol. It usually is measured as unconjugated estriol in order to exclude maternal contribution to the conjugated fraction. Urine estriol can be measured as total estriol or as total estrogens, since estriol normally constitutes about 90% of urine total estrogens. Web site: http://www.delphion.com/details?pn=US05198366__ •

Method for treating pregnant females for pain and anxiety Inventor(s): Frederickson; Robert C. A. (Indianapolis, IN) Assignee(s): Eli Lilly and Company (Indianapolis, IN) Patent Number: 4,430,327 Date filed: May 18, 1982 Abstract: A method is described for preventing or minimizing the effects of a drug on an embryo or a fetus by placental transport while alleviating pain and anxiety of the pregnant female by administering a pharmaceutically effective amount of a compound of the formulaH-L-Tyr-D-Ala-Gly-L-Phe-L-(N-CH.sub.3)Met-NH.sub.2or a pharmaceutically acceptable salt thereof. Excerpt(s): This invention is directed to a method for preventing or minimizing the effects of a drug on an embryo or a fetus by placental transport while alleviating pain and anxiety of the pregnant female during such pregnancy. It has long been recognized that analgesics, at best, have limited use for women at all stages of pregnancy including labor and delivery. This limitation is due to the recognized transfer of the analgesic across the placental barrier with resultant potential detremental effect on the developing embryo or fetus. In addition, during labor, placental transport can produce depression of respiration of the newborn. and is covered by U.S. Pat. No. 4,322,342. It is to the use of this compound and pharmaceutically acceptable salts thereof that this invention is directed. Web site: http://www.delphion.com/details?pn=US04430327__

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Method for using breath carbon monoxide concentration measurements to detect pregnant women at risk for or experiencing various pathological conditions relating to pregnancy Inventor(s): Seidman; Daniel (Tel-Hashomer, IL) Assignee(s): Natus Medical, Inc. (San Carlos, CA) Patent Number: 6,416,479 Date filed: July 14, 2000 Abstract: A non-invasive method for the early detection and assessment of the severity of various pathological conditions in pregnancy including pregnancy-induced hypertension, preeclampsia, premature uterine contractions and intrauterine growth retardation. The carbon monoxide or end-tidal carbon monoxide concentration is measured in a pregnant woman's breath and compared to thresholds for determining

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the likelihood of onset or actual onset of these pathological conditions. The measurements can be made in a clinic, hospital, physician's office, or any other location easily accessible to pregnant women using any of a number of devices for measuring breath carbon monoxide. One solution is to measure end-tidal breath carbon monoxide using the Natus.RTM. CO-Stat.RTM. End Tidal Breath Analyzer, manufactured and sold by Natus Medical Inc. of San Carlos, Calif. This particular device allows an operator to perform non-invasive, simple and rapid, automatic sampling and analysis of end-tidal carbon monoxide in expiratory air without the requirement for laboratory analysis or highly trained personnel. Thus, the method can be employed using a device that does not required laboratory analysis or highly trained personnel, and results in an on-thespot, immediate determination which is vital for rapid treatment of these serious conditions of pregnancy. Excerpt(s): The present invention relates generally to methods for using breath carbon monoxide ("CO"), more particularly end-tidal carbon monoxide ("ETCOc") concentration measurements, to predict the occurrence of various pathological conditions during pregnancy as well as methods for using such measurements to determine the actual onset of such conditions. Pregnancy-induced hypertension ("PIH") is a common medical complication of pregnancy which encompasses a group of disorders including preeclampsia ("PET"). PET is primarily a disease of the last trimester of pregnancy and is the most common medical complication of pregnancy. It has a reported incidence ranging between 5% and 10% depending on the population demographics.sup.1 As the pathogenesis of these disorders is unclear, prediction and prevention remain an elusive goal. End-organ damage, especially to the kidneys and liver, may result if the condition is not recognized early enough, and the condition can be life-threatening. Consequences for the late-term fetus include diminished placental blood flow, and subsequent wasting and asymmetrical growth of the fetus. At present, the best cure for the disease is delivery of the preterm baby followed by intensive neonatal care for the baby and intensive surgical care for the mother. Web site: http://www.delphion.com/details?pn=US06416479__ •

Method of predicting and enhancing success of IVF/ET pregnancy Inventor(s): Stewart; Dennis R. (Sacramento, CA), Vandervoort; Catherine A. (El Macero, CA) Assignee(s): The Regents of University of California (Oakland, CA) Patent Number: 5,994,148 Date filed: June 23, 1997 Abstract: A method of determining the probability of an in vitro fertilization (IVF) or embryo transfer (ET) method being successful is disclosed. Relaxin can be measured directly in the serum or indirectly by culturing granulosa lutein cells extracted from the patient as part of an IVF/ET procedure. A method of enhancing the rate of a successful pregnancy resulting from an IVF/ET procedure is also disclosed whereby relaxin is administered. Excerpt(s): The invention relates generally to the field of assays and methods of treatment. In particular the invention relates to determining relaxin levels and relating the levels to the probability of success in an in vitro fertilization or embryo transfer procedure. Reproductive failure is a serious problem that has been addressed clinically by in vitro fertilization (IVF) and embryo transfer (ET). These procedures might be

Patents 365

expected to yield exceptionally high conception rates as in vitro fertilization provides an already fertilized ova for transfer into a fully primed recipient. Despite these efforts the success rate of IVF/ET is less than ideal. In the published data for IVF/ET in the United States and Canada in 1994, there were 26,961 initiated cycles of standard IVF. Of these, 86.2% led to a retrieval and of these 90.2% led to a transfer. However, the overall success rate in terms of clinical pregnancies was 22.7% per initiated cycle and a 29.1% pregnancy rate per transfer. Additionally, there appears to be a high incidence of early pregnancy loss after in vitro fertilization with a biochemical pregnancy rate of 18% and a spontaneous abortion rate of 27%. Thus, it appears that the IVF technique has been well optimized but implantation failure may be the cause for a large number of losses with ET and this implantational loss is an area of potential improvement. The factors which contribute to the success of in vitro fertilization/embryo transfer (IVF/ET) have been extensively studied. In looking at what factors may affect implantation, many studies have reported correlations of hormonal or measurement of other parameters with conception rate. High conception rates have been associated with lowered follicular phase PP14 concentrations, large increases in PP14 concentrations from the day of hCG stimulation to the day of embryo transfer, high preretrieval concentrations of CA-125, large increases in CA-125 from the day of hCG stimulation to oocyte retrieval, increased uterine blood flow, increased uterine artery impedance, and an inhibition of uterine motility in the periimplantation period. It has also been suggested that lowered estradiol concentrations at the time of ovulation induction lowered progesterone concentrations at the time of hCG stimulation, or the magnitude of the increase in progesterone in response to hCG stimulation have a higher success of conception. These reports generally fail to determine the mechanism by which these observations are translated into impaired conception. Web site: http://www.delphion.com/details?pn=US05994148__ •

Method of predicting threatened premature delivery in a pregnant woman Inventor(s): Awaya; Juichi (Nagoya, JP), Kurono; Masayasu (Nagoya, JP), Yasuda; Yoshika (Nagoya, JP), Morioka; Akihiro (Nagoya, JP), Kanayama; Naohiro (Hamamatsu, JP), Terao; Toshihiko (Nagoya, JP), Sawai; Kiichi (Nagoya, JP), Kamiya; Masami (Nagoya, JP) Assignee(s): Sanwa Kagaku Kenkyusho Co., Ltd. (Nagoya, JP) Patent Number: 5,290,679 Date filed: June 15, 1992 Abstract: Even when the specimen contains human granulocyte elastase in the form of a mixture of free elastase with an elastase-inhibitor complex or complexes, the present invention enables the total quantity of elastase in that specimen to be precisely detected. The inhibitor is added to free elastase to convert it into an elastase-inhibitor complex, whereby the quantity of elastase can be measured by immunoassay as the total amount including the previously existing elastase-inhibitor complex. It is possible to precisely measure the total amount of elastase in mucus collected from the cervical canal of a pregnant woman, sputum or a rinsed solution of bronchovesicular lavage in which free elastase is mixed with an elastase-inhibitor complex. It is thus possible to predict and prevent threatened premature delivery, premature delivery or premature rupture of membranes by immunoassay of mucus collected from the cervical canal of a pregnant woman, to make a diagnosis of chronic or repetitive airway infections and pulmonary emphysema based on chronic respiratory diseases by immunoassay of sputum and a

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rinsed solution of bronchovesicular lavage and to make a diagnosis of urinary tract infections by immunoassay of urine. Excerpt(s): The present invention relates generally to making immunoassay of human granulocyte elastase and, more particularly, to a method for precisely assaying the amount of human granulocyte elastase in the specimen to be assayed as the total amount of human granulocyte elastase, when that specimen contains a mixture of free elastase with an elastase-inhibitor complex as well as how to use it clinically. Human granulocytes are located in the forefront of the biophylaxis mechanism, gathering on the site of infection at the very initial stage of invasion and releasing proteases and active enzymes for decomposition, degradation and sterilization of foreign matters and bacteria. Of the released proteases, elastase has the strongest action and so holds a central position of the biophylaxis mechanism. However, on the other hand, this enzyme is too low in substrate specificity to decompose various connective tissue components (elastin, collagen, proteoglycan, etc.), inducing destruction of the living body's tissue due to digestion and degradation of constructive proteins. Usually, a living body has in its blood a large amount of inhibitors, like.alpha.sub.1 -antitrypsin, so as to protect the tissue not subject to invasion against the strong digestive actions of enzymes; that is, even when elastase released from granulocytes gathering on the site of invasion is diffused throughout the living body by blood circulation, elastase-inhibitor complexes are immediately formed, whereby the activity of elastase is deactivated to prevent the tissue from being destructed more than required. Web site: http://www.delphion.com/details?pn=US05290679__ •

Method of preventing or treating toxemia in pregnancy using a thromboxane A.sub.2 receptor antagonist Inventor(s): Ogletree; Martin L. (Newtown, PA) Assignee(s): E. R. Squibb & Sons, Inc. (Princeton, NJ) Patent Number: 4,808,627 Date filed: December 16, 1987 Abstract: A method is provided for preventing or treating toxemia during pregnancy by administering a thromboxane A.sub.2 receptor antagonist before or during toxemia. Excerpt(s): The present invention relates to a method for preventing or treating toxemia in pregnancy by administering a thromboxane A.sub.2 receptor antagonist to a pregnant woman. Hypertension of pregnancy/preeclampsia". In addition, at page 135, it is indicated that preeclampsia and pregnancy-induced hypertension are associated with increased production of TxA.sub.2 by the placenta and by platelets and that TxA.sub.2 may be a pivotal mediator in certain complication of pregnancy. In accordance with the present invention, a method is provided for preventing or treating toxemia during pregnancy in mammalian species, wherein a therapeutically effective amount of a thromboxane A.sub.2 receptor antagonist is systemically administered, such as orally or parenterally, to mitigate adverse effects of thromboxane during pregnancy, for example, as may be indicated in an ovine model of pregnancy-induced hypertension, as described by Keith, J. C., Jr. et al., Am. J. Obstet. Gynecol., 157, No. 1, 199-203, 1987. Web site: http://www.delphion.com/details?pn=US04808627__

Patents 367

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Method of treatment for premature rupture of membranes in pregnancy (PROM) Inventor(s): Kablik; J. Jeffrey (Tyngsboro, MA), Kazo; Glenn M. (New Ipswich, NH), Enscore; David J. (Sudbury, MA), Herman; Stephen J. (Andover, MA) Assignee(s): Andre Bieniarz (Chicago, IL) Patent Number: 6,350,463 Date filed: May 21, 1999 Abstract: Premature Rupture of the Membranes (PROM) is a serious complication of pregnancy. PROM is treated by creation of a seal or barrier at the site of the rupture or in or near the cervix, thereby controlling the loss of amniotic fluid and preventing bacterial access. Instruments and techniques for application of sealing and barrier-forming materials at appropriate sites are described, as well as appropriate selection of materials and formation techniques. The instruments and techniques facilitate application of any fluent material to physiology associated with pregnancy and rendering the fluent material non fluent so as to form a barrier of seal. Excerpt(s): If membrane rupture could be repaired, or if leakage of amniotic fluid could be minimized or prevented, it is believed that premature delivery could be significantly delayed, thereby significantly extending the degree of fetal maturity. Every day of extension of pregnancy can decrease the severity of fetal impairment due to prematurity by up to one percent; thus, maximizing the duration of pregnancy is clinically important. Cessation of leakage would also tend to minimize intrauterine infection. However, there are at present no reliable techniques for such treatment. In particular, the amniotic membrane is poorly vascularized and slow to heal, and is not easily accessible. Moreover, the location of the rupture is often difficult to determine. The literature describes attempts to block amniotic fluid release by means of balloons, or with fibrin glue. Neither of these techniques has been sufficiently successful to enter general practice. Restriction of amniotic fluid loss with a balloon or similar device may be ineffective to prevent infection, and fibrin glue is typically rapidly degraded. Materials and techniques for treating body tissues and sealing leaking lesions in tissues are known. Web site: http://www.delphion.com/details?pn=US06350463__

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Methods for detecting pregnancy Inventor(s): Pandian; Murugan R. (Mission Viejo, CA), Lu; Julie Y. (Mission Viejo, CA) Assignee(s): Quest Diagnostics Investments Incorporated (Wilmington, DE) Patent Number: 6,627,457 Date filed: July 30, 2001 Abstract: Methods for detecting pregnancy in a woman comprise screening a biological sample of the woman for pregnancy markers. The methods of the invention include chemiluminescent assays for the pregnancy markers. The methods of the invention also comprise utilizing at least two capture antibodies that specifically bind different epitopes of the pregnancy marker in one assay. The methods of the invention permit detection of pregnancy within about 7 days after ovulation or implantation. Excerpt(s): The present invention provides methods for detecting pregnancy in a woman. In particular, the methods comprise screening biological samples for biological markers associated with pregnancy. One aspect of the invention is related to the

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discovery that using a combination of two capture antibodies that specifically bind different epitopes of ITA in one assay improves the sensitivity of the assay for the biological markers. In one embodiment of the invention, a method for detecting pregnancy in a woman comprises the step of: contacting a biological sample of the woman with antibodies that bind invasive trophoblast antigen (ITA), in a chemiluminescent assay, wherein the assay comprises at least two antibodies that specifically bind different epitopes of the ITA, wherein a label coupled to at least one of the two antibodies produces a detectable signal, and wherein the presence of a detectable signal indicates pregnancy in the woman. In another embodiment of the invention, a method for detecting pregnancy in a woman comprises contacting a biological sample of the woman with antibodies that bind ITA in an assay, wherein the assay comprises at least two antibodies that specifically bind different epitopes of ITA, wherein a label coupled to at least one of the two antibodies produces a detectable signal. Web site: http://www.delphion.com/details?pn=US06627457__ •

Methods for predicting pregnancy outcome in a subject by HCG assay Inventor(s): Birken; Steven (Dumont, NJ), Kovalevskaya; Galina I. (New York, NY), O'Connor; John F. (New Rochelle, NY) Assignee(s): The Trustees of Columbia University in the City of New York (New York, NY) Patent Number: 6,500,627 Date filed: February 3, 1998 Abstract: The present invention provides a method of predicting pregnancy outcome in a subject by determining the amount of an early pregnancy associated molecular isoform of hCG in a sample. The present invention further provides a method for determining the amount of early pregnancy associated molecular isoforms of human chorionic gonadotropin (hCG) in a sample. The present invention also provides a diagnostic kit for determining the amount of early pregnancy associated hCG is a sample. The present invention additionally provides an antibody which specifically binds to an early pregnancy associated molecular isoform of human chorionic gonadotropin. Finally, the present invention provides methods for detecting trophoblast or non-trophoblast malignancy in a sample. Excerpt(s): Throughout this application, various publications are referenced by author and date. Full citations for these publications may be found listed alphabetically at the end of the specification immediately preceding the claims. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art. Early pregnancy loss (EPL) is a widespread, but largely undiagnosed problem. In order to adequately diagnose and develop treatments for EPL it is essential to be able to detect and measure the rate of occurrence of EPL. This is critically important in epidemiological studies, some of which are related to exposures to known or suspected reproductive toxins in the workplace, in the environment or by personal use. These early pregnancy losses are often not recognized by women or physicians and are detected solely by the measurement of hCG in the urine at the time between implantation and expected menses. They are sometimes termed "chemical pregnancies" or "occult pregnancies." A landmark epidemiological study established that the incidence of EPL was 22% in a population of healthy women attempting to conceive (Wilcox, A. J., et al., 1988). This investigation employed a very

Patents 369

sensitive (0.01 ng/ml hCG) assay which detected only the intact hCG molecule with the unique beta subunit carboxyterminal peptide present. There are multiple likely causes for EPL and clinical spontaneous abortion including genetic abnormality, immunological dysfunction, untreated infection or other unknown physiological problems. In addition, losses may be caused by failure of human chorionic gonadotropin (hCG) to induce adequate response at its target, the corpus luteum. This could result from inadequate hormonal potency. "Nicking" of the beta subunit in the loop 2 region of the molecule, specifically between residues 44-49, can reduce biopotency hCG. Cleaved peptide bonds in this area of the molecule also exhibit reduced biopotency and reduced immunochemical recognition by monoclonal antibodies directed to the heterodimeric hormone (Cole, L. A., et al., 1991a; Cole , L. A., et al., 1991b; Puisieux, A., et al., 1990; Nishimura, R., et al., 1988; Nishimura, R. T., et al., 1989). Nicked forms of hCG were examined as possibly more prevalent in EPL situations and, at least in part responsible, for early pregnancy loss. Unfortunately many of the reports claiming that substantial concentrations of nicked hCG are produced during pregnancy, losses or successful pregnancies, are not accurate due to faulty assumptions regarding assay specificity (Wilcox, A. J., et al., 1988). Carbohydratemodified hCG can also exhibit reduced biopotency. It is known that if the hCG has much reduced sialic acid content and its carbohydrate chains terminate in galactose, much hCG would be removed by the liver receptor for such altered glycoproteins (Braun, J. R., et al., 1996; Kawasaki, T. and G. Ashwell, 1996). The circulating life-time of asialo hCG is reduced and its in vivo potency is thereby low. Other carbohydrate changes also alter circulating half life; glycoproteins terminating in sulfate-N-acetyl galactosamine are also extracted by a specific liver receptor and have reduced circulating lifetime (Baenziger, J. U., 1994; Fiete, D., et al., 1991). Web site: http://www.delphion.com/details?pn=US06500627__ •

Methods of terminating pregnancy Inventor(s): Espey; Lawrence L. (San Antonio, TX) Assignee(s): Trinity university (San Antonio, TX) Patent Number: 5,356,876 Date filed: August 21, 1992 Abstract: A method of terminating pregnancy in mammals is described by a novel application of the common fertility-promoting hormone known as human menopausal gonadotropin. A single injection of this gonadotropic hormone as early as the first day of conception can terminate pregnancy. Excerpt(s): This invention relates to a novel use of the common fertility-promoting hormone hMG (human menopausal gonadotropin) as an agent to terminate the fertile state of pregnancy in female mammals. This invention also relates to the use of hMG for terminating pregnancies in humans. If an egg is fertilized and the developing embryo becomes implanted in the uterus, special embryonic cells called trophoblasts begin secreting a hormone called chorionic gonadotropin (CG). (In humans this hormone is called human chorionic gonadotropin and is abbreviated as hCG.) CG circulates from the uterus back to the ovaries and stimulates any ruptured follicles (which are now called corpora lutea) to produce large amounts of the steroid hormone progesterone (Espey, L. L., and I. A. BenHalim, Obstet. Gynecol. Clin. N. Amer. 17:275, 1990). Progesterone has two principal functions; (1) it maintains the uterine lining in the nutritive state that is required to support a developing embryo, and (2) it circulates back

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to the hypothalamus and the pituitary gland and inhibits further secretion of GnRH, FSH, and LH. This inhibitory action of progesterone prevents a second ovulatory process from occurring in a gravid animal. That is to say, a second pregnancy cannot occur "on top of" an existing pregnancy. Thus, progesterone functions as a natural contraceptive during pregnancy. This steroid hormone is also the basis of the oral contraceptive pills that are commonly used today. Synthetic progestins (along with some estrogens) are used in "the pill" to block ovulation by inhibiting the normal preovulatory surge in GnRH, FSH, and LH (Espey, L. L., and I. A. BenHalim, Obstet. Gynecol. Clin. N. Amer. 17:275, 1990). Web site: http://www.delphion.com/details?pn=US05356876__ •

Multipurpose pregnancy and labor timing device Inventor(s): Handy; Jeffrey D. (Collierville, TN), Lloyd; Mark J (Cary, NC) Assignee(s): J.D.H. Enterprises, Inc. (Gainesville, FL) Patent Number: 5,876,335 Date filed: February 28, 1997 Abstract: A multipurpose pregnancy and labor timing device for use by expectant parents during the gestation, labor, and birth of their child. The timing device includes an output device for conveying a plurality of datum to a human ovserver. The datum conveyed may represent a current time, day and date, an expected date of birth of the child, an estimated elapsed time period since the conception date of the child, an estimated time period until the birth of the child, the count of contractions experienced by a woman undergoing the process of labor, the time interval between contractions, the duration of a contraction, and the actual time and date of the birth of the child. The timing device also includes a nonvolatile memory for storing at least some of the plurality of datum, a data selection device for selecting at least some of the plurality of datum for conveyance by the output device, and a data initialization device for initializing the first datum and the second datum. The timing device further includes a processor control device for performing a first sequence of operations to store at least some of the plurality of datum into the nonvolatile memory, for performing a second sequence of operations to retrieve at least some of the plurality of datum from the nonvolatile memory so that at least some of the plurality of datum is conveyed by the output device, and for calculating at least some of the plurality of datum. Excerpt(s): Not applicable. Not applicable. The present invention relates, in general, to a medical device, and in particular, to a multipurpose pregnancy and labor timing device for assisting a pregnant woman and a prospective father in keeping track of the expected time until the birth of their child, for timing contractions when the woman is experiencing labor, and for recording the exact time and date of birth of their child. Web site: http://www.delphion.com/details?pn=US05876335__

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Multi-vitamin and mineral supplement for pregnant women Inventor(s): Levinson; R. Saul (Chesterfield, MO), Cuca; Robert (Edwardsville, IL), Kirschner; Mitchell I. (St. Louis, MO), Paradissis; George (St. Louis, MO), Heeter; Gary (Chesterfield, MO) Assignee(s): DrugTech Corporation (Wilmington, DE) Patent Number: 6,228,388 Date filed: May 7, 1997 Abstract: Multi-vitamin and mineral supplements for administration to a pregnant woman during her first, second, and third trimesters of pregnancy comprising specific regimens of a pharmaceutically acceptable calcium compound, vitamin D, folic acid, vitamin B.sub.12, vitamin B.sub.6, and vitamin B.sub.1. The prenatal supplements are specifically tailored to maximize fetal development and maternal health during each trimester of pregnancy. Excerpt(s): The present invention relates to multi-vitamin and mineral supplements, and particularly to a novel multi-vitamin and mineral supplement for administration during pregnancy. Vitamin and mineral preparations are commonly administered to treat specific medical conditions or as general nutritional supplements. Recent studies have elucidated the important physiological roles played by vitamins and minerals, and established a correlation between deficiencies or excesses of these nutrients and the etiologies of certain disease states in humans. See, e.g., Diplock, "Antioxidant Nutrients and Disease Prevention: An Overview," Am. J. Clin. Nutr., 53:189-193 (1991); Documenta Geigy Scientific Tables, 457-497 (Diem and Cemtuer eds., 7th ed., 1975). It has further become recognized that various groups of the human population require different quantities and types of vitamins and minerals to prevent or alleviate diseases, as well as to maintain general good health. For example, it is known that pregnant women commonly require iron therapy to prevent or treat iron-deficiency anemia. Various prior patents have been directed to improving the efficacy of iron supplements for use during pregnancy. U.S. Pat. No. 4,994,283, for example, discloses nutritional mineral supplements which include iron and calcium compounds in combination with citrates or tartrates, ascorbates, and fructose. The tendency of calcium to inhibit the bioavailability of iron is said to be reduced in such compositions, so that the conjoint bioavailability of these two minerals is enhanced. Web site: http://www.delphion.com/details?pn=US06228388__

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Nutritional supplement preparation intended for pregnant and breast-feeding women based on milk constituents as well as a process for preparing it Inventor(s): Hersevoort; Aart (Nieuwegein, NL), Uiterwaal; Dirk J. D. (Bodegraven, NL) Assignee(s): Melkunte Holland B.V. (AE Woerden, NL) Patent Number: 4,710,387 Date filed: November 7, 1985 Abstract: Nutritional supplement preparation for pregnant and breast-feeding women based on milk constituents for pregnant and breast-feeding women containing 10-20% by weight of protein, 16-28% by weight of fat, 43-65% by weight of carbohydrates, at most 3.5% by weight of moisture and minerals, trace elements and vitamins such as calcium, phosphorus, magnesium, copper, zinc, iodine, iron, vitamin A, vitamin B1,

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vitamin B6, vitamin C, vitamin D3, vitamin E, niacin and folic acid, and, optionally flavoring and/or colorant as well as a process for preparing said preparation. Excerpt(s): The invention relates to a nutritional supplement preparation intended for pregnant and breast-feeding women based on milk constituents. It is generally known that the nutrition of pregnant and breast-feeding women has to meet higher requirements in respect of all the nutrients (energy, proteins, minerals and vitamins). In most cases, pregnant and breast-feeding women are advised to consume relatively calorie-rich food and more proteins; in milk-producing countries, especially, this complement is based on dairy products, frequently complemented with other supplementary preparations, such as one or more minerals, vitamins and/or ironcontaining preparations. Concerning the requirements as to the quantities of the extra nutrients, there exists a number of generally accepted standards, such as the "recommended daily allowances" (RDA). Such recommendations are in general based on calculations, extrapolations and assumptions. Though some guidelines for advice to the women in question can be derived from these RDA standards, these standards, in their present form, provide no answer to the question of the optimum nutritional supplement. Web site: http://www.delphion.com/details?pn=US04710387__ •

Post-pregnancy compression garment Inventor(s): Rosenberg; Jennifer (3208 NW. 63rd St., Boca Raton, FL 33496) Assignee(s): none reported Patent Number: 6,062,946 Date filed: October 2, 1998 Abstract: A post-pregnancy compression garment that provides abdominal support to facilitate a faster return to the individual's pre-pregnancy figure. The garment consists of a tubular body encompassing an anatomical region from the thighs to beneath the chest. Compression material or strips are constructed from an elastic memory fabric positioned so as to cause compression to the abdomen area. Maximum compression may be provided to the waist section with the remaining portion of the garment providing support with minimum compression. Excerpt(s): This invention relates to post-pregnancy rehabilitation and, in particular, to a garment worn by a woman after childbirth which creates a compression to the skin and underlying tissues/muscles to encourage shrinkage of the abdomen to pre-pregnancy conditions. There are a number of products used to support a woman's abdominal area during pregnancy. These devices are for the benefit of improved appearance or support of the unborn. For instance, U.S. Pat. No. 4,746,318 discloses a maternity exercise garment that provides support during exercise. The garment is close fitting without placing excess pressure on the abdomen. U.S. Pat. No. 4,976,653 discloses a maternity garment having a two position band that provides a range of support to the woman. This support is directed between two positions for lessening the stress on the woman's abdominal muscles. However, such a garment cannot be worn continuously due to the uncomfortable state in which it places the woman's body. Web site: http://www.delphion.com/details?pn=US06062946__

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Pregnancy and childbirth educational board game Inventor(s): Siller; Aimee C. (7006 N. 44th St., Milwaukee, WI 53223), McQuitty; LaNette J. (2821 S. Franklin Ct., New Berlin, WI 53151) Assignee(s): none reported Patent Number: 6,428,004 Date filed: July 11, 2000 Abstract: A pregnancy and childbirth education board game includes a game board, a plurality game pieces, and at least one set of playing cards. The game board includes a plurality of playing spaces. Preferably, there are two groups of playing spaces. The first group of playing spaces are formed around a periphery of the game board. The second group of playing spaces are disposed inside the first group. The at least one set of playing cards instruct players to move their game piece a set number of space(s) and player also reads information out loud on the playing card concerning pregnancy and childbirth. The first player to reach the last playing space wins the game. Excerpt(s): The present invention relates generally to board games and more specifically to a pregnancy and childbirth board game which educates and entertains players about pregnancy, labor, and childbirth. Currently it appears there is no board game which educates and entertains expectant parents, family members, friends, health care providers, and players about pregnancy, labor, and childbirth. It also appears that there is no board game which provides learning experiences and facilitates communication between expectant parents, family members, friends, health care provides and players about pregnancy, labor, and childbirth. It further appears that there exists no board game which helps improve the physical and emotional outcome of pregnancy, labor and childbirth. Accordingly, there is a clearly felt need in the art for a pregnancy and childbirth educational board game which educates and entertains players about pregnancy, labor, and childbirth. Web site: http://www.delphion.com/details?pn=US06428004__

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Pregnancy data recording system Inventor(s): Enhorning; Goran (Buffalo, NY) Assignee(s): The Research Foundation of State University of New York (Amherst, NY) Patent Number: 5,636,870 Date filed: October 25, 1994 Abstract: This invention provides a system for management of data collected over the course of a pregnancy which allows the physician to make better use of patient data in the ascertainment and treatment of potentially pathological conditions and which facilitates transfer of patient data to computer memory. The system includes a chart upon which a data point are indicated by placement of a mark relative to a vertical measurement axis and a horizontal gestational week time axis. Data expressed on the chart provide a retrospective graphical representation of developmental progress through the date of the most recent entry. Data from the chart may be transferred into computer memory with a laser scanner. A marking implement to facilitate scanning is also included. Excerpt(s): A portion of the disclosure of this patent document contains material which is subject to copyright protection. The owner has no objection to the facsimile

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reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever. This invention provides a system for management of data collected over the course of a pregnancy which allows the physician to make better use of patient data in the ascertainment and treatment of potentially pathological conditions and which facilitates transfer of patient data to computer memory. Medical science has demonstrated that early and continual monitoring of fetal development and maternal health is essential to detecting complications in pregnancy and lowering infant mortality and morbidity. Historically, physicians have maintained handwritten records of the progress of mother and fetus for diagnosis of potential complications. However, this method of supervision may not facilitate an early detection of pathological states, since the handwritten format makes retrospective envisionment of developmental progress difficult, especially when visits occur at non-uniform time intervals. In addition, changes in some parameters may be of negligible importance at a certain gestational age, but of utmost significance at another, and therefore may be overlooked for lack of a conspicuous correlation between the change itself and the gestational week of its occurrence. As a result, developing pathological conditions indicated by handwritten records may be overlooked until more obvious symptoms appear. Web site: http://www.delphion.com/details?pn=US05636870__ •

Pregnancy pillow with inflatible bladder Inventor(s): Ortman; Chet B. (712 11th Ave. N.E., Wenatchee, WA 98802), Ortman; Jennifer L. (712 11th Ave. N.E., Wenatchee, WA 98802) Assignee(s): none reported Patent Number: 4,984,315 Date filed: June 1, 1990 Abstract: A pillow is provided for use by a woman during pregnancy. The pillow comprises a polyfill core having an adjustable bladder within one end of the pillow. The bladder may receive air through a hand pump so that the pillow may be adjusted to a woman's shape depending upon how the pillow is to be used. When the bladder is fully deflated, the pillow is of an oblong shape in elevation. When the bladder is filled with air, the pillow takes on an L-shaped elevation that can more closely hug a woman's body in certain lying and sitting positions. The bladder also includes a valve for holding or releasing the air from the pillow. Excerpt(s): The present invention relates to a pillow for use by women who are pregnant. There are currently a number of pillows specifically designed for pregnant women to aide in relieving the stress involved in routine activities such as resting, reclining and sleeping. Although these devices do fulfill their function in a limited manner, there are many improvements to be made upon these type of pillows. First, none of these pillows are fully adjustable for women of various sized frames nor are they adaptable for different stages of the pregnancy. Generally, they include some type of aperture or projection for lower support of the woman's abdomen, but they fail to be very adaptable to any position except the sleeping position. It is an object of this invention to provide a pillow that is adjustable to a variety of contours depending upon the frame of a woman. Another object the invention is to provide a pillow that may be used in a variety of positions while lying down or sitting up. Web site: http://www.delphion.com/details?pn=US04984315__

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Pregnancy test Inventor(s): Banik; Upendra K. (Pierrefonds, CA), Givner; Morris L. (Pierrefonds, CA) Assignee(s): American Home Products Corporation (New York, NY) Patent Number: 4,123,509 Date filed: April 11, 1977 Abstract: A simple, sensitive, reliable and safe method and device for detecting pregnancy is disclosed. The test involves concentration by ultrafiltration of a sample of urine or serum from a subject; followed by determining the presence of human chorionic gonadotropin or of its.beta.-subunit in the concentrated sample. Excerpt(s): This invention relates to a method and device for detecting pregnancy. More specifically, this invention concerns a simple and sensitive method and device for the detection of pregnancy in women; the method and device being especially useful for the detection of pregnancy in its very early stages. A simple, sensitive test for the early diagnosis of human pregnancy would be an important contribution to medicine and society. For instance, it would be advantageous in cases of unwanted pregnancies or in cases of habitual aborters who would benefit from early therapy. It would also be advantageous for the physician to have knowledge of an early pregnancy before prescribing a drug that may be teratogenic, or in those instances where a woman has unwittingly been exposed to a possibly teratogenic drug. Also, not to be overlooked, is the all important psychological factor for the woman to know for certain whether she is pregnant or not. The most widely used pregnancy tests employed today are those based on the detection of human chorionic gonadotropin (HCG) in urine samples by immunological methods. These tests rely on the fact that HCG is the gonadotropin of pregnancy, being secreted by the chorionic tissue of the placenta in increasing amounts soon after the implantation therein of a fertilized ovum. [The peak secretion of HCG of more than 50,000 i.u. per a 24 hour collection of urine occurs between 56 and 84 days after the last menstrual period, E. H. Venning in "Text Book of Gynecologic Endocrinology", J. J. Gold, Ed., Harper and Row, New York, 1968, pp. 95 - 97]. These tests are generally reliable for detecting pregnancy after about the 12 day following a missed menstrual period (i.e., about the 40th day of amenorrhea) giving about a 2 to 6% error when correctly performed, B. M. Hibbard, Brit. Med. J., 1, 593 (1971) and C. A. Horwitz, et al., Obstet. Gynecol., 43, 693 (1974). However, the tests cannot be relied upon prior to that time since they only can detect minimum concentrations of HCG of about 1000 - 3000 m. i.u./ml of urine. The main reason for not increasing the sensitivity of these test by concentrating urine samples is to avoid false positives resulting from substances which cross react with the HCG-antiserum, B. M. Hobson, J. Reprod. Fertil., 12, 33 (1966). Web site: http://www.delphion.com/details?pn=US04123509__

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Pregnancy test device Inventor(s): Schilling; Guenther (Westmount, CA), Givner; Morris Lincoln (Pierefonds, CA) Assignee(s): American Home Products Corporation (New York, NY) Patent Number: 4,033,723 Date filed: December 31, 1975 Abstract: A simple, sensitive method and device for detecting pregnancy. The test involves concentration by ultrafiltration of a sample of urine or serum from a subject; followed by determining the presence of human chorionic gonadotropin or of its.beta.subunit in the concentrated sample. Excerpt(s): This invention relates to a method and device for detecting pregnancy. More specifically, this invention concerns a simple and sensitive method and device for the detection of pregnancy in women; the method and device being especially useful for the detection of pregnancy in its very early stages. A simple, sensitive test for the early diagnosis of human pregnancy would be an important contribution to medicine and society. For instance, it would be advantageous in cases of unwanted pregnancies or in cases of habitual aborters who would benefit from early therapy. It would also be advantageous for the physician to have knowledge of an early pregnancy before prescribing a drug that may be teratogenic, or in those instances where a woman has unwittingly been exposed to a possibly teratogenic drug. Also, not to be overlooked, is the all important psychological factor for the woman to know for certain whether she is pregnant or not. The most widely used pregnancy tests employed today are those based on the detection of human chorionic gonadotropin (HCG) in urine samples by immunological methods. These tests rely on the fact that HCG is the gonadotropin of pregnancy, being secreted by the chorionic tissue of the placenta in increasing amounts soon after the implantation therein of a fertilized ovum. [The peak secretion of HCG of more than 50,000 i.u. per a 24 hour collection of urine occurs between 56 and 84 days after the last menstrual period, E. H. Venning in "Text Book of Gynecologic Endocrinology," J. J. Gold, Ed., Harper and Row, New York, 1968, pp. 95- 97.] These tests are generally reliable for detecting pregnancy after about the twelfth day following a missed menstrual period (i.e., about the fortieth day of amenorrhea) giving about a 2 to 6% error when correctly performed, B. M. Hibbard, Brit. Med. J., 1, 593 (1971) and C. A. Horwitz, et al., Obstet. Gynecol., 43, 693 (1974). However, the tests cannot be relied upon prior to that time since they only can detect minimum concentrations of HCG of about 1000- 3000 m. i.u./ml. of urine. The main reason for not increasing the sensitivity of these tests is to avoid false positives resulting from substances which cross react with the HCG-antiserum, B. M. Hobson, J. Reprod. Fertil., 12, 33 (1966). Web site: http://www.delphion.com/details?pn=US04033723__

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Pregnancy test with EPF Inventor(s): de Week; Alain L. (Fribourg, DE), Henderson; David (Berlin, DE), Maly; Friedrich E. (Bern, DE) Assignee(s): Schering Aktiengesellschaft (Berlin and Bergkamen, DE) Patent Number: 4,877,742 Date filed: January 29, 1987

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Abstract: A method for the early detection of a pregnancy comprises determination of EPF in the blood or urine or in a biochemical derivative of the blood or urine of pregnant women, by measuring the influence of EPF on the production of electronically excited states or radicals, especially oxygen radicals, or their secondary products, in leukocyte or cell line preparations. The method can also be used to determine gonadal tumors. Excerpt(s): Therefore, with the aid of EPF diagnostics, a pregnancy can be detected at a very early moment (1-5 days after conception). However, the rosette inhibition test is labor-and time-consuming; moreover, it is subject to a high error rate. Even a positive pregnancy is often detected only after repeated tests. On the other hand, to rule out a pregnancy, several repetitions of the test are always necessary. Therefore there is a great interest in a simple and reliable process for early detection of a pregnancy based on the occurrence of EPF. Accordingly, it is an object of this invention to provide such a method, inter alia. Web site: http://www.delphion.com/details?pn=US04877742__ •

Pregnancy-specific.beta.sub.1 -glycoprotein and process for isolating it Inventor(s): Stutzinger; Ferdinand (Bretzenheim, DE), Bohn; Hans (Marburg, DE) Assignee(s): Behringwerke Aktiengesellschaft (Marburg an der Lahn, DE) Patent Number: 4,191,533 Date filed: December 9, 1977 Abstract: A pregnancy-specific.beta.sub.1 -glycoprotein, characterized by an electrophoretic migration speed in agar gel in the range of the.beta.sub.1 -globulins, a sedimentation constant of 4.6 S.+-.0.5 S, a molecular weight of 100 000.+-.15 000, an extinction coefficient E.sub.1cm.sup.1% of 11.6.+-.0.5 (278 m.mu. 1/15-molar phosphate buffer, pH 7.0), a carbohydrate content of 28.05.+-.1.55%, comprising 10.7.+-.1.0% of hexoses, 10.0.+-.0.5% of hexosamine, 0.55.+-.0.05% of fucose and 7.0.+-.0.5% of neuraminic acid, and process for isolating it from the placenta or blood or urine of pregnant women. This protein may be used as a reagent and for the preparation of antisera as reagents for the detection of pregnancy and for pre-natal supervision. Excerpt(s): This invention relates to a pregnancy specific.beta.sub.1 -glycoprotein and to a process for isolating it. It has not been known hitherto that the placenta and the urine of pregnant women contain a pregnancy-specific.beta.sub.1 -glycoprotein. Although a protein in the.beta.-range has already been proved immunologically in the serum of pregnant women, a process for isolating it has not yet been described. The object of the invention is a process for isolating the pregnancy-specific.beta.sub.1 -glycoprotein (abbreviated SP.sub.1) by fractionation from the placenta and the blood or urine of pregnant women. Another object of the invention is the pregnancy-specific.beta.sub.1 glycoprotein which is characterized by an electrophoretic migration speed in agar gel in the range of the.beta.sub.1 -globulins, a sedimentation constant of 4.6 S.+-.0.5 S, a molecular weight of 100 000.+-.15 000, an extinction coefficient E.sub.1 cm.sup.1% of 11.6.+-.0.5 (278 m.mu. 1/15-molar phosphate buffer, pH 7.0), a carbohydrate content of 28.05.+-.1.55%, comprising 10.7.+-.1.0% hexoses, 10.0.+-.0.5% of hexosamine, 0.55.+.0.05% of fucose and 7.0.+-.0.5% of neuraminic acid. Web site: http://www.delphion.com/details?pn=US04191533__

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Pregnancy-supporting lounge chair Inventor(s): Castelot; Lawrence E. (168 Glendale Ave., Bridgeport, CT 06606), Castelot; Linda A. (168 Glendale Ave., Bridgeport, CT 06606) Assignee(s): none reported Patent Number: 4,508,384 Date filed: September 27, 1982 Abstract: This pregnancy-supporting lounge chair is designed to support a pregnant woman's stomach safely and comfortably, when she lies in prone position, and it can also comfortably seat a person when desired. Primarily, it consists of a main seat frame with a backrest and a footrest, and it further includes a second seat frame, to cover an open area in the main seat frame, containing an adjustable stretch band, which supports the woman's stomach when she is in the face-down prone position. Excerpt(s): This invention relates to furniture, and more particularly, to a pregnancysupporting lounge chair. The principal object of this invention is to provide a pregnancy-supporting lounge chair, which will be especially designed to give the comfort and support which a pregnant woman needs when lying on her stomach. Another object of this invention is to provide a pregnancy-supporting lounge chair, which will be unique and novel, in that it will include an additional folding leaf portion, for enabling the covering of a stretch band in the main body portion of the structure. Web site: http://www.delphion.com/details?pn=US04508384__

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Pregnant mother doll and separable baby doll Inventor(s): Kaplan; Ida B. (Cincinnati, OH) Assignee(s): MTR Enterprises (Cincinnati, OH) Patent Number: 4,883,442 Date filed: January 20, 1987 Abstract: A doll set comprising a mother doll and a baby doll which can be placed in an expansible pouch on the mother doll to impart a realistically pregnant look to the mother. When the baby doll is not in the pouch, the mother has a trim, non-pregnant appearance. Excerpt(s): This invention relates to dolls, and more particularly, to the combination of a pregnant mother doll and a separable baby doll. Overholt U.S. Pat. No. 1,431,482, shows a doll wherein the mother can carry a baby doll across her chest, the baby being held there by snaps. Graves U.S. Pat. Nos. 2,551,433 and 2,551,560, show mannequins for teaching midwifery, which include an abdominal cavity wherein which a baby doll can be placed for teaching purposes. A rigid cap or cover is used to provide a pregnant appearance. Glass U.S. Pat. No. 3,812,613 shows a doll which is made to look pregnant by an internal spring mechanism which expands the abdomen. Web site: http://www.delphion.com/details?pn=US04883442__

Patents 379

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Pretreatment agent for subject fluid in pregnancy test Inventor(s): Yoshida; Isamu (Takatsuki, JP), Kobayashi; Takashi (Hikari, JP), Kondo; Koichi (Osaka, JP) Assignee(s): Takeda Chemical Industries, Ltd. (Osaka, JP) Patent Number: 4,270,923 Date filed: December 26, 1979 Abstract: By using a new pretreatment agent consisting essentially of a carboxylic acidtype cation exchange resin fiber or a siliconized glass fiber, the interfering components and the elements of turbidity present in a subject fluid for immunologic pregnancy test can be specifically removed without entailing a substantial loss of human chorionic gonadotropin contained in the subject fluid. Excerpt(s): The present invention relates to an improvement in the pretreatment of subject fluids for immunologic pregnancy tests. Immunologic tests have been used for the diagnosis of pregnancy, which estimate the human chorionic gonadotropin (hereinafter briefly, HCG) in the urine or body fluid (serum, plasma, etc.) of a pregnant woman. The principle of the anti-HCG antibody-sensitized latex agglutination test (latex direct agglutination reaction; hereinafter briefly, LDAR) is that as a latex particles carrying anti-HCG antibodies as adsorbed thereon are admixed with a subject urine, serum or plasma sample, the latex particles are agglutinated if HCG is present in the sample, the detection of such agglutination establishing a diagnosis of pregnancy. On the other hand, the principle of the HCG-sensitized latex agglutination inhibition test (latex agglutination inhibition reaction; hereinafter briefly, LAIR), is that as a latex carrying HCG as adsorbed thereon is admixed with a given amount of an anti-HCG antiserum, the latex particles are agglutinated, but if the latex is added after admixture of an HCG-containing subject fluid with a given amount of anti-HCG antiserum, the latex will not be agglutinated because the anti-HCG antibody has already been coupled to the HCG in the subject fluid. This, in LAIR the absence of latex agglutination establishes a diagnosis of pregnancy. Another method is the hemagglutination inhibition test (hereinafter briefly, HAIR) in which a diagnosis of pregnancy is performed using HCG-sensitized human or animal red blood cells in place of latex particles. Web site: http://www.delphion.com/details?pn=US04270923__

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Prevention of pregnancy miscarriages Inventor(s): Tracey; Kevin J. (Greenwich, CT), Wang; Haichao (Avenel, NJ) Assignee(s): The Picower institute for Medical Research (Manhassett, NY) Patent Number: 6,011,005 Date filed: September 18, 1997 Abstract: There is disclosed a method for helping to prevent miscarriages during pregnancy, comprising administering an effective amount of a fetuin polypeptide. Excerpt(s): The present invention provides a method for prevention of miscarriages during pregnancy. Pregnancy has been termed "Nature's transplant" because the developing fetus, essentially a foreign tissue graft, is protected from rejection by its host, the mother (Editorial: "Nature's transplant" Lancet 1:345-346, 1974). Rejection of a transplanted allograft in an immunocompetent host is normally mediated by the

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macrophage-derived cytokine tumor necrosis factor (TNF) (Eason et al., Transplantation 59:300-305, 1995). Excessive production of TNF during pregnancy causes spontaneous abortion (Shaarawy et al., Acta Obstet. Gynecol. Scand. 76:205-211, 1997; and Mallmann et al., Arch. Gynecol. Obstet. 249:73-78, 1991). Recently, spermine, a ubiquitous biogenic amine present in large amounts in the amnion, has been shown to counter-regulate the immune response by inhibiting the production of TNF and other pro-inflammatory cytokines by human mononuclear cells (Zhang et al., J. Exp. Med. 185:1759-1768, 1997). Fetuin is a globular 341-amino acid protein containing 20-25% carbohydrate (by weight) and 6 internal disulfide bonds. The human fetuin sequence (also known as.alpha.2-HS glycoprotein) is provided herein as SEQ ID NO. 1 and SEQ ID NO. 2. Fetuin was first identified over 50 years ago as a major protein component of bovine fetal serum but its biological function remains unclear. Bovine fetuin is a globular 341 amino acid polypeptide with six internal disulfide bonds and three N-linked and two O-linked oligosaccharide chains. Primary amino acid sequence and the position of cysteine residues are well conserved in human, bovine, sheep, rat and mouse fetuin homologs (Dziegielewska et al., J. Biol. Chem. 265:4354, 1990; Rauth et al., Eur. J. Biochem. 205:321,1992; Lee et al., Proc. Natl. Acad. Sci. USA 84:4403, 1987; and Brown et al., Eur. J. Biochem. 205:321, 1992). Fetuin levels in human plasma are regulated in the manner of a negative acute phase reactant (Lebreton et al., J. Clin. Invest. 64:1118, 1979). IL-1 was shown to suppress fetuin transcript levels in cultured hepatocytes (Akhoundi et al., J. Biol. Chem. 8:15925, 1994). Fetuin appears to be expressed in bone because transcripts have been detected in both chondrocytes and osteoblasts (Yang et al., Blood 12:7, 1991). The polypeptide.alpha.2-HS glycoprotein is a human homolog of fetuin and is secreted in high levels by adult liver into the peripheral circulation (Triffitt et al., Nature 262:226, 1976). Web site: http://www.delphion.com/details?pn=US06011005__ •

Process for interrupting pregnancy with sulfonamidoaminophene interceptive agents Inventor(s): Comer; William T. (Evansville, IN), Gallo; Duane G. (Evansville, IN) Assignee(s): Mead Johnson & Company (Evansville, IN) Patent Number: 3,979,514 Date filed: August 26, 1974 Abstract: A process for interrupting pregnancy is disclosed which comprises administration to a mammal an interceptive agent selected from a group of sulfonamidoaminophenones. Illustrative of sulfonamidoaminophenone interceptive agents useful in the process of the present invention for interrupting pregnancy are 4'(N,N-diethylalanyl)-methanesulfonanilide and 4'-[N-.alpha.,.alpha. dimethylphenethyl)alanyl]methanesulfonanilide. Excerpt(s): This invention relates to drug and body treating compositions and is particularly concerned with a process for interrupting pregnancy after implantation of the fertilized ovum has taken place by administration of a p-sulfonamidoaminophenone interceptive agent. At the present time, there are a number of available oral contraceptives containing estrogenic and progestational steroids that inhibit pregnancy by preventing ovulation if administered on an almost daily regimen. But, after fertilization and implantation of the ovum has taken place, there is presently little, short of mechanical (vacuum aspiration) or surgical abortion, that can be done to prevent delivery of viable offspring. Thus, there remains a large unmet need for a safe medication which requires infrequent or at the most only short periods of treatment to

Patents 381

induce elimination of unwanted embryos. For the purpose of this disclosure, agents that interrupt pregnancy after implantation of the fertilized ovum are called "interceptives" as opposed to the term "contraceptives" which applies to agents that prevent pregnancy by inhibiting conception; refer to R. H. Naqvi, et al., Steroids, 18:731, 1971. A few of the p-sulfonamidoaminophenones useful in the present invention are specifically disclosed by A. A. Larsen, et al., U.S. Pat. No. 3,341,584 to be of value as central nervous system agents. It was not recognized, however, until the present discovery that some of the psulfonamidoaminophenones disclosed by Larsen, et al. as well as other novel compounds of that class are effective interceptive agents. Web site: http://www.delphion.com/details?pn=US03979514__ •

Process for testing for maternal-fetal immunoincompatibility in pregnant women Inventor(s): Vanderbeeken; Yves-E (3475 Redpath Avenue, Montreal, Quebec, CA) Assignee(s): none reported Patent Number: 5,132,209 Date filed: September 14, 1987 Abstract: A kit for testing materno-fetal immunoincompatibility in women, particularly in women whose fetuses are in danger, comprises two containers containing an identical amoung of HLA-D antigen-containing material and one container containing male serum as control. In the test, maternal serum of the patient is added to one container of antigen while the control serum is mixed with the other container of antigen. The amount of expressed HLA-D antigen remaining in each case is established by conventional HLA-D directed monoclonal antibody immunoassay techniques such as conventional radio-immunoassay. The maternal serum assay divided by the control serum assay gives an immunoincompatibility quotient (IQ). The IQ is from 40 to 50% in healthy pregnant women and is about 70% in pathological cases. The test provides reliable results since the antigenic portion is non-living and therefore does not offer the inconstances of living test reagents. Excerpt(s): This invention relates to a diagnostic kit useful in establishing the existence or potential existence of materno-fetal immunoincompatibility in women. The invention also relates to a method of preparing the kit, its constituents and to a method of using the kit. In normal pregnancy, a fetus, despite being an immunologically separate entity from its mother, is not attacked by its mother's immune system. Thus a "host versus graft reaction" (HVGR) as in rejection of transplanted organs, does not occur. In other words, the antigenic determinants of the fetus are not recognized by the mother's immune system. This is because the (blood) serum of the mother normally contains blocking substances which partially block the fetus' minor histocompatibility antigenic determinants rendering them "invisible" to the mother's immune system. Web site: http://www.delphion.com/details?pn=US05132209__

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Processes, reagents and means for early diagnosis of pregnancy Inventor(s): Prugnaud; Robert Louis (Paris, FR) Assignee(s): Laboratoire Theranol (Paris, FR) Patent Number: 4,071,314 Date filed: June 29, 1976 Abstract: A reagent for the early diagnosis of pregnancy comprising a substrate of suitable erythrocytes or polymer having adsorbed thereon a predetermined ratio of chorionic gonadotropin antigen and antisera therefor. The ratio is selected so as to be insensitive to the presence of less than 1,500 I.U. per liter of chorionic gonadotropin in the urine being tested. The reagent is used by combining with a predetermined quantity of the urine to be tested and after 1/2-2 hours inspecting for agglutination, the presence of which indicates a negative result. An apparatus is also disclosed for carrying out the process. Excerpt(s): The present invention relates to a new and novel process for an early diagnosis of pregnancy and further to a modified reagent and improved means for implementing the process. As is known, the gonadotropic hormones or gonadotropins are hormones stimulating the gonads. In mammals, the gonadotropins are generated by the hypophysis, the placenta, and, as regards pregnant mares, also by the endometrium. The gonadotropic hormones comprise the follicle-stimulating ones (FSH), the luteinizing ones (LH) luteotropine (LTH) and chorionic gonadotropin (HCG). It is known that the biological effects of HCG and LH are similar. It is also known that the urine of pregnant mammals contains chorionic gonadotropin of placental origin and that in women, in the midst of the menstrual cycle, the urine contains LH of hypophyseal origin of which the action causes ovulation and formation of yellow body. It is further known that the urine of the female in the pre-menopause period, that is, in the case of incipient menopause, contains gonadotropins of hypophyseal origin. The presence of chorionic gonadotropin of placental origin in the urine constitutes one of the early diagnostic means for pregnancy. This is the reason reagents allowing early diagnosis of pregnancy were developed. Web site: http://www.delphion.com/details?pn=US04071314__

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Prone pregnancy cushion Inventor(s): Satto; Peter J. (10 Balsam Ct., Selden, NY 11784) Assignee(s): none reported Patent Number: 5,400,449 Date filed: September 21, 1994 Abstract: A prone pregnancy cushion, for allowing a pregnant woman to lay on her abdomen, comprising an early stage segment, a later stage segment, and an attachment mechanism connecting the early stage segment and later stage segment. The early stage segment and later stage segment each have abdominal hollows and breast hollows, containing breast cut-outs and abdominal cut-outs which are removable to accommodate women of different sizes and at different stages of their pregnancy. Excerpt(s): The invention relates to a prone pregnancy cushion. More particularly, the invention relates to a cushion for allowing a pregnant woman to lie face-down comfortably in all stages of her pregnancy. During pregnancy, women undergo a great

Patents 383

deal of stress, both mental and physical. The expectancy of motherhood can create a great deal of mental stress. It is necessary for the woman's health for her to be able to rest comfortably. Many woman are accustomed to resting face-down, and therefore cannot rest comfortably during their pregnancy. In addition, the typical weight gain of a pregnant woman creates tremendous stress on the lower back. The growing fetus tends to project forwardly within the woman's abdomen. The added weight of the fetus causes an imbalance that the woman must compensate for by holding her upper torso back, and pushing her lower torso and pelvis forward. This posture adjustment adversely affects the distribution of weight throughout her body, particularly in the pelvis region. Doctors and chiropractors suggest that lying face-down would help relieve stress and pain on the lower back and pelvis. Web site: http://www.delphion.com/details?pn=US05400449__ •

Reversible fertility control for prevention of pregnancy in females Inventor(s): Kaushic; Charu (New Delhi, IN), Sharma; Madan G. (New Delhi, IN), Upadhyay; Shakti (New Delhi, IN), Talwar; Gursaran P. (New Delhi, IN), Singh; Amarjeet (New Delhi, IN) Assignee(s): National Institute of Immunology (New Delhi, IN) Patent Number: 5,196,197 Date filed: August 28, 1990 Abstract: There is provided a means for reversible fertility control for prevention of pregnancy in female mammals for several months through the use of neem oil or its components, applied locally to the uterus. There is also provided a spermicidal composition containing neem oil or its components in combination with reetha extract as a vaginal cream. Excerpt(s): The present invention relates to the control of fertility and the prevention of pregnancy in females. In particular, the invention relates to a new method for blocking reversibly the fertility of a female without disturbing physiological functions such as hormonal profiles and without impairment of ovulation or libido. The invention also includes within its ambit spermicidal compositions for local application in the vagina. The control of population particularly in the developing countries of the world has become an economic necessity. Although a number of methods for population control, popularly referred to as "family planning", are currently available, there is a continuing need for newer and improved methods. In particular, it has been the objective of researchers to develop population control methods which do not require day to day application or intake, which are free from the risk of user failure or side effects, which do not impair the normal reproductive functions and, above all, are reversible. Certain family planning methods such as vasectomy and tubal ligation are largely irreversible and even though surgery is available for recanalisation, this is an expensive procedure. Furthermore, on the evidence of even the best series of surgical operations for the reestablishment of the passage of sperm or eggs, the percentage of successful cases where fertility is actually regained is small indeed. These characteristics generally dissuade couples from opting for these methods till a fairly late stage in their reproductive life. Web site: http://www.delphion.com/details?pn=US05196197__

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Screening test for the lethal genetic trait of recurrent spontaneous pregnancy loss Inventor(s): Lanasa; Mark C. (Pittsburgh, PA), Hoffman; Eric P. (Kensington, MD), Hogge; W. Allen (Pittsburgh, PA) Assignee(s): Children's National Medical Center (Washington, DC), University of Pittsburgh (Pittsburg, PA) Patent Number: 6,268,145 Date filed: September 22, 1999 Abstract: A screening test to identify women carrying a lethal genetic trait that predisposes to recurrent spontaneous pregnancy loss. The test method involves the quantitative determination of the frequency of highly skewed X chromosome inactivation in DNA derived from tissue cells of female patients, relative to appropriate normal control women. "Highly skewed" is defined as preferential use of one chromosome in at least 90% of the patient's cells being tested. Suitable test tissues include, but are not limited to, peripheral leukocytes, oral mucosal cells, and biopsy material. Excerpt(s): The invention is concerned with a screening method for diagnosing the etiology of spontaneous pregnancy loss in women. More particularly, the inventive method involves the use of quantitative X chromosome inactivation analysis for the prediction of the presence of gene-linked recurrent spontaneous pregnancy loss. Recurrent spontaneous abortion (RSA) is a major health concern to women, affecting about 17% of couples wishing to have children. The diagnostic evaluation of RSA is extensive and complex, with many different etiologies, each causing a small proportion of the total cases. The etiologies can be grouped into five categories: anatomic, infectious, hormonal, immunological, and genetic, thereby requiring the collaborative efforts of many medical specialists. Despite such thorough (and expensive) diagnostic workups, it has been estimated that the specific cause for RSA remains unknown in 3779% of affected women (Stephenson, Fertil. Steril. 66:24 (1996)). It has been assumed that a large portion of idiopathic RSA is genetic in origin. To date, however, the standard genetic evaluation consists solely of parental and abortus karyotyping. This identifies parental defects, such as balanced translocations that can cause RSA, and it ascertains fetal aneuploidy, a common cause of spontaneous abortion that intrinsically has little recurrence risk. As a result, the published total "genetic" contribution to RSA is essentiually the frequency of translocations in the cohort of women with RSA, which is only about 3%. This is quite likely an underestimation, as subcytogenetic defects are almost certainly a significant cause of RSA. Web site: http://www.delphion.com/details?pn=US06268145__

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Seat belt lap pillow and positioner for use by pregnant women Inventor(s): Benson; Janice J. (Warren, MI), Harper; Carolyn (Clinton Township, MI), McComb; Heather (Santa Rosa Beach, FL) Assignee(s): Harben, Inc. (Clinton Township, MI) Patent Number: 6,322,150 Date filed: October 21, 1999 Abstract: A device, particularly for use by a pregnant woman having an enlarged abdomen. The device attaches to the lap belt portion of a vehicle seat belt assembly for

Patents 385

increasing comfort and thus encouraging use of the seat belt assembly, as well as to urge the lap belt portion into proper position across the pelvis. The device includes an attachment portion which can be repeatedly attached to and removed from the lap belt, and a cushioning element attached to the attachment portion at the relatively upper edge of the lap belt for padding the relatively upper edge. Excerpt(s): The invention relates generally to vehicle seat belt assemblies, which typically include a lap belt and a diagonally-extending shoulder strap. The invention more particularly relates to a device which encourages use of seat belt assemblies by pregnant women, and which also encourages correct positioning the lap belt below the enlarged abdomen of a pregnant women and over the pelvis. The safety benefits of vehicle seat belt assemblies are well known, and their use is mandated by law in most jurisdictions. However, many pregnant women find the seat belt, particularly the lap belt, to be quite uncomfortable, and, for that reason, will avoid wearing the seat belt assembly, despite good reasons for doing so. In addition, even when the seat belt assembly is worn, the lap belt tends to extend across the abdomen in an unsafe position, rather than across the pelvis. Web site: http://www.delphion.com/details?pn=US06322150__ •

Seatbelt positioning assembly for a pregnant person Inventor(s): Kruse; Steinar (Ste. 109, 1055 S. American Way, Miami, FL 33132) Assignee(s): none reported Patent Number: 5,005,865 Date filed: July 31, 1990 Abstract: A seatbelt positioning assembly for positioning a seatbelt of an automobile along the lower abdominal region of a pregnant person so as to avoid crossing over the womb. The seatbelt positioning assembly comprises a seat pad adapted to be positioned on the seat of the automobile being secured thereto by a securing strap fastened about the seat back portion. A sleeve is removably fitted along a portion of the length of the seatbelt wherein a pair of positioning straps connected to and extending from the seat pad are adapted for attachment with a bottom edge of the sleeve so as to pull the sleeve and, accordingly, the attached seatbelt downwardly in position along the lower abdominal region of the user. Excerpt(s): A seatbelt positioning assembly for positioning a seatbelt in a preferred position along the lower abdominal region of a pregnant person so as to avoid the womb. Most modern day automobiles include a seatbelt apparatus which includes a lower seatbelt designed to extend across the abdomen of the user. Additionally, most modern day seatbelt apparatus include a shoulder harness connected to an end of the seatbelt and adapted to extend across the user's upper body over one shoulder so as to limit forward movement in the event of a collision. With the seatbelt apparatus in its attached secured position, the shoulder harness tends to pull the seatbelt upwardly such that the seatbelt tends to ride up across the user's stomach. When using the commonly known seatbelt apparatus, a pregnant person normally encounters the problem of the belt riding up so as to cross a lower portion of the womb. This creates an extremely dangerous condition in that a sudden jerk caused by impact of the automobile with another object results in the seatbelt squeezing or tightening about the womb. This may result in injury to the infant as well as the mother. Additionally, the constant strain of the seatbelt across the womb, in normal use, causes severe discomfort to the user.

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Web site: http://www.delphion.com/details?pn=US05005865__ •

Sulfonic acid and aldehyde condensation polymers for preventing pregnancy Inventor(s): Chancellor; Toni (Watertown, MA), McKinlay; Margo (Barrington, RI), Profy; Albert T. (Cambridge, MA), Sonderfan; Andrew J. (Sudbury, MA) Assignee(s): Procept, Inc. (Cambridge, MA) Patent Number: 5,958,399 Date filed: May 1, 1997 Abstract: This invention pertains to the discovery that condensation polymers of an aldehyde and aromatic sulfonic acids and fractions thereof, such as formaldehyde naphthalenesulfonic acid condensation polymers, can prevent pregnancy in an individual. Excerpt(s): Many condensation polymers of formaldehyde and aromatic sulfonic acids have been previously described. U.S. Pat. No. 4,604,404 and U.S. application Ser. Nos. 08/467,725, 08/245,619 and 08/156,443, the entire teachings of which are incorporated by reference herein, disclose the use of such polymers as antiviral agents against the Herpes simplex virus and HIV infection. However, the references do not teach or suggest the use of such polymers in preventing pregnancy. Spermicidal formulations are popular forms of reversible contraception in the USA (Forrest, J. D. and Fordyce, R. R. Fam. Plann. Perspect. 20:112-118 (1988)). Most intravaginal contraceptive formulations contain the spermicide, nonoxynol-9 (N9) as the active ingredient. These formulations, typically creams, gels, or foams, are generally effective immediately upon application, and can be instilled up to approximately an hour before intercourse (Hatcher, R. A. et al., "Contraceptive Technology, 16th Revised Edition," New York, Irvington Publishers (1994)). Vaginal contraceptive films, such as "VCF" (Apothecus, Inc., Oyster Bay, N.Y.), are more recent introductions to the marketplace, at least in the USA. In contrast to other intravaginal contraceptives, films must be introduced several minutes before intercourse to ensure adequate dissolution and dispersion prior to contact with sperm. When used alone, spermicides have a failure rate of approximately 21% (that is, typically 21% of couples using these products will experience an accidental pregnancy in the first year of use). Efficacy reportedly improves greatly when spermicides are used in combination with barrier methods, e.g., condoms (Hatcher, R. A. et al., "Contraceptive Technology, 16th Revised Edition," New York, Irvington Publishers (1994)). Web site: http://www.delphion.com/details?pn=US05958399__

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Support pillow for pregnant women, obese people, people who suffer from various forms of back pain and people who suffer from sleep apnea, snoring and sciatica Inventor(s): Friedman; Loretta (9269 Shore Rd., Apt. B1, Brooklyn, NY 11209) Assignee(s): none reported Patent Number: 6,044,505 Date filed: August 27, 1998 Abstract: A pillow (10) for pregnant, over weight, back-pain suffering, sleep apnea suffering, and sciatica suffering persons lying in a prone position, is provided. The pillow has an aperture (90) extending through it, and is sized for receipt of a portion of

Patents 387

the abdomen of the user. The aperture is defined by at least first (20), second (30) and third (40) support structures, and is of a substantially uniform thickness (T). The first support structure extends substantially traversely across the lower-chest and upperabdominal regions of the user, the second support structure extends along a first sideabdominal region of the user to end proximate to the person's pelvic region, and the third support structure extends along a second side-abdominal region of the user to also end proximate to the pelvic region of the user. Excerpt(s): This invention relates to the field of pillows, and more particularly, to the field of abdominal support pillows for pregnant women, over weight people and otherwise regular people who suffer from back pain. Citizens of the United States spend eleven percent of the nation's gross national product on hospital and medical care. The United States has more doctors and hospitals that nearly any other industrialized nation, and yet the United Nations World Health Organization continually rates the population of the United States as having one of the lowest general health indexes in the world. The symptoms of bad health and poor physical condition are the end result of the body's inability to function properly. Currently, if you are a pregnant woman, an obese person, an athlete, an individual who suffers from back pain, sleep apnea, snoring or sciatica, your ability to lay on your stomach is greatly diminished. The posture that is assumed during pregnancy, or in the obese, creates hyper-extension in the low back region, causing jamming of the thoracolumbar facets, posterior narrowing of the disc space and myospasms in the erector spinae muscles. Sciatica, and lower back pain, are usually caused by misalignment of bones, nerve interference and vertebral subluxation. Web site: http://www.delphion.com/details?pn=US06044505__ •

System and method for remote pregnancy monitoring Inventor(s): Mault; James R. (Evergreen, CO) Assignee(s): Healthetech, Inc. (Golden, CO) Patent Number: 6,610,012 Date filed: April 10, 2001 Abstract: A system and method for remote pregnancy monitoring of a pregnant woman is provided. The system includes an ultrasound transducer positioned on a pregnant woman having a processor, a transmitter and a receiver, and a personal digital assistant operatively connected to the ultrasound transducer via a communication link. The system also includes a patient computer system operatively connected to the personal digital assistant via a second communication link. The system further includes a healthcare provider computer system operatively connected to the patient computer system via an internet, and activation of the ultrasound transducer generates a data signal transmitted to the personal digital assistant via the communication link, and transmission of the signal to the healthcare provider computer system via the second communication link, for monitoring the pregnant woman by a healthcare provider. Excerpt(s): The present invention relates generally to medical monitoring, more specifically, to a system and method for remote monitoring of a pregnancy-related physiological condition in a pregnant female patient. Medical monitoring involves the measurement of a physiological condition of a patient. An example of a medical monitor is disclosed in U.S. application Ser. Nos. 09/669,125 (filed Sep. 25, 2000) and 09/821,417 (filed Mar. 29, 2001, "Monitoring System"), the disclosures of which are incorporated herein by reference. With certain medical conditions, it is advantageous from a health

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and cost perspective to conduct this type of monitoring within a home-based setting. For example, a pregnant female patient may require periodic evaluation of uterine activity for pre-term labor management by a healthcare provider. In the past, the patient was taught to time her uterine contractions, and report her results to the healthcare provider. However, this method is not very accurate, since it relies on the patient to accurately perceive uterine activity. Alternatively, the patient was monitored either in her home or at the doctor's office using an electronic uterine monitoring system. Monitoring the patient at the doctor's office requires frequent visits to the doctor's office, which is time consuming and may contradict prophylactic bed rest for a high risk patient. Home monitoring involves the use of a home uterine activity monitor, which includes a transducer operatively connected to a data recorder, which is operatively connected via a phone line to a healthcare provider. Activation of the transducer produces a signal that is transmitted via the phone lines to the healthcare provider for evaluation. The signal may be sent directly to the healthcare provider, or to a home healthcare management service, for data analysis and evaluation. Web site: http://www.delphion.com/details?pn=US06610012__ •

System for identifying premature rupture of membrane during pregnancy Inventor(s): Smith; Ramada S. (34153 Lyncroft Ct., Farmington Hills, MI 48331), Torok; Brian A. (960 W. 11 Mile Rd., Berkley, MI 48072) Assignee(s): none reported Patent Number: 6,149,590 Date filed: July 13, 1999 Abstract: An article for the identification of the premature rupture of a membrane during pregnancy is disclosed. In its preferred embodiment, the article comprises a pad having an upper outer layer, a lower outer layer, and an intermediate pH-responsive component. A double-sided adhesive strip is attached to the lower outer layer. The upper outer layer is composed of a liquid permeable material. Intermediate of the upper out layer and the inner outer layer is a pH-sensitive component. This intermediate layer is a pH-sensitive material and may be one of a variety of such materials, although a preferred material is nitrazine paper. In the presence of an alkaline fluid, such as amniotic fluid, the pH-sensitive material responds by turning to a purple-blue color. The change in color acts as a visual indicator to the wearer of the possible presence of amniotic fluid outside of the amniotic sac. As an alternate embodiment, the article may be fitted with a slide for gathering amniotic fluid, thus allowing the examining physician to make a visual evaluation. Excerpt(s): The present invention is generally directed to an article for the identification of the premature rupture of a membrane during pregnancy. More particularly, the present invention is directed to an indicating article in the form of a multilayered pad that is fitted to the undergarment of a user. The multilayered pad includes a treated component which responds to the presence of amniotic fluid as a discharge. As an alternate embodiment, a thin flexible plastic slide may be incorporated with the pad for microscopic examination. The amnion develops around the embryo during the second week following fertilization. This is the second membrane to appear after the placenta forms around the chorion. The margin of the amnion is attached to the periphery of the embryonic disk. Eventually, as the embryo grows, the amnion fuses with the chorion surrounding it, and the two membranes become a single amniochorionic membrane. Amniotic fluid fills the amniochorionic membrane to provide a watery environment to

Patents 389

protect the growing embryo. Ordinarily the amniochorionic membrane acts as a primary barrier to bacteria and other potentially damaging organisms by providing a protected, substantially sealed environment throughout the development of the embryo until it ruptures subsequent to the onset of labor. However, this environment is occasionally compromised when it is prematurely ruptured prior to the onset of labor. Technically, premature rupture of the membrane can occur at any time during the forty weeks of gestation. Although definitions vary, "premature rupture of the membrane" refers to rupture of the amniochorionic membrane prior to the onset of labor at any time. In either case, a ruptured membrane poses a considerable risk of infection to both mother and fetus. Web site: http://www.delphion.com/details?pn=US06149590__ •

Topical application of antibodies for prophylaxis against sexually transmitted diseases and pregnancy Inventor(s): Cone; Richard A. (Baltimore, MD), Whaley; Kevin J. (Baltimore, MD) Assignee(s): Johns Hopkins University (Baltimore, MD) Patent Number: 6,045,786 Date filed: February 1, 1993 Abstract: Certain antibody molecules are so stable and so potent at immobilizing sperm as well as the pathogens for sexually transmitted diseases (STDs) that they make possible new prophylactic contraceptive methods: (a) for men, a skin lotion containing antibodies against sperm and against STD pathogens to be applied to the penis and external genitals during sexual activity, thereby delivering prophylactically effective doses of antibodies to virtually all areas of skin and epithelia across which most STDs, including AIDS, are usually transmitted, and, during vaginal intercourse, the penis will deliver a contraceptively reliable dose of the antibodies to the cervical region of the vagina; and (b) for women, intrauterine devices (IUDs) and intravaginal devices (IVDs) that release antibodies into the uterus or into the vagina to provide continuous protection against pregnancy and STDs for periods of months to years. Excerpt(s): This invention describes methods of contraception and prophylaxis against sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS), and compositions and devices for use in such methods. There is an urgent need, worldwide, for improved contraceptives, especially male contraceptives. There is also an urgent need, worldwide, for improved prophylactic methods for preventing the spread of STDs. Vaccines could be highly valuable for meeting these needs and substantial efforts are being made to develop vaccines that will stimulate the body to synthesize its own antibodies against sperm and against STD pathogens. However, no contraceptive vaccine is yet available, and for some STDs, including AIDS, there is considerable doubt that a vaccine can ever be developed--infected individuals develop high titers of anti-HIV antibodies but this immunity to HIV does not stop the fatal course of AIDS. In the absence of vaccines, the most effective methods now available for preventing both pregnancy and STDs are the condom, and the topical spermicidal contraceptives--foams, jellies, suppositories, and sponges. Condoms are both contraceptive and prophylactic since they create a mechanical barrier that prevents sperm as well as STD pathogens in the ejaculate from contacting the sexual partner. Many topical contraceptives are also both contraceptive and prophylactic since they use detergents for their active (spermicidal) ingredient, usually the nonionic detergent nonoxynol-9. Detergents not only kill (lyse) sperm, they also kill many pathogenic

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bacteria, protozoa, and viruses. Unfortunately, detergents also injure epithelial cells, and many people cannot use topical contraceptives because the detergents cause too much irritation, especially to the urethra. Also, detergents are only active for a short time after being applied to a mucus epithelium: contraceptive suppositories start to become unreliable about 45 minutes after being inserted in the vagina because detergents become inactive after solubilizing oily molecules. Detergents are also absorbed into the body through mucus epithelia. Web site: http://www.delphion.com/details?pn=US06045786__ •

Torso support for pregnant women Inventor(s): Turner; Linda L. (406 Entrada Dr., J-10, Golden, CO 80401) Assignee(s): none reported Patent Number: 5,094,648 Date filed: April 1, 1991 Abstract: A torso support for pregnant women includes abdominal, breast and back support panels and laterally extending upper and lower elastic strips. The upper strip extending along a junction of the lower edge of the breast support panel and the upper edge of the abdominal support panel, and the lower elastic strip extending around a bottom edge of the abdominal support panel adjacent a waist opening of the torso support, are stretchable in only a lateral direction. A pair of shoulder straps extending from an upper portion of the breast support panel to a central upper region on a back of the torso support define neck and shoulder openings. The back support panel has a hexagonal configuration and tapers in width from a widest upper portion to a narrower lower portion. Side edges of the back support panel extend in conformance with arcuate peripheral edge portions of the shoulder openings. Ends of the upper strip are secured to central regions of lateral edges of the back support panel. A bottom arcuate edge of the back support panel is sewn to the lower elastic strip. The breast and abdominal support panels are formed from a woven cotton blend fabric material stretchable in longitudinal and lateral directions. The back support panel is formed from a woven fabric material stretchable in only a longitudinal direction. The torso support is worn as an undergarment or outergarment and provides support for the lower abdomen, back and breasts of a pregnant woman. Excerpt(s): The present invention relates to torso supports for pregnant women, and more particularly pertains to an improved torso support designed to be worn as an undergarment or outergarment for supporting the lower abdomen, back and breasts of a pregnant woman. Physiological changes which occur during pregnancy place a great deal of strain on the body of a woman, and can result in chronic debilitating physical injury, as described in U.S. Pat. No. 4,836,824, the entire disclosure of which is hereby incorporated by reference herein. In particular, the lower abdomen, breasts, and back of a pregnant woman require increased support to prevent muscle strain and possible skeletal dislocation. In order to achieve these and other objects of the invention, the present invention provides an improved torso support for pregnant women which includes an abdominal support panel, a breast support panel, a back support panel, and substantially laterally extending upper and lower elastic strips. The upper elastic strip extends along a junction of the lower edge of the breast support panel and the upper edge of the abdominal support panel. The lower elastic strip extends around a bottom edge of the abdominal support panel adjacent a waist opening of the torso support. A pair of shoulder straps extend from an upper portion of the breast support panel to a

Patents 391

central upper region on a back of the torso support. The shoulder straps define a head and neck opening and left and right shoulder openings. The back support panel has a generally hexagonal configuration and tapers in width from a widest upper portion to a narrower lower portion. Arcuate side edges of the back support panel extend in close conformance with arcuate peripheral edge portions of respective left and right shoulder openings. Opposite ends of the upper elastic strip are secured respectively to a central region of left and right lateral edges of the back support panel. A bottom arcuate edge of the back support panel is sewn to the lower elastic strip. The breast and abdominal support panels are formed from a woven cotton blend fabric material stretchable in longitudinal and lateral directions. The back support panel is formed from a woven fabric material stretchable in only a substantially longitudinal direction, while the upper and lower elastic strips are stretchable in only a substantially lateral direction. The torso support is worn as an undergarment or outergarment and provides support for the lower abdomen, back and breasts of a pregnant woman. There has thus been outlined, rather broadly, the more important features of the invention in order that the detailed description thereof that follows may be better understood, and in order that the present contribution to the art may be better appreciated. There are, of course, additional features of the invention that will be described hereinafter and which will form the subject matter of the claims appended hereto. In this respect, before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein are for the purpose of description and should not be regarded as limiting. As such, those skilled in the art will appreciate that the conception, upon which this disclosure is based, may readily be utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the present invention. It is important, therefore, that the claims be regarded as including such equivalent constructions insofar as they do not depart from the spirit and scope of the present invention. Web site: http://www.delphion.com/details?pn=US05094648__ •

Use of 8-anilino-1-naphthalenesulfonate in the uterus to prevent pregnancy Inventor(s): Cormier; Milton J. (Bogart, GA) Assignee(s): University of Georgia Research Foundation, Inc. (Athens, GA) Patent Number: 4,416,897 Date filed: July 14, 1982 Abstract: The use of 8-anilino-1-naphthalenesulfonate by injecting or introducing such drug directly into the uterus is disclosed as a means of preventing pregnancy after intercourse has occurred. Various means of introducing such drug are disclosed, such as by mixing such drug with jelly carriers, foam carriers, or paraffin oil. Excerpt(s): The present invention relates to a method of preventing pregnancy. More specifically, the present invention relates to the use of calmodulin binding drugs as a means to prevent pregnancy after intercourse by injecting such drugs into the uterus. Presently, there is no effective method or product known for preventing conception or pregnancy after sexual intercourse has occurred, especially after an hour or more has elapsed after intercourse. For the purpose of this application pregnancy is intended to be

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defined as the implantation of a fertilized egg to the uterus. Currently, in cases of rape or other cases of intercourse where pregnancy is unwanted, other than using douches or other normally ineffective methods to attempt to prevent conception, the normal practice is to wait to see whether the signs of pregnancy occur and, if so, have an abortion if the pregnancy is to be terminated. Web site: http://www.delphion.com/details?pn=US04416897__ •

Use of 9-anthroylcholine in the uterus to prevent pregnancy Inventor(s): Cormier; Milton J. (Bogart, GA) Assignee(s): University of Georgia Research Foundation, Inc. (Athens, GA) Patent Number: 4,421,764 Date filed: July 14, 1982 Abstract: The use of 9-anthroylcholine by injecting or introducing such drug directly into the uterus is disclosed as a means of preventing pregnancy after intercourse has occurred. Various means of introducing such drug are disclosed, such as by mixing such drug with jelly carriers, foam carriers, or paraffin oil. Excerpt(s): The present invention relates to a method of preventing pregnancy. More specifically, the present invention relates to the use of calmodulin binding drugs as a means to prevent pregnancy after intercourse by injecting such drugs into the uterus. Presently, there is no effective method or product known for preventing conception or pregnancy after sexual intercourse has occurred, especially after an hour or more has elapsed after intercourse. For the purpose of this application pregnancy is intended to be defined as the implantation of a fertilized egg to the uterus. Currently, in cases of rape or other cases of intercourse where pregnancy is unwanted, other than using douches or other normally ineffective methods to attempt to prevent conception, the normal practice is to wait to see whether the signs of pregnancy occur and, if so, have an abortion if the pregnancy is to be terminated. Web site: http://www.delphion.com/details?pn=US04421764__

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Use of a pregnancy specific protein as an immunosuppressive Inventor(s): Sasser; R. Garth (Moscow, ID) Assignee(s): Idaho Research Foundation, Inc. (Moscow, ID) Patent Number: 5,559,097 Date filed: January 12, 1990 Abstract: Methods and compositions are provided for maintaining pregnancy and preventing rejection of transplanted tissue. A polypeptide characterized as capable of isolation from conceptus tissue and capable of inhibiting mitogen induced lymphocyte blastogenesis is employed which is introduced into the uterus or systemically. Excerpt(s): The field of this invention concerns compositions and methods relating to immunosuppression in mammals. Circulating lymphocytes respond to the presence of foreign antigens by undergoing blastogenesis. This allows for a major change in cell number and aids in neutralizing the effect of the antigen. It is one way that the immune system meets the challenge of disease or presence of foreign tissue. This response is seen

Patents 393

when tissue transplants occur and can result in tissue rejection. The fetus is also foreign to the host (mother) since it has antigens that are contributed by the paternal genome. Mechanisms preventing maternal rejection of the semiallogenic fetus are not well understood. However, the maternal immune system is fully capable of rejecting paternal antigens expressed by the conceptus and it is well documented in sheep that the uterus is capable of tissue transplant rejection and that the fetus therefore must regulate the immune system in a protective way. Proposed mechanisms include secretion by the fetus of proteinaceous products which act to suppress the immune system. Web site: http://www.delphion.com/details?pn=US05559097__ •

Use of fibronectin having a variable included type III repeat sequence as a marker for toxemia in pregnancy Inventor(s): Lockwood; Charles J. (210 Hobart, Hingham, MA 02043), Peters; John H. (3290-58 Via Marin, La Jolla, CA 92037) Assignee(s): none reported Patent Number: 5,108,898 Date filed: January 18, 1989 Abstract: The elevation of human cellular fibronectin monomers having a variably included Type III repeat in a pregnant woman, as early as the first trimester, has been found to precede the onset of the clinical manifestations of toxemia and correlate with the severity of the disease state. The present invention provides a means of detection for and the monitoring of the toxemias of pregnancy, particularly preeclampsia and eclampsia, by the use a marker, human fibronectin having a variably included Type III repeat sequence, ED1 or ED2. Excerpt(s): The present invention relates to a method for the detection and monitoring of toxemia, particularly preeclampsia, in a pregnant woman by use of a marker, human fibronectin having a variably included Type III repeat (ED1+Fn or ED2+Fn). More specifically, it relates to a method for the determination of the concentration of the fibronectin in a body sample from a pregnant woman, which concentration has been found to correlate with the disease state. Preeclampsia and eclampsia are toxemias associated with pregnancy. Preeclampsia is classically defined as the triad of hypertension, proteinuria, and edema associated with pregnancy. Other manifestations of preeclampsia are vascular prostenoid and platelet derangements, vasospasm, uteroplacental vascular lesions, and in severe cases, convulsions and coma (eclampsia). Walsh et al., Am. J. Obstet. Gynecol., 151:100-15 (1985); Goodman et al., Am. J. Obstet. Gynecol., 142:817-22 (1982); Kitzmiller et al., Am. J. Obstet. Gynecol., 118:362-8 (1974); Giles et al., Br. J. Obstet. Gynecol., 88:1115-19(1981); and Gant et al., J. Clin Invest., 52:2682-89 (1973). Toxemia occurs more often in women pregnant for the first time and in those over the age of thirty-five. Toxemia is especially frequent in patients with prior renal and vascular disease. A significant percentage of pregnant women with preexisting hypertension are also likely to have a toxemic episode. Web site: http://www.delphion.com/details?pn=US05108898__

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Use of hydrolytic enzymes for the prophylaxis of spontaneous abortion in pregnant women with habitual idiopathic abortion in their anamneses Inventor(s): Ransberger; Karl (Seeshaupt, DE), Dittmar; Friedrich-Wilhelm (Socking, DE), Kunze; Rudolf (Berlin, DE), Stauder; Gerhard (Wolfratshausen, DE) Assignee(s): Mucos Pharma GmbH & Co. (DE) Patent Number: 5,505,942 Date filed: October 21, 1994 Abstract: The present invention relates to the use of hydrolytic enzymes for the prophylaxis of spontaneous abortion in pregnant women in need thereof with habitual idiophathic abortion in their anamneses. Excerpt(s): The present invention relates to the use of at least one hydrolytic enzyme for the prophylaxis of abortion in pregnant women with habitual idiopathic abortion in their anamneses. One talks about habitual abortion when at least three successive pregnancies end before the 28th gestational week with spontaneous abortion. (Pschyrembel, Klinisches Worterbuch, 255th ed., Walter de Gruyter, 1986). Habitual spontaneous abortions are sometimes due to anatomic, genetic or hormonal anomalies of the patients concerned. Examples thereof are congenital uterine anomalies, chromosomal abnormalities, thyroid dysfunctions, diabetes mellitus, autoimmune diseases, viral or bacterial infections, etc. (Makino, T. et al., Annals New York Academy of Sciences, pp. 597-604, 1990). At an incidence of 0.4%, however, this kind of abortion is idiopathic, i.e., of unknown cause (disposition). Therapeutic or prophylactic measures which have so far been taken to maintain pregnancy in case of pending abortion without any hints at a possible cause are cervical cerclage, hormone supplementation (estrogen, gestagen, progesterone, etc.) and the administration of allogenic leukocytes and polyvalent immunoglobulins. Web site: http://www.delphion.com/details?pn=US05505942__

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Use of N-(6 aminohexyl)-5-chloro-1-naphthalenesulfonamide, N-(6 aminohexyl)-5chloro-2-naphthalenesulfonamide, or N-(6 aminohexyl)-5-bromo-2naphthalenesulfonamide in the uterus to prevent pregnancy Inventor(s): Cormier; Milton J. (Bogart, GA) Assignee(s): University of Georgia Research Foundation, Inc. (Athens, GA) Patent Number: 4,419,366 Date filed: July 14, 1982 Abstract: The use of N-(6 aminohexyl)-5-chloro-1-naphthalenesulfonamide, N-(6 aminohexyl)-5-chloro-2-naphthalenesulfonamide, or N-(6 aminohexyl)-5-bromo-2naphthalensulfonamide by injecting or introducing such drugs directly into the uterus is disclosed as a means of preventing pregnancy after intercourse has occurred. Various means of introducing such drugs are disclosed, such as by mixing such drugs with jelly carriers, foam carriers, or paraffin oil. Excerpt(s): The present invention relates to a method of preventing pregnancy. More specifically, the present invention relates to the use of calmodulin binding drugs as a means to prevent pregnancy after intercourse by injecting such drugs into the uterus. Presently, there is no effective method or product known for preventing conception or pregnancy after sexual intercourse has occurred, especially after an hour or more has

Patents 395

elapsed after intercourse. For the purpose of this application pregnancy is intended to be defined as the implantation of a fertilized egg to the uterus. Currently, in cases of rape or other cases of intercourse where pregnancy is unwanted, other than using douches or other normally ineffective methods to attempt to prevent conception, the normal practice is to wait to see whether the signs of pregnancy occur and, if so, have an abortion if the pregnancy is to be terminated. Web site: http://www.delphion.com/details?pn=US04419366__ •

Use of N-phenyl-1-naphthylamine in the uterus to prevent pregnancy Inventor(s): Cormier; Milton J. (Bogart, GA) Assignee(s): University of Georgia Research Foundation, Inc. (Athens, GA) Patent Number: 4,416,900 Date filed: July 14, 1982 Abstract: The use of N-phenyl-1-naphthylamine by injecting or introducing such drug directly into the uterus is disclosed as a means of preventing pregnancy after intercourse has occurred. Various means of introducing such drug are disclosed, such as by mixing such drug with jelly carriers, foam carriers, or paraffin oil. Excerpt(s): The present invention relates to a method of preventing pregnancy. More specifically, the present invention relates to the use of calmodulin binding drugs as a means to prevent pregnancy after intercourse by injecting such drugs into the uterus. Presently, there is no effective method or product known for preventing conception or pregnancy after sexual intercourse has occurred, especially after an hour or more has elapsed after intercourse. For the purpose of this application pregnancy is intended to be defined as the implantation of a fertilized egg to the uterus. Currently, in cases of rape or other cases of intercourse where pregnancy is unwanted, other than using douches or other normally ineffective methods to attempt to prevent conception, the normal practice is to wait to see whether the signs of pregnancy occur and, if so, have an abortion if the pregnancy is to be terminated. Web site: http://www.delphion.com/details?pn=US04416900__

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Use of parathormone, its biologically active fragments and correlated peptides, for the preparation of pharmaceutical compositions useful for the treatment of pregnancy Inventor(s): Bagnoli; Franco (Via Olanda, 53100 Carpineto (Province of Siena) Assignee(s): none reported Patent Number: 5,880,093 Date filed: April 5, 1995 Abstract: Pharmaceutical compositions containing Parathormone as active ingredient, its biologically active fragments and correlated peptides (PTHrP), eventually in combination with appropriate pharmaceutically acceptable additives, useful in the prevention and therapy of abortion and of premature birth and in general for the treatment of pregnancy are described. Excerpt(s): The present invention relates to the use of Parathormone, its biologically active fragments and its correlated peptides (PTHrP) for the prevention and therapy of

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abortion and of premature birth and in general for the treatment of pregnancy. The generic term Parathormone or parathyroid hormones (commonly indicated by the initials PTH eventually followed by the number of amino acids characterizing the particular fragment) refers to a series of proteins or their fragments which can be found in nature and are assigned to different physiological effects. Such effects relate principally to the regulation of calcemic homeostasis, favouring the intestinal calcium absorption by the indirect mechanism of hydroxylation of Vitamin D, increasing the reabsorption of calcium in the renal tubules and activating the osteoclasts. More recently it was shown that PTH and PTHrP have a relaxing action on the gastrointestinal muscles and on vascular tissue. Moreover, an increase of hematic flow in the coronaries and a positive chronotropic effect and negative inotropic effect have been demonstrated. Web site: http://www.delphion.com/details?pn=US05880093__ •

Use of phenothiazine 5-oxide drugs in uterus to prevent pregnancy Inventor(s): Cormier; Milton J. (Bogart, GA) Assignee(s): University of Georgia Research Foundation, Inc. (Athens, GA) Patent Number: 4,578,385 Date filed: November 13, 1984 Abstract: The use of phenothiazine 5-oxide drugs by injecting or introducing such drugs directly into the uterus is disclosed as a means of preventing pregnancy after intercourse has occurred. Various means of introducing such drugs are disclosed, such as by mixing such drugs with jelly carriers, foam carriers, or paraffin oil. Excerpt(s): This application is a continuation-in-part of application Ser. No. 398,847 filed 7-14-82, now abandoned; which is a continuation-in-part of application Ser. No. 253,567 filed 7-6-81, now U.S. Pat. No. 4,377,577; which, in turn, is a continuation-in-part of application Ser. No. 155,800 filed 5-30-80, now U.S. Pat. No. 4,443,446. The present invention relates to a method of preventing pregnancy. More specifically, the present invention relates to the use of calmodulin binding drugs as a means to prevent pregnancy after intercourse by injecting such drugs into the uterus. Presently, there is no effective method or product known for preventing conception or pregnancy after sexual intercourse has occurred, especially after an hour or more has elapsed after intercourse. For the purpose of this application pregnancy is intended to be defined as the implantation of a fertilized egg to the uterus. Web site: http://www.delphion.com/details?pn=US04578385__

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Use of psychoactive drugs in uterus to prevent pregnancy Inventor(s): Cormier; Milton J. (Bogart, GA) Assignee(s): University of Georgia Research Foundation, Inc. (Athens, GA) Patent Number: 4,377,577 Date filed: July 6, 1981 Abstract: The use of psychoactive drugs by injecting or introducing such drugs directly into the uterus is disclosed as a means of preventing pregnancy after intercourse has occurred. Various means of introducing such drugs are disclosed, such as by mixing such psychoactive drugs with jelly carriers, foam carriers, or paraffin oil.

Patents 397

Excerpt(s): The present invention relates to a method of preventing pregnancy. More specifically, the present invention relates to the use of calmodulin binding drugs as a means to prevent pregnancy after intercourse by injecting such drugs into the uterus. Presently, there is no effective method or product known for preventing conception or pregnancy after sexual intercourse has occurred, especially after an hour or more has elapsed after intercourse. For the purpose of this application pregnancy is intended to be defined as the implantation of a fertilized egg to the uterus. Currently, in cases of rape or other cases of intercourse where pregnancy is unwanted, other than using douches or other normally ineffective methods to attempt to prevent conception, the normal practice is to wait to see whether the signs of pregnancy occur and, if so, have an abortion if the pregnancy is to be terminated. Web site: http://www.delphion.com/details?pn=US04377577__ •

Use of the pregnancy-specific.beta.sub.1 -glyco-protein and its antibody for contraception Inventor(s): Bohn; Hans (Marbach, near Marburg an der Lahn, DT), Weinmann; Ernst (Michelbach, near Marburg an der Lahn, DT) Assignee(s): Behringwerke Aktiengesellschaft (Frankfurt an der Lahn, DT) Patent Number: 3,957,975 Date filed: September 10, 1974 Abstract: Use of the pregnancy-specific.beta.sub.1 -glycoprotein (SP.sub.1) and its antibody for contraception and for inducing miscarriages. Excerpt(s): The present invention relates to the use of the pregnancy-specific.beta.sub.1 glycoprotein (SP.sub.1) and its antibody for contraception and for inducing miscarriages. Attempts have been made in which antisera against extracts of animal placentae were to prevent rabbits from conception and to induce miscarriages in monkeys and mice. Further attempts have been made to reduce the fertilisation rate of rats by the active immunisation with human placenta-lactogen. All these attempts did not reach beyond the commencing stage and, especially, were not used in medicine. Now, it was found that the pregnany-specific.beta.sub.1 -glycoprotein which can be obtained from placentae or sera, and its antiserum can be used for contraception and induction of miscarriages in primates, for example, in human beings and in monkeys. Web site: http://www.delphion.com/details?pn=US03957975__

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Vagina cleaning system for preventing pregnancy and sexually transmitted diseases Inventor(s): Pan; Shen (462 Burns Dr., Westerville, OH 43082), Liu; James Zhou (462 Burns Dr., Westerville, OH 43082) Assignee(s): none reported Patent Number: 6,447,490 Date filed: May 17, 2000 Abstract: The present invention discloses an improved vagina cleaning system. The improved system comprises a vagina opener, a vagina cleaning-solution sprayer, a multiple-functional vagina cleaning solution, and a health-promoting bacteria introducer. The system is used to remove semen from the vagina to prevent pregnancy,

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to reduce pathogenic microorganisms in the vagina to prevent sexually transmitted diseases, to remove other unwanted materials from the vagina to eliminate discomfort, and to add health-promoting bacteria into the vagina to prevent abnormal colonization of microflora in the vaginal cavity. The present invention also discloses methods of using the system for cleaning the vaginal cavity and for introducing health-promoting bacteria into the vaginal cavity. Excerpt(s): The present invention relates generally to an improved vagina cleaning system to be used for removing unwanted substances from a woman's vagina. The vagina cleaning system of the present invention includes an improved vagina opener, a simplified vagina-cleaning device and a multi-functional vagina cleaning solution. A device used to introduce health-promoting probiotic bacteria into the vagina may also be used as part of the system. Also included is a method of using the vagina cleaning system of the present invention. The incidence of sexually transmitted diseases, including human immunodeficiency virus (HIV) infection, is increasing in children, adolescents, young adults, as well as others who are sexually active. It has been reported that approximately 50% of American adolescents are sexually active by age 16 years (Committee on Infectious Diseases, American Academy of Pediatrics: 1994 Red Book, Report of the Committee on Infectious Diseases, 23rd edition, G. Peter, N. A. Halsey, E. K. Marcuse & L. K. Pickering, eds. p. 103, American Academy of Pediatrics, 1994, Elk Grove Village, Ill.). Sexually experienced adolescents have the highest rate of sexually transmitted diseases as compared to any age group. Being pregnant is not the desired consequence of sexual activity for most adolescent girls. The American Academy of Pediatrics reported that traditional sexually transmitted diseases, including syphilis, gonorrhea, chancroid, and lymphogranuloma venereum, are still prevalent today. Currently, HIV, hepatitis B virus and Chlamydia trachomatis are major pathogens of sexually transmitted diseases (Committee on Infectious Diseases, American Academy of Pediatrics: 1994 Red Book. Report of the Committee on Infectious Diseases, 23rd edition, G. Peter, N. A. Halsey, E. K. Marcuse & L. K. Pickering, eds. pp. 104-106, American Academy of Pediatrics, 1994, Elk Grove Village, Ill.). Although certain sexually transmitted diseases are treatable, some of those caused by Candida albicans, cytomegalovirus, HIV, and Herpes simplex types 1 and 2, lack effective and/or inexpensive treatment methods. Web site: http://www.delphion.com/details?pn=US06447490__ •

Weighing scale for determining the weight of a pregnant woman Inventor(s): Kimura; Kentaro (Tokyo, JP) Assignee(s): Tanita Corporation (Tokyo, JP) Patent Number: 6,369,338 Date filed: July 31, 2000 Abstract: Disclosed is an improved weighing scale for determining a most appropriate antenatal weight of a pregnant woman for each number of the weeks since conception on the basis of the "antenatal weight-to-week" relationship identified in terms of the BMI of the pregnant woman, which index is determined from the height and progestational weight of the pregnant woman, and for making a comparison between the so determined most appropriate antenatal weight and the weight of the pregnant woman measured each week.

Patents 399

Excerpt(s): The present invention relates to a weighing scale for determining a most appropriate weight of a pregnant woman in terms of her physical features or body mass index (hereinafter abbreviated as "BMI"), the most appropriate weight varying with time, and being determined for each number of antenatal weeks which have passed since conception. Pregnant women's weights have been hitherto monitored by comparing their antenatal weights with progestational ones prior to conception to determine the increment of weight, thereby making a decision as to whether their weights have been increasing in normal condition or not by referring to weight control tables or other data. The increment of the weight of a pregnant woman, however, is dependent on the height and progestational weight of the pregnant woman, that is, the BMI of the pregnant woman, and therefore, the weight monitoring cannot be effected appropriately for the purpose so far as the monitoring relies simply on the number of the antenatal weeks since conception and the increment of antenatal weight relative to the progestational weight. As a matter of fact, however, nobody knows how a most appropriate antenatal weight can be determined from the BMI of an individual pregnant woman and the number of the antenatal weeks since conception. Web site: http://www.delphion.com/details?pn=US06369338__

Patent Applications on Pregnancy As of December 2000, U.S. patent applications are open to public viewing.10 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 pregnancy: •

Activated carbon for preventing pregnancy and sexually transmitted disease Inventor(s): Sunberg, Richard Joseph; (Oxford, OH), Hunt, Sheri Anne; (West Chester, OH) Correspondence: THE PROCTER & GAMBLE COMPANY; INTELLECTUAL PROPERTY DIVISION; WINTON HILL TECHNICAL CENTER - BOX 161; 6110 CENTER HILL AVENUE; CINCINNATI; OH; 45224; US Patent Application Number: 20030003095 Date filed: August 8, 2002 Abstract: Activated carbon, as well as compositions and kits comprising the same, are effective for preventing pregnancy and sexually transmitted diseases including HIV. Excerpt(s): The World Health Organization ("WHO") announced that world population growth is the highest priority for global health. WHO also emphasized that sexually transmitted diseases ("STDs") are of paramount concern. To this end, most of the global population growth is attributed to developing countries thereby straining already sparse resources. Many devices attempt to address the world's population growth and occurrence of STDs. Examples of such devices are described in: U.S. Pat. Nos. 5,756,681; 5,985,275; 5,952,009; and 6,165,493. STD caused by C. trachomatis and N. gonorrhoeae account for 88 and 62 million new infections per year worldwide, respectively. These diseases may be asymptomatic, especially in females, yet lead to serious illnesses including pelvic inflammatory disease. While treatable with inexpensive antibiotics such

10

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

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as tetracycline and penicillin, the global cost of these two STDs alone is said to be approximately 2.5 billion U.S. dollars per year. Both of these infections may recur repeatedly, even in heavily exposed individuals such as sex workers, as antigenic variation of these STD agents permits evasion of host immunity. Both of these STDs can be prevented with the use of barrier methods, i.e., male condoms. Use of a diaphragm with spermicidal nonoxynol-9 offers some protection. Both of these methods require compliance and professional counsel for correct use and benefit. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Administering IgE antagonists during pregnancy to ameliorate allergic diseases in the offspring Inventor(s): Anderson, David; (Houston, TX), Thomas, David; (Houston, TX) Correspondence: Eric Mirabel; Tanox, Inc. 10301 Stella Link # 110; Houston; TX; 770255497; US Patent Application Number: 20020006402 Date filed: January 12, 2001 Abstract: The invention relates to IgE antagonists, including monoclonal antibodies, and their use in ameliorating asthma and allergic diseases in offspring of mothers treated during pregnancy with such antagonists. The preferred IgE antagonists do not induce release of the mediators of allergy. One example of such IgE antagonists are anti-IgE antibodies which bind to secreted IgE, to membrane IgE on the surface of IgE-producing B cells, but not to IgE bound to the Fc.di-elect cons.RI on the surface of basophils or mast cells. Preferably, these antibodies also do not bind to IgE bound to Fc.di-elect cons.RII receptors. It is also preferable if these antibodies have human IgG1 or IgG3 constant regions, as well as further human portions, if desired. Excerpt(s): The invention relates to IgE antagonists, including monoclonal antibodies, and their use in ameliorating asthma and allergic diseases in offspring of mothers treated during pregnancy with such antagonists. Immunoglobulin E (IgE) is one class of immunoglobulin (or "antibody") molecule. IgE is present in human serum in lower concentrations than the other immunoglobulins: IgG, IgM, IgA, and IgD. IgE is thought to have a role in protection against parasites, but has never been definitively established as playing a necessary, or even a beneficial role, at least in developed countries where parasite infections are not a significant problem. IgE is well known as the mediator of immediate-type hypersensitivity allergic reactions, including allergic rhinitis ("hay fever"), extrinsic asthma, and food and drug allergies. In IgE-mediated allergic reactions, IgE, after it is secreted by B cells, binds through its Fc portion to the Fc.di-elect cons.RI receptors, which are present on the surface of basophils, mast cells and Langerhans cells. If the IgE bound to the surface of these cells now contacts and binds an allergen, this causes a cross-linking of the bound IgE molecules and hence the underlying receptors, and triggers the release of pharmacologic mediators, such as histamine, serotonin, leukotrienes and the slow-reacting substance of anaphylaxis. These mediators cause the pathologic manifestations of allergic reactions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 401

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Apparatus and method for detection of estrus and/or non-pregnancy Inventor(s): Redford, Chris R. (Webster Groves, MO), Mehrotra, Vikram P. (Wildwood, MO) Correspondence: Matthew L. Madsen; Howrey Simon Arnold & White, LLP; 750 Bering Drive; Houston; TX; 77057-2198; US Patent Application Number: 20020156394 Date filed: April 18, 2002 Abstract: The present invention is directed to devices for detection estrus-state and/or non-pregnancy in mammals and methods for using the same. The device and/or methods may be of particular use in cattle. The devices disclosed include at least a housing of a size, shape, and outer surface quality permitting it to be securely maintained within a mammals vagina. The housing has at least one interior space for installation of instrument(s) for measuring, intra-vaginally, at least on indicia of estrus (heat) or non-pregnancy, converting the resulting measurement into a signal or signals (electronic or otherwise). The device also comprises a signal transmitting means and, optionally, a remote receiving station capable of interpreting the signal(s). Excerpt(s): This application claims the benefit of U.S. Provisional Application Serial No. 60/285,315 filed Apr. 20, 2001. Commercial raising of cattle for dairy production requires proper management. In addition to the various husbandry concerns such as herd health and nutrition, a critical management area for economic survival of any cattle operation, is the breeding management of the cows. Dairy cows are managed intensely and there are costs associated with breeding the cow, how long it takes each cow to become pregnant, as well as associated labor costs. Economics of a dairy make it important to both minimize the amount of time a dairy cow is not pregnant and yet still have a high probability of the cow becoming pregnant. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Body fat measuring system for pregnant woman and health care system for pregnant woman Inventor(s): Ashitaka, Yoshihiko; (Ashiya-shi, JP), Maruo, Motoyoshi; (Haibara-cho, JP), Kitahara, Yuko; (Niiza-Shi, JP), Honda, Yuka; (Itabashi-ku, JP), Ueda, Yasuo; (SasayamaShi, JP) Correspondence: McDERMOTT, WILL & EMERY; 600 13th Street, N.W. Washington; DC; 20005-3096; US Patent Application Number: 20030023186 Date filed: July 23, 2002 Abstract: Measurements by use of a conventional caliper process require skills and experiences. Further, since different pregnant women gain and keep fats in their bodies in different ways, results of measurements of their body fats vary. To overcome the inconvenience, there is provided a system for measuring a percent body fat or a total body fat by a bioelectrical impedance method, which comprises first input means, second input means and computation means, wherein personal data of a patient such as a height and a body weight is input into the first input means, a weight of a fetal part is input into the second input means, and the computation means computes a percent body fat or a total body fat by subtracting the body weight input into the second input

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means from the body weight input into the first input means. Further, to overcome the inconvenience, there is provided a system for measuring a percent body fat by a bioelectrical impedance method which comprises first input means, second input means and computation means, wherein personal data of a patient such as a height and a body weight is input into the first input means, a weight of a fetal part is input into the second input means, and the computation means computes a percent body fat by subtracting the body weight input into the second input means from the body weight input into the first input means. Excerpt(s): The present invention relates to a system for measuring a body fat, particularly a system for measuring a body fat of a pregnant woman and also a system for administrating health of a pregnant woman, particularly a system for administrating health of a pregnant woman with respect to edema and toxemia of pregnancy. From the viewpoint of ages, a conventional body fat measuring device is capable of measuring body fats of subjects ranging from children to elderly people. However, it is not capable of measuring body fats of pregnant women. Meanwhile, an examiner can see an alteration in fats of a pregnant woman by observing an alteration in subcutaneous fats by an ultrasonic adipometer, a caliper or the like. However, measurements by use of a conventional caliper process require skills and experiences. Further, the distribution of fat was different by each pregnant woman. Therefore, results of measurements of their body fats vary. In addition, heretofore, to determine onset of edema of a pregnant woman, it has been checked whether an impression is made and left when tibia is pressed with a thumb. Lower extremities of the pregnant woman shows edema of pregnancy toxemias. And this pregnant woman is diagnosed with slight pregnancy toxemias that body weight of the pregnant woman which appeared of edema increases more than 500 g in one week. Furthermore, this pregnant woman is diagnosed as severe toxemia of pregnancy when this edema extends to a whole body of pregnant woman. However, determination of onset of edema is apt to be dependent on subjectivity of a doctor who diagnoses a patient, and its quantitative determination has heretofore been impossible. Further, it is known that an increase in body weight also varies greatly according to an intake of food, an amount of excrement and an amount of sweat on a day and a body weight can be increased or decreased by about 500 g soon. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cadherin-11 as an indicator of viable pregnancy Inventor(s): Stephenson, Mary D. (Vancouver, CA), MacCalman, Colin D. (Vancouver, CA) Correspondence: MARSHALL, GERSTEIN & BORUN; 6300 SEARS TOWER; 233 SOUTH WACKER; CHICAGO; IL; 60606-6357; US Patent Application Number: 20030124558 Date filed: June 5, 2002 Abstract: Novel diagnostic/monitoring methods are provided using cadherin-11 expression by endometrial tissue as indicator of ability to establish or maintain a viable pregnancy. Excerpt(s): This invention relates to production of cadherin-11 in human endometrial tissue as an indicator of ability to establish or maintain a viable pregnancy. The molecular defects responsible for common reproductive health problems such as infertility and habitual or recurrent spontaneous abortion are not fully known.

Patents 403

However, it is believed that implantation failure may contribute to a substantial proportion of cases. In addition, despite increasing experience with assisted reproduction technologies, a low proportion of women undergoing in vitro fertilization and embryo transfer establishes a viable pregnancy. A limiting factor in this setting may be the ability of the (pre-embryonic) blastocyst to attach and/or invade the uterine endometrium, process called implantation. Recurrent spontaneous abortion (RSA), defined as two or more consecutive pregnancy losses under 20 weeks of gestation, is a prevalent health problem affecting up to 5% of couples trying to establish a family. Genetic (translocations of either partner), endocrine (thyroid disease, hyperprolactinemia or luteal phase deficiency) anatomical (septate uterus, intrauterine adhesions or a submucous fibroid) and autoimmune factors (the Antiphospholipid Antibody (APA) or the Undifferentiated Connective Tissue (UCT) Syndromes) are known risk factors for RSA. The majority (80%) of endocrine-associated RSA is the result of a luteal phase deficiency (LPD), defined as two "out-of-phase" endometrial biopsies, each consisting of.gtoreq.3 days of maturation delay according to endometrial morphology and the onset of the next menses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Determination of pregnancy status Inventor(s): Ott, Troy L. (Moscow, ID) Correspondence: Howard Eisenberg, Esq. Suite 1600; 601 S.W. Second Avenue; Portland; OR; 97204; US Patent Application Number: 20020192838 Date filed: June 10, 2002 Abstract: A method and kit for determining whether an animal is not pregnant, or is pregnant following a breeding. The level of expression of a pregnancy induced protein is determined in an animal for which pregnancy status information is desired and the level is compared to that of the level in animals that are not pregnant. Excerpt(s): This application claims the benefit of pending provisional patent application Serial No. 60/299,553, filed Jun. 19, 2001. The invention relates to methods for determining the pregnancy status of animals. Particularly, the invention relates to methods for determining the pregnancy status of non-ungulates, ungulates, and ruminant animals. In the rearing of livestock, it is very important to accurately determine the pregnancy status of bred animals. In particular, it is the accurate and early identification of failed pregnancy of an animal that has been bred that is economically important. Presently, once an animal is bred, for example a cow, pregnancy status is determined by such methods as palpation, which does not provide an accurate determination of pregnancy status until after 30 days following breeding. Because cattle have an estrous cycle of about 21 days, this means that with presently available methods at least one opportunity for breeding an animal that fails to conceive, the estrus period immediately following the failed breeding, will be missed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Developmental device for use during and after pregnancy Inventor(s): Sica, Kimberly A. (Ravenna, OH) Correspondence: Heather M. Barnes; Fourteenth Floor; One Cascade Plaza; Akron; OH; 44308; US Patent Application Number: 20030016840 Date filed: July 18, 2001 Abstract: The present invention is a developmental device for use during and after pregnancy and comprises an elongated, elasticized belt, having a soft, looped fabric on both sides. The developmental device also comprises at least one speaker disposed within the belt. A playback device selectively attaches to the belt and is in electronic communication with the speaker. The playback device further comprises at least one preprogrammed microchip for transmitting an electrical signal to the speakers. A recordable microchip may also be included in the playback device to record a personalized message for the unborn child. Excerpt(s): The present invention relates to apparatuses and methods for a developmental device for use during, and after, pregnancy. More specifically, the present invention relates to apparatuses and methods for a belt comprising speakers and a playback unit for playing audible output to a fetus developing in a woman's womb or to a baby subsequent to birth. In the art of prenatal development, it is well known that a fetus is capable of detecting and discerning audible input as soon as twenty-six weeks after development in the womb. Studies further show that certain classical music, such as selections composed by Mozart, Hayden, Bach and Beethoven, has positive neurological and psychological effects on the developing fetus. Scientific studies support the notion that playing classical music to a baby may increase the baby's intellectual capacity. Babies who have had classical music played to them during gestation have been found to have higher I.Q.'s, higher creativity, and greater linguistic skills. It has also been shown that newborn babies who were familiar with classical music during development in the womb, are easily comforted or quieted when the same music is played for them once they are outside the womb. In another application of this theory, fetuses can become familiar with their loving parents' voices if the parents speak to the baby during pregnancy. When the baby is born, they have already become familiar with their mother and/or father's voice and have formed a bond with the mother and father. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Diagnostic device for distinguishing between normal and ectopic pregnancy and method for preparing the same Inventor(s): Chang, Jin-Dong; (Yangcheon-gu, KR), Nam, Jung-Hyun; (Uiwang-si, KR), Cha, Jung-Hak; (Gunpo-si, KR) Correspondence: HESLIN ROTHENBERG FARLEY & MESITI PC; 5 COLUMBIA CIRCLE; ALBANY; NY; 12203; US Patent Application Number: 20030153093 Date filed: February 10, 2003 Abstract: A one-step diagnostic device for simultaneously detecting and distinguishing between a normal pregnancy and an ectopic pregnancy and methods for preparing the device are disclosed. Utilizing the device and principles of the present invention, normal

Patents 405

pregnancy and ectopic pregnancy can be rapidly and accurately determined at an early stage by immunologically detecting the morphological differences between human chorionic gonadotropin (hCG) and modified forms thereof, which are secreted into the body fluid of a pregnant female. Excerpt(s): The present application is a continuation of International Patent Application Number PCT/KR01/01365, filed Aug. 10, 2001 and published Feb. 21, 2002 as WO 02/13685, and claims foreign priority benefits from Korean Patent Application Number 2000/46755, which was filed Aug. 12, 2000. The entire content of each of the earlier applications is incorporated herein. The present invention relates to various embodiments of diagnostic devices for distinguishing between a normal pregnancy and an ectopic pregnancy and methods for preparing these devices. More particularly, the present invention relates to diagnostic devices requiring a one-step procedure for the rapid and accurate determination of a normal pregnancy versus an ectopic pregnancy at an early stage. During a normal pregnancy, human chorionic gonadotropin ("hCG") is secreted into the body fluid of the female; with an ectopic pregnancy, a modified form of hCG is secreted. The device of the present invention immunologically detects these morphological differences. In a normal pregnancy, the fertilized egg implants itself within the uterine endometrial lining. With an ectopic pregnancy, the fertilized egg is implanted outside of the uterine endometrial lining. Depending upon the actual site of implantation, an ectopic pregnancy may be classified, for example, as a tubal pregnancy, a cervical pregnancy, an ovarian pregnancy, or a peritoneal pregnancy. More than 95% of ectopic pregnancies are tubal pregnancies, which therefore is often used as a general designation for an ectopic pregnancy. The etiology of ectopic pregnancy includes previous tubal ligation (contraception), PID (Pelvic Inflammatory Disease), administration of ovulation controlling formulations and STD (Sexually Transmitted Disease). The incidence of ectopic pregnancy is quite high, approaching as many as one per about 64-241 pregnant females. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Diagnostic kit for predicting pregnancy outcome Inventor(s): Birken, Steven; (Dumont, NJ), O'Connor, John F. (New Rochelle, NY), Kovalevskaya, Galina I. (New York, NY) Correspondence: John P. White, Esq. Cooper & Dunham LLP; 1185 Avenue of the Americas; New York; NY; 10036; US Patent Application Number: 20030124737 Date filed: December 31, 2002 Abstract: The present invention provides a method of predicting pregnancy outcome in a subject by determining the amount of an early pregnancy associated molecular isoform of hCG in a sample. The present invention further provides a method for determining the amount of early pregnancy associated molecular isoforms of human chorionic gonadotropin (hCG) in a sample. The present invention also provides a diagnostic kit for determining the amount of early pregnancy associated hCG is a sample. The present invention additionally provides an antibody which specifically binds to an early pregnancy associated molecular isoform of human chorionic gonadotropin. Finally, the present invention provides methods for detecting trophoblast or non-trophoblast malignancy in a sample.

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Excerpt(s): Throughout this application, various publications are referenced by author and date. Full citations for these publications may be found listed alphabetically at the end of the specification immediately preceding the claims. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art. Early pregnancy loss (EPL) is a widespread, but largely undiagnosed problem. In order to adequately diagnose and develop treatments for EPL it is essential to be able to detect and measure the rate of occurance of EPL. This is critically important in epidemiological studies, some of which are related to exposures to known or suspected reproductive toxins in the workplace, in the environment or by personal use. These early pregnancy losses are often not recognized by women or physicians and are detected solely by the measurement of hCG in the urine at the time between implantation and expected menses. They are sometimes termed "chemical pregnancies" or "occult pregnancies." A landmark epidemiological study established that the incidence of EPL was 22% in a population of healthy women attempting to conceive (Wilcox, A. J., et al., 1988). This investigation employed a very sensitive (0.01 ng/ml hCG) assay which detected only the intact hCG molecule with the unique beta subunit carboxyterminal peptide present. There are multiple likely causes for EPL and clinical spontaneous abortion including genetic abnormality, immunological dysfunction, untreated infection or other unknown physiological problems. In addition, losses may be caused by failure of human chorionic gonadotropin (hCG) to induce adequate response at its target, the corpus luteum. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Kit for diagnosing non-pregnancy, and method for diagnosing non-pregnancy using the same Inventor(s): Cho, Min; (Kyonggi-do, KR), Kim, In Wook; (Kyonggi-do, KR), Won, Yoo Deok; (Kyonggi-do, KR), Seong, Hwan Hoo; (Seoul, KR) Correspondence: STAAS & HALSEY LLP; 700 11TH STREET, NW; SUITE 500; WASHINGTON; DC; 20001; US Patent Application Number: 20020168781 Date filed: June 22, 2001 Abstract: The present invention relates to a kit for diagnosing non-pregnancy and a method for diagnosing non-pregnancy of an animal using the same, and more particularly, to a kit for diagnosing non-pregnancy of animal comprising: an assay strip, formed of thin film type paper comprising a plurality of holes for moving a test sample, wherein progesterone-BSA conjugate is immobilized on one end portion as a test line and anti-IgG is immobilized on the other end portion as a control line; and antiprogesterone IgG-gold conjugate for reacting with the test sample such as blood or milk. The inventive kit for diagnosing non-pregnancy can test the non-pregnancy of milch cow without any special device about 20 days after the artificial insemination. Furthermore, more accurate result can be obtained by using the kit since the nonpregnancy diagnosis is performed by comparing color of the test line with that of the control line. Excerpt(s): The present invention relates to a kit for diagnosing non-pregnancy and a method for diagnosing non-pregnancy of animal using the same, and more particularly, to a kit for diagnosing non-pregnancy and a method for early and easy diagnosis of nonpregnancy by detecting concentration of progesterone in blood, milk et al. of the animal. The estrous cycle of a normal milch cow is 19-22 days, and the progesterone

Patents 407

concentration in blood or milk of the cow is almost 0 on estrous day. The progesterone concentration increases day by day from the estrous day, and generally decreases to below 1 ng/ml on 19th day after the estrous day if the cow is non-pregnant. On the other hand, if the milch cow is pregnant, the progesterone concentration does not decrease. Accordingly, non-pregnancy of milch cow can be examined by measuring progesterone concentration of crude milk or blood between 19th day and 22nd day after the estrous day. Before 1990s, pregnancy of milch cow was examined through a rectal examination by an expert when 50 or 60 days have passed after artificial insemination or mating. However, such a method generally requires a skilled veterinarian and causes quite a big economical loss because a long time is required to confirm the pregnancy of milch cow. In addition, if an ovary or an embryo is spurred during the rectal examination for the pregnancy diagnosis, there are possibility of ovarian disease or abortion, and the milch cow can get stressed. Further, according to the method mentioned above, the non-pregnancy can be doubtlessly diagnosed 50-60 days after the artificial insemination. If the milch cow is examined not to be pregnant at this moment, the process to catch the estrous sign of the non-pregnant animal and the artificial insemination should be repeated, which results in the big economical loss. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for determining pregnancy possibility Inventor(s): Kodama, Miyuki; (Tokyo, JP) Correspondence: McDERMOTT, WILL & EMERY; 600 13th Street, N.W. Washington; DC; 20005-3096; US Patent Application Number: 20020040194 Date filed: October 2, 2001 Abstract: Disclosed are method and apparatus for making a decision of possibility of pregnancy in terms of how the values of bioelectrical impedance vary after expiration of a certain length of time since the ovulation day. Excerpt(s): The present invention relates to a method and apparatus for determining pregnancy possibility. Another method of checking the pregnancy possibility uses test papers to detect hormone if any, in urine. As for the decision-making of pregnancy possibility relying on basal body temperature it is required that a woman holding a clinical thermometer in her mouth is lying still a few minutes in bed. This is difficult to continue a long length of time, and women often fall in sleep in bed while measuring her basal body temperature. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for the abdominal suspension for pregnant women, dorsal and abdominal protector for carrying out the method Inventor(s): Castellarin, Gianluca; (Verona, IT), Cosentino, Lorenzo; (Caselle di Sommacampagna, IT), Torregrossa, Gabriell; (Verona, IT), Bucci, Stefano; (Verona, IT) Correspondence: BIRCH STEWART KOLASCH & BIRCH; PO BOX 747; FALLS CHURCH; VA; 22040-0747; US Patent Application Number: 20030171068 Date filed: March 7, 2003 Abstract: The present invention concerns a method for the abdominal suspension for pregnant women, as well as the related structural-type protector for supporting a pregnant abdomen through an abdominal suspensor having several composite and variously backed straps enveloping the bottom area of the lumbar spine extending topwise of the iliac crestae to continue with a continuous tensional union into a top dorsal bodice (15), loosely enveloping the shoulders to protect the spine (17) supporting the weight of the abdomen, burdened by the pregnancy, onto the shoulder girdle with the entailed relieving of the vertebrae (17) and of the related intervertebral disks, in particular bringing the abdomen upwards to push it back in order to activate the backing of the body barycentre allowed by the significant reduction of the gravitational load onto the abdomen itself. Said backing off reduces a hyperlordosis, as well as the tilt of the lumbosacral angle, with a substantial reduction of the stress of the sacroiliac joints. Excerpt(s): The present invention concerns a method for the abdominal suspension for pregnant women which are subjected, due to the increase in dimensions and weight of the uterus, to lumbar and pelvic pain associated both to the increased lordosis with the entailed overloading of the vertebrae and related intervertebral disks, particularly at the fifth lumbar and first sacral vertebrae due both to the increased tilt of the lumbosacral angle and to the frontal stretching of the pubic symphysis by the uterus. In particular, the present invention also concerns a multiple strap-structured protector for supporting the pregnant abdomen through an abdominal suspensor tensionally joined to a top dorsal bodice, loosely enveloping back and shoulders. The substantial weight increase in pregnancy, mainly occurring over the latter 20 gestational weeks is known. Incidentally, in pregnancy the weight increase may often reach about 15 Kg and over, the 70% thereof occurring over the latter 20 gestational weeks, and being largely due to water retention and to an increase of the fat reserve. It is also known that in pregnancy the joints, the ligamenta and the musculotendinous structure of the pelvis and of the spine are particularly lax. The increased joint laxity and elasticity allows an easier adaptation of the pelvic shape to the foetus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of monitoring the menstrual cycle and/or pregnancy in a female Inventor(s): Croy, Barbara Anne; (Niagara-on-the-Lake, CA), Evans, Sharon S. (Hamburg, NY) Correspondence: KRAMER + ASSOCIATES, P.C. CRYSTAL PLAZA ONE; 2001 JEFFERSON DAVIS HWY. SUITE 1101; ARLINGTON; VA; 22202; US Patent Application Number: 20030130592 Date filed: October 25, 2002

Patents 409

Abstract: The present invention relates to methods of monitoring the menstrual cycle and/or the first half of pregnancy in a female by assessing the adhesion of lymphocytes from the female to uterine or lymphoid histological tissues from a pregnant animal or an animal that has been treated with gestational hormones. The method can be used to determine the ability of the lymphocyte donor's immune system to recognize and respond to an environment suitable for sustaining a pregnancy. Excerpt(s): This application is a continuation-in-part of PCT/CA01/01699 filed Nov. 29, 2001 and claims priority from U.S. Provisional Patent Application No. 60/253,734 filed Nov. 29, 2000 and Canadian Patent Application No. 2,345,478, filed Apr. 27, 2001. The present invention relates to methods of monitoring uterine status to determine the suitability for a successful pregnancy. More specifically, the present invention relates to methods of assessing or monitoring the menstrual cycle from the pre-ovulatory stage into the luteal phase and/or the first half of pregnancy by assessing the adhesion of human lymphocytes to uterine or lymphoid tissues under the influence of gestational hormones. Transient granulated lymphocytes are described in the pregnant uteri of >20 species.sup.1. In women and mice, these cells are Natural Killer (NK) cells and their activation/maturation depends upon uterine decidualization rather than presence of conceptuses.sup.2,3 The life history and functions of uterine NK (uNK) cells are more fully known in rodents than women. In women, uNK cells are most frequent in first trimester, representing over 70% of the nucleated bone marrow-derived cells in decidual cell suspensions. Human data also suggest that uNK cells are distinctive, tissue based cells. Most circulating human NK cells are CD16.sup.+ CD56.sup.dim; uNK cells are CD16.sup.- CD56.sup.bright 2,4. The minor circulating CD56.sup.bright subset preferentially expresses (95%) very high levels of L-selectin.sup.5, a molecule central to initiation of extravasation. Fewer CD56.sup.dim circulating cells (24%) express Lselection and at a much lower surface density.sup.5. The two major NK cells functions, target cell lysis and cytokine production, may be displayed separately or dually by single cells.sup.6. Human uNK cells display both functions in vitro.sup.7-9 but their in vivo functions are undefined. Many current studies of human uNK function address interactions with trophoblast.sup.10-12. Other recent reports indicate human uNK cells express angiogenic factors including Ang-2.sup.13, an antagonist to endothelial cell TIE2 and thus, a vessel destabilizing molecule and NKG5, a potent endothelial cell mitogen.sup.14. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods for detecting pregnancy Inventor(s): Lu, Julie Y. (Mission Viejo, CA), Pandian, Murugan R. (Mission Viejo, CA) Correspondence: Donald E. Stout; Stout, Uxa, Buyan & Mullins, LLP; Suite 300; 4 Venture; Irvine; CA; 92618; US Patent Application Number: 20030022381 Date filed: July 30, 2001 Abstract: Methods for detecting pregnancy in a woman comprise screening a biological sample of the woman for pregnancy markers. The methods of the invention include chemiluminescent assays for the pregnancy markers. The methods of the invention also comprise utilizing at least two capture antibodies that specifically bind different epitopes of the pregnancy marker in one assay. The methods of the invention permit detection of pregnancy within about 7 days after ovulation or implantation.

410 Pregnancy

Excerpt(s): The present invention provides methods for detecting pregnancy in a woman. In particular, the methods comprise screening biological samples for biological markers associated with pregnancy. One aspect of the invention is related to the discovery that using a combination of two capture antibodies that specifically bind different epitopes of ITA in one assay improves the sensitivity of the assay for the biological markers. In one embodiment of the invention, a method for detecting pregnancy in a woman comprises the step of: contacting a biological sample of the woman with antibodies that bind invasive trophoblast antigen (ITA), in a chemiluminescent assay, wherein the assay comprises at least two antibodies that specifically bind different epitopes of the ITA, wherein a label coupled to at least one of the two antibodies produces a detectable signal, and wherein the presence of a detectable signal indicates pregnancy in the woman. In another embodiment of the invention, a method for detecting pregnancy in a woman comprises contacting a biological sample of the woman with antibodies that bind ITA in an assay, wherein the assay comprises at least two antibodies that specifically bind different epitopes of ITA, wherein a label coupled to at least one of the two antibodies produces a detectable signal. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

METHODS FOR PREDICTING PREGNANCY OUTCOME IN A SUBJECT BY HCG ASSAY Inventor(s): BIRKEN, STEVEN; (DUMONT, NJ), O'CONNOR, JOHN; (NEW ROCHELLE, NY) Correspondence: JOHN P WHITE; COOPER AND DUNHAM LLP; 1185 AVENUE OF THE AMERICAS; NEW YORK; NY; 10036 Patent Application Number: 20030003597 Date filed: May 13, 1999 Abstract: The present invention provides a method of predicting pregnancy outcome in a subject by determining the amount of an early pregnancy associated molecular isoform of hCG in a sample. The present invention further provides a method for determining the amount of early pregnancy associated molecular isoforms of human chorionic gonadotropin (hCG) in a sample. The present invention also provides a diagnostic kit for determining the amount of early pregnancy associated hCG in a sample. The present invention additionally provides an antibody which specifically binds to an early pregnancy associated molecular isoform of human chorionic gonadotropin. Finally, the present invention provides methods for detecting trophoblast or non-trophoblast malignancy in a sample. Excerpt(s): This application is a continuation-in-part application of International Application No. PCT/US99/02289 which is a continuation-in-part of U.S. Ser. No. 09/017,976, filed Feb. 3, 1998, the contents of which are hereby incorporated by reference into this application. Throughout this application, various publications are referenced by author and date. Full citations for these publications may be found listed alphabetically at the end of the specification immediately preceding the claims. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art. Early pregnancy loss (EPL) is a widespread, but largely undiagnosed problem. In order to adequately diagnose and develop treatments for EPL it is essential to be able to detect and measure the rate of occurance of EPL. This is critically important in epidemiological studies,

Patents 411

some of which are related to exposures to known or suspected reproductive toxins in the workplace, in the environment or by personal use. These early pregnancy losses are often not recognized by women or physicians and are detected solely by the measurement of hCG in the urine at the time between implantation and expected menses. They are sometimes termed "chemical pregnancies" or "occult pregnancies." A landmark epidemiological study established that the incidence of EPL was 22% in a population of healthy women attempting to conceive (Wilcox, A. J., et al., 1988). This investigation employed a very sensitive (0.01 ng/ml hCG) assay which detected only the intact hCG molecule with the unique beta subunit carboxyterminal peptide present. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel isoforms of human pregnancy-associated protein-E Inventor(s): Shannon, Mark E. (Livermore, CA), Gu, Yizhong; (Sunnyvale, CA) Correspondence: FISH & NEAVE; 1251 AVENUE OF THE AMERICAS; 50TH FLOOR; NEW YORK; NY; 10020-1105; US Patent Application Number: 20020102252 Date filed: April 6, 2001 Abstract: The invention provides isolated nucleic acids that encode three novel isoforms of human pregnancy associated plasma protein E, hPAPP-E, and fragments thereof, vectors for propagating and expressing PAPP-E nucleic acids, host cells comprising the nucleic acids and vectors of the present invention, proteins, protein fragments, and protein fusions of the novel PAPP-E isoforms, and antibodies thereto. The invention further provides transgenic cells and non-human organisms comprising human PAPP-E isoform nucleic acids, and transgenic cells and non-human organisms with targeted disruption of the endogenous orthologue of the human PAPP-E gene. The invention further provides pharmaceutical formulations of the nucleic acids, proteins, and antibodies of the present invention, and diagnostic, investigational, and therapeutic methods based on the PAPP-E nucleic acids, proteins, and antibodies of the present invention. Excerpt(s): The present invention relates to novel isoforms of a human protein, and particularly relates to novel isoforms of human pregnancy-associated plasma protein-E. Pregnancy-Associated Plasma Protein-A (PAPP-A) was first identified as a component of a circulating protein complex uniquely present in the serum of pregnant women. Principally of placental, that is, fetal, origin, and detectable in maternal serum as early as 4 weeks into gestation, PAPP-A has proven useful as a readily sampled marker for prenatal monitoring of fetal health and diagnosis of a number of human fetal abnormalities. Maternal serum PAPP-A levels normally increase throughout gestation. Failure of PAPP-A levels to increase at the normal rate--that is, PAPP-A levels lower than the average for the respective gestational age--has been associated with a variety of fetal disorders. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

412 Pregnancy

•

Optically-assisted high precision pregnancy progress monitoring Inventor(s): Ho, Winston Z. (Hacienda Heights, CA), Wang, Fu-Nan; (Hacienda Heights, CA), Suh, Bo Y. (Los Angeles, CA) Correspondence: Winston Z. Ho; 14541 Langhill Drive; Hacienda Heights; CA; 91745; US Patent Application Number: 20030175991 Date filed: March 18, 2002 Abstract: The disclosure describes how to use an optical-based lateral flow matrix method to accurately monitor and quantify human chorionic gonadotropin (hCG) concentration, 0-150,000 mIU/ml, in specimen from a female. The method relies on using a capture zone immobilized with anti-hCG probes having the capability to capture a maximum of 150,000 mIU/ml of hCG in specimen. The method employs an optical beam to illuminate the entire said capture zone, and precisely quantify said hCG concentration in said specimen by measuring the change of the optical property occurred at said capture zone. The method further includes a mechanism to provide an alarm to inform users according to the test results. According to the invention, the device provides the method for easily and accurately monitoring the daily progress of the pregnancy. Excerpt(s): The invention is related to lateral flow matrix devices that utilize optical detection mechanism to quantify human chorionic gonadotropin (hCG), 0-150,000 mIU/ml, with high precision. Apparatus and methods thereof are disclosed for easily and rapidly analyzing hCG samples from female for pregnancy monitoring. Human chorionic gonadotropin (hCG) is a glycoprotein containing a protein core with branched carbohydrate side chains that usually terminate with sialic acid. The hormone is a heterodimer composed of two nonidentical, noncovalently bound glycoprotein subunits, alpha (.alpha.) and beta (.beta.). When the dimmer is dissociated, the hormone activity is lost. There is a single gene for the.alpha.-subunit of all four glycoptotein hormones (TSH, LH, FSH, and hCG) located on chromosome. From a physiological point of view, hCG has an important role in maintaining the function of the corpus luteum during the first weeks of pregnancy. No specific receptor is known; it binds to and activated the LH receptor in cells of the corpus luteum in the maternal ovary. The glycation of the subunit has a dominant role in signal transduction, an increase in intracellular cyclic adenosine monophosphate (cyclic AMP). This cyclic AMP increase stimulates the production of progesterone, which prevents menses and thus maintains the pregnancy. The most important aspect of pregnancy management is an early detection of pregnancy and establishing a diagnosis of viable or non-viable pregnancy as pregnancy in human females can be terminated by unfortunate circumstance, such as spontaneous abortion and ectopic pregnancy. Qualitative tests for hCG in blood or urine are primarily used for the confirmation of pregnancy. Urine hCG tests that is a qualitative measurement of hCG is usually suffice enough to diagnose pregnancy when it has progressed beyond the first week after the first missed period. However, quantitative tests have advantages for prognosis of early pregnancy. Serial determinations of hCG concentration can differentiate a normal pregnancy from an abnormal pregnancy. Further, the downward trends of hCG concentration can prove the prognosis of hCG-producing tumors after surgery. When a pregnancy takes place outside of the uterus, it is called as ectopic pregnancy. Serial quantitative measurements of hCG along with ultrasound is a vital tool, not only important to identify the ectopic pregnancy but also essential to follow the ectopic pregnancy because a negligent follow up of hCG can turn out to be fatal. Therefore, only an attainment of correct diagnosis

Patents 413

can render a proper treatment prior its rupture, which doomed to cause a lifethreatening hemorrhage. Other areas equally beneficial by obtaining quantitative measurements of hCG are a follow up of abnormal pregnancy and hCG producing tumors after surgery. An abnormal pregnancy can be handled sooner in an adequate manner before the patient being devastated psychologically, if the obtained hCG result could differentiate from that of a normal pregnancy. Those patients with hCG producing tumors who had surgery need to follow with quantitative measurements of hCG periodically. Because the persistence or recurrent hCG producing tumors after surgery can be determined only by a serial quantitative measurement of hCG, that fails to decrease to close to a normal level or plateau is a suggestive of existing disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Oral contraceptives symptomatology

to

prevent

pregnancy

and

diminish

premenstrual

Inventor(s): Iskold, Beata; (Livingston, NJ), Bell, Robert G. (Palm Harbor, FL), BenMaimon, Carole; (Merion, PA) Correspondence: STERNE, KESSLER, GOLDSTEIN & FOX PLLC; 1100 NEW YORK AVENUE, N.W. WASHINGTON; DC; 20005; US Patent Application Number: 20030139381 Date filed: December 4, 2002 Abstract: This invention relates to a method of preventing pregnancy and treating PMS including PMDD. More particularly, the invention relates to a method, which involves administering one of several combination oral contraceptive regimens in combination with an antidepressant and a kit containing the same. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/335,807, filed Dec. 5, 2001, the disclosure of which is hereby incorporated herein by reference. This invention relates to oral contraceptives that prevent pregnancy and diminish or eliminate premenstrual symptomatology, including PMS and PMDD, and to a method of preventing pregnancy and diminishing or eliminating premenstrual symptomatology, including PMS and PMDD. The human menstrual cycle involves a repetitive sequence of hormonal changes that result in episodic uterine bleeding. Normally, each menstrual cycle has a mean interval of 21 to 35 days, conventionally beginning with the first day of menstrual flow and ending on the day before the next onset of bleeding. Duration of the menstrual flow is usually 2 to 6 days with loss of 20 to 60 ml of blood. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Panty-liner for women, in particular for pregnant women Inventor(s): Buzluhan, H?uuml;lya; (US) Correspondence: WILLIAM COLLARD; COLLARD & ROE, P.C. 1077 NORTHERN BOULEVARD; ROSLYN; NY; 11576; US Patent Application Number: 20030133173 Date filed: November 1, 2002

414 Pregnancy

Abstract: The invention relates to a pantyliner, in particular for pregnant women, with a liquid-impermeable lower layer and a liquid-permeable covering layer, where a test insert (3) provided with a test substance is arranged between the lower layer (1) and the covering layer (2). Excerpt(s): The invention relates to a pantyliner having the features of the precharacterizing clause of Patent claim 1. As prior art, it is, for example, known to medically investigate pregnant women regularly in the vaginal area and to chemically analyse the secretions which arise therein. In this connection, for example, the pH in the vaginal area is regularly determined using litmus test strips in order, for example, to enable detection of undesired premature amniorrhexis of the amniotic sac, during which the pH noticeably changes relative to the state prior to amniorrhexis. If premature amniorrhexis is thereby detected, birth may be induced by the attending doctor. If such premature amniorrhexis is not recognized, this may lead to health risks for the child and mother and, in extreme cases, lead to miscarriage. The object of the invention is to provide a pantyliner, in particular for pregnant women, with which the risk of a delayed diagnosis of secretions in the vaginal area is reduced or eliminated completely. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pregnancy and sex identification test based on saliva or other bodily fluids Inventor(s): D'Aurora, Vito J. (Bella Vista, CA) Correspondence: SAND & SEBOLT; 4801 DRESSLER RD., N.W. SUITE 194; CANTON; OH; 44718; US Patent Application Number: 20030138971 Date filed: January 23, 2003 Abstract: A method of testing an animal for pregnancy or sex identification comprising the steps of first, providing a first vessel containing a liquid and having a removable surface wherein said removable surface is at least partially coated with an antibody and then introducing a bodily fluid from the female animal into said first vessel so that said bodily fluid contacts the liquid and then manipulating the first vessel so that the liquid contacts the antibody. Then, a second vessel containing a reporter hormone solution is provided and the removable surface from the first vessel is displaced to the second vessel and manipulating the second vessel so that the reporter hormone solution contacts the removable surface. Then, a third vessel containing an indicating solution which has an appearance which is related to the amount of the reporter hormone contacted is provided, and the removable surface is displaced from the second vessel to the third vessel. The third vessel is manipulated so that the indicating solution contacts the removable surface. Then, a determination is made regarding the pregnancy or sex of the animal based on the appearance of the indicating solution. Excerpt(s): This patent application is a continuation-in-part of U.S. patent application Ser. No. 09/912,342, filed Jul. 24, 2001, which claims priority from U.S. provisional patent application serial No. 60/220,279, filed Jul. 24, 2000; the disclosures of which are incorporated herein by reference. The present invention relates to molecular biology and microbiology and, more particularly, to pregnancy tests for mammals and sex determination in animals. Still more particularly, this invention relates to pregnancy tests for equine mammals which are based on saliva or other bodily fluids. The prior art discloses a number of ways to test for pregnancy in female mammals. U.S. Pat. No. 3,968,011 to Manantou, et al., for example, discloses a method for clorimetrically

Patents 415

assaying the quantity of N-acetyl-.beta.-glucosaminidase in a female biological medium, such as saliva, which quantity is indicia of fertility or pregnancy. The implement is an absorbent material, such as paper strip, impregnated with a phenolic derivative of Nacetyl-.beta.-d-glucosamine that reacts in the presence of the glucosaminidase at an acide pH to form a phenol that has a distinct color at an alkaline pH, and a buffer that maintains said acid pH. The method may be carried out by wetting the implement with the medium, allowing the phenol to form, raising the pH to alkalinity by wetting the implement with an appropriate buffer solution, and comparing the color of the implement with a color standard. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pregnancy-associated plasma protein-A2 (PAPP-A2) Inventor(s): Overgaard, Michael Toft; (Arhus C., DK), Oxvig, Claus; (Viby, DK) Correspondence: BROWDY AND NEIMARK, P.L.L.C. 624 Ninth Street, N.W. Washington; DC; 20001; US Patent Application Number: 20030124529 Date filed: October 22, 2001 Abstract: The present invention provides nucleotide and amino acid sequences that identify and encode a new protein with homology to pregnancy-associated plasma protein-A (PAPP-A). We denote this protein PAPP-A2. The cDNA encoding PAPP-A2 was derived from human placenta. The present invention also provides for antisense molecules to the nucleotide sequences which encode PAPP-A2, expression vectors for the production of purified PAPP-A2, antibodies capable of binding specifically to PAPPA2, hybridization probes or oligonucleotides for the detection of PAPP-A2-enoding nucleotide sequences, genetically engineered host cells for the expression of PAPP-A2, use of the protein to produce antibodies capable of binding specifically to the protein, methods for screening for pathologies in pregnant and non-pregnant patients that are based on detection of PAPP-A2 antigen in human body fluids or PAPP-A2-encoding nucleic acid molecules, use of the protein to screen for agents that alter the protease activity of PAPP-A2, use of the protein as a therapeutic target for such agents, and use of the protein as a therapeutic agent in relevant pathological states. Methods for screening for altered focal proliferation states in pregnant and/or non-pregnant patients, which include detecting levels of PAPP-A2, are also described. The present invention also provides the identification of a natural substrate of PAPP-A2, insulin-like growth factor binding protein (IGFBP)-5. Excerpt(s): The present invention relates to a novel polypeptide with homology to pregnancy-associated plasma protein-A (PAPP-A). The novel polypeptide according to the invention is denoted PAPP-A2. The invention further relates to novel polynucleotides comprising a nucleic acid sequence encoding such a polypeptide, or a fragment thereof. The invention further relates to methods for using the novel polynucleotides, including fragments thereof as defined herein below, and methods for using the novel polypeptides capable of being produced from such polynucleotides. The invention also relates to expression and purification of recombinant PAPP-A2, and to production of polyclonal and monoclonal antibodies against PAPP-A2, and to the purification of native PAPP-A2 from human tissues or body fluids. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

416 Pregnancy

•

Process for the preparation of conjugated estrogens from pregnant mare urine Inventor(s): Wang, Jing-Yi; (Tainan, TW), Soong, Vallapa; (Hsien, TW) Correspondence: FINNEGAN, HENDERSON, FARABOW, GARRETT &; DUNNER LLP; 1300 I STREET, NW; WASHINGTON; DC; 20005; US Patent Application Number: 20020156303 Date filed: April 19, 2001 Abstract: This invention is directed to a process for the preparation of conjugated estrogens from pregnant mare urine (PMU), comprising the steps of(a) treating PMU material with an alkaline solvent;(b) filtrating the treated PMU material to remove mucilaginous substances and solids;(c) contracting the filtered PMU resultant with a sufficient quantity of polystyrene absorber resins; and(d) eluting the resins with a watermiscible solvent to separate conjugate estrogens and resins and then obtaining crude extract conjugated estrogens. Excerpt(s): This invention is directed to a process for the preparation of conjugated estrogens from pregnant mare urine (PMU). Conjugated estrogens are effective drugs for treating the symptoms of menopause. Conjugated estrogens coming from a natural source such as pregnant mare urine (PMU) are found to be particularly effective. The extracts containing conjugated estrogens can be obtained from the PMU by extraction with a polar organic solvent. However, such liquid-liquid extractions cause a number of problems such as foaming, sedimentation, emulsification and poor phase separation. Therefore, a solid-liquid extraction method has been developed for the extraction of conjugated estrogens from PMU. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Products containing highly unsaturated fatty acids for use by women and their children during stages of preconception, pregnancy and lactation/post-partum Inventor(s): Elswyk, Mary Van; (Longmont, CO) Correspondence: SHERIDAN ROSS PC; 1560 BROADWAY; SUITE 1200; DENVER; CO; 80202 Patent Application Number: 20030060509 Date filed: August 26, 2002 Abstract: A method and product for improving maternal and child health through nutrition. Omega-6 fatty acid and/or omega-3 fatty acid are provided to a woman and/or child prior to, during and/or after pregnancy to improve the health of the woman and her child. The ratios of the omega-6 and omega-3 fatty acids vary during various stages, e.g., pre-pregnancy, pregnancy and post-pregnancy. The omega-6 and omega-3 fatty acids can be in a variety of forms, such as at least one of highly purified algal oil comprising 70% by weight or more of the desired HUFA, triglyceride oil combined with phospholipid, phospholipid, protein and phospholipid combination, or dried marine microalgae. Excerpt(s): The present invention is directed to maternal and child nutritional supplements, and in particular maternal and child nutritional supplements that include at least one omega-6 highly unsaturated fatty acid (HUFA) and at least one omega-3 HUFA in certain desired ratios. The ratios of omega-6 HUFA:omega-3 HUFA recommended during various stages vary, for example, the ratios of omega-6

Patents 417

HUFA:omega-3 HUFA can vary between stages of preconception, pregnancy and lactation/postpartum. Currently the scientific literature suggests supplementation with the omega-6 HLTA arachidonic acid (ARA) and the omega-3 HUFA docosahexaenoic acid (DHA) is important for pre-term infant growth and development. Pre-term infants provided with ARA/DHA either from breast milk or enriched infant formula demonstrate improved cognitive abilities, including better vocabulary development, memory, and problem-solving skills, than their unsupplemented counterparts. Pre-term infants fed ARA/DHA have improved visual acuity equivalent to 1 line on an eye exam chart and recent studies suggest these infants also have improved motor skills. The fullterm infant literature, however, is not as clear. Several studies have documented similar benefits to fall-term infants fed ARA/DHA, however, several have failed to demonstrate any significant benefits. Conflicting studies have led to a hypothesis that differences in maternal HUFA status may be responsible for these conflicting data. DHA is accumulated preferentially to other fatty acids by the fetus during the last intrauterine trimester. When this period is abbreviated, as in premature birth, the accumulation of DHA is limited and hence the response to supplementation may be greater in the preterm infant. Given a complete third trimester, full-term infants may, depending on the status of maternal supply, acquire adequate, near adequate or insufficient amounts of DHA. The response of full-term infants to HUFA supplementation would be expected to vary significantly and thus the results of studies to date have as well. Due at least in part to these conflicting data, controversy about the use of these fatty acids in infant formulas continues. U.S. Pat. No. 5,374,657 discloses the combination of DHA and omega-6 gamma linolenic acid (GLA) and the combination of DHA and ARA added to infant formulas. The amount of DHA and ARA present is comparable to the amount present in human breast milk. The GLA is present in an amount that can be converted to an amount of ARA attainable from human breast milk. The GLA, DHA and ARA are preferably triglyceride oils. The amount of the EPA present is much less than the amount of ARA present. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

RELAXIN LEVELS CORRELATED TO IVF/ET PREGNANCY SUCCESS Inventor(s): STEWART, DENNIS R. (SACRAMENTO, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20010053553 Date filed: June 22, 1998 Abstract: A method of determining the probability of an in vitro fertilization (IVF) or embryo transfer (ET) method being successful is disclosed. Relaxin can be measured directly in the serum or indirectly by culturing granulosa lutein cells extracted from the patient as part of an IVF/ET procedure. A method of enhancing the rate of a successful pregnancy resulting from an IVF/ET procedure is also disclosed whereby relaxin is administered and/or endogenous relaxin levels are enhanced by varying convention IVF/ET procedures. Excerpt(s): This application is a continuation-in-part application of Ser. No. 08/879,662, filed Jun. 23, 1997, which is incorporated herein by reference in its entirety and to which application we claim priority under 35 USC.sctn.120. The invention relates generally to the field of assays and methods of treatment. In particular the invention relates to determining relaxin levels and relating the levels to the probability of a successful

418 Pregnancy

fertilization of a human female and particularly success in an in vitro fertilization or embryo transfer procedure. The invention further relates to methods of enhancing the probability of obtaining a successful IVF/ET procedure. Reproductive failure is a serious problem that has been addressed clinically by in vitro fertilization (IVF) and embryo transfer (ET). These procedures might be expected to yield exceptionally high conception rates as in vitro fertilization provides an already fertilized ova for transfer into a fully primed recipient. Despite these efforts the success rate of IVF/ET is less than ideal. In the published data for IVF/ET in the United States and Canada in 1994, there were 26,961 initiated cycles of standard IVF. Of these, 86.2% led to a retrieval and of these 90.2% led to a transfer. However, the overall success rate in terms of clinical pregnancies was 22.7% per initiated cycle and a 29.1% pregnancy rate per transfer. Additionally, there appears to be a high incidence of early pregnancy loss after in vitro fertilization with a biochemical pregnancy rate of 18% and a spontaneous abortion rate of 27%. Thus, it appears that the IVF technique has been well optimized but implantation failure may be the cause for a large number of losses with ET and this implantational loss is an area of potential improvement. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and method for remote pregnancy monitoring Inventor(s): Mault, James R. (Evergreen, CO) Correspondence: Beverly M. Bunting; Gifford, Krass, Groh, Sprinkle,; Anderson & Citkowski, P.C. 280 North Old Woodward, Suite 400; Birmingham; MI; 48009; US Patent Application Number: 20020028995 Date filed: April 10, 2001 Abstract: A system and method for remote pregnancy monitoring of a pregnant woman is provided. The system includes an ultrasound transducer positioned on a pregnant woman having a processor, a transmitter and a receiver, and a personal digital assistant operatively connected to the ultrasound transducer via a communication link. The system also includes a patient computer system operatively connected to the personal digital assistant via a second communication link. The system further includes a healthcare provider computer system operatively connected to the patient computer system via an internet, and activation of the ultrasound transducer generates a data signal transmitted to the personal digital assistant via the communication link, and transmission of the signal to the healthcare provider computer system via the second communication link, for monitoring the pregnant woman by a healthcare provider. The method includes the steps of positioning the ultrasound transducer on the pregnant female in a predetermined location to monitor a predetermined condition and activating the ultrasound transducer to generate a signal for monitoring the predetermine condition. The method also includes the steps of transmitting the signal from the ultrasound transducer to the personal digital assistant, and transmitting the signal for monitoring the predetermined condition via an internet to a healthcare provider computer. The method further includes the steps of using the signal to remotely monitor the pregnant woman. Excerpt(s): This application claims priority of United States Provisional Patent Application Serial Nos. 60/195,779 (filed Apr. 10, 2000), 60/206,905 (filed May 25, 2000), and 60/225,454 (filed Aug. 15, 2000), the entire contents of all of which are incorporated herein by reference. The present invention relates generally to medical monitoring, more specifically, to a system and method for remote monitoring of a pregnancy-related

Patents 419

physiological condition in a pregnant female patient. Medical monitoring involves the measurement of a physiological condition of a patient. An example of a medical monitor is disclosed in U.S. application Ser. No. 09/669,125 (filed Sep. 25, 2000) and ______ (filed Mar. 29, 2001, "Monitoring System"), the disclosures of which are incorporated herein by reference. With certain medical conditions, it is advantageous from a health and cost perspective to conduct this type of monitoring within a home-based setting. For example, a pregnant female patient may require periodic evaluation of uterine activity for pre-term labor management by a healthcare provider. In the past, the patient was taught to time her uterine contractions, and report her results to the healthcare provider. However, this method is not very accurate, since it relies on the patient to accurately perceive uterine activity. Alternatively, the patient was monitored either in her home or at the doctor's office using an electronic uterine monitoring system. Monitoring the patient at the doctor's office requires frequent visits to the doctor's office, which is time consuming and may contradict prophylactic bed rest for a high risk patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System for identifying premature rupture of membrane during pregnancy Inventor(s): Torok, Brian A. (Berkly, MI), Smith, Ramada S. (Columbia, MD) Correspondence: POWELL, GOLDSTEIN, FRAZER & MURPHY LLP; P.O. BOX 97223; WASHINGTON; DC; 20090-7223; US Patent Application Number: 20010053876 Date filed: February 26, 2001 Abstract: An article for the identification of the premature rupture of a membrane during pregnancy is disclosed. In its preferred embodiment, the article comprises a pad having an upper outer layer, a lower outer layer, and an intermediate pH-responsive component. A double-sided adhesive strip is attached to the lower outer layer. The upper outer layer is composed of a liquid permeable material. Intermediate of the upper out layer and the inner outer layer is a pH-sensitive component. This intermediate layer is a pH-sensitive material and may be one of a variety of such materials, although a preferred material is nitrazine paper. In the presence of an alkaline fluid, such as amniotic fluid, the pH-sensitive material responds by turning to a purple-blue color. The change in color acts as a visual indicator to the wearer of the possible presence of amniotic fluid outside of the amniotic sac. As an alternate embodiment, the article may be fitted with a slide for gathering amniotic fluid, thus allowing the examining physician to make a visual evaluation. Excerpt(s): The present invention is generally directed to an article for the identification of the premature rupture of a membrane during pregnancy. More particularly, the present invention is directed to an indicating article in the form of a multilayered pad that is fitted to the undergarment of a user. The multilayered pad includes a treated component which responds to the presence of amniotic fluid as a discharge. As an alternate embodiment, a thin flexible plastic slide may be incorporated with the pad for microscopic examination. The amnion develops around the embryo during the second week following fertilization. This is the second membrane to appear after the placenta forms around the chorion. The margin of the amnion is attached to the periphery of the embryonic disk. Eventually, as the embryo grows, the amnion fuses with the chorion surrounding it, and the two membranes become a single amniochorionic membrane. Amniotic fluid fills the amniochorionic membrane to provide a watery environment to protect the growing embryo. Ordinarily the amniochorionic membrane acts as a primary

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barrier to bacteria and other potentially damaging organisms by providing a protected, substantially sealed environment throughout the development of the embryo until it ruptures subsequent to the onset of labor. However, this environment is occasionally compromised when it is prematurely ruptured prior to the onset of labor. Technically, premature rupture of the membrane can occur at any time during the forty weeks of gestation. Although definitions vary, "premature rupture of the membrane" refers to rupture of the amniochorionic membrane prior to the onset of labor at any time. In either case, a ruptured membrane poses a considerable risk of infection to both mother and fetus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Vagina cleaning system for preventing pregnancy and sexually transmitted diseases Inventor(s): Pan, Shen; (Westerville, OH), Liu, James Zhou; (Westerville, OH) Correspondence: STANDLEY & GILCREST LLP; 495 METRO PLACE SOUTH; SUITE 210; DUBLIN; OH; 43017; US Patent Application Number: 20020055723 Date filed: May 17, 2000 Abstract: The present invention discloses an improved vagina cleaning system. The improved system comprises a vagina opener, a vagina cleaning-solution sprayer, a multiple-functional vagina cleaning solution, and a health-promoting bacteria introducer. The system is used to remove semen from the vagina to prevent pregnancy, to reduce pathogenic microorganisms in the vagina to prevent sexually transmitted diseases, to remove other unwanted materials from the vagina to eliminate discomfort, and to add health-promoting bacteria into the vagina to prevent abnormal colonization of microflora in the vaginal cavity. The present invention also discloses methods of using the system for cleaning the vaginal cavity and for introducing health-promoting bacteria into the vaginal cavity. Excerpt(s): This is a continuation-in-part of application Ser. No. 09/201,219, filed Nov. 30, 1998, now pending, which itself is a continuation-in-part of application Ser. No. 08/908,419, filed Aug. 7, 1997, now abandoned. The present invention relates generally to an improved vagina cleaning system to be used for removing unwanted substances from a woman's vagina. The vagina cleaning system of the present invention includes an improved vagina opener, a simplified vagina-cleaning device and a multi-functional vagina cleaning solution. A device used to introduce health-promoting probiotic bacteria into the vagina may also be used as part of the system. Also included is a method of using the vagina cleaning system of the present invention. The incidence of sexually transmitted diseases, including human immunodeficiency virus (HIV) infection, is increasing in children, adolescents, young adults, as well as others who are sexually active. It has been reported that approximately 50% of American adolescents are sexually active by age 16 years (Committee on Infectious Diseases, American Academy of Pediatrics: 1994 Red Book, Report of the Committee on Infectious Diseases, 23rd edition, G. Peter, N. A. Halsey, E. K. Marcuse & L. K. Pickering, eds. p. 103, American Academy of Pediatrics, 1994, Elk Grove Village, Ill.). Sexually experienced adolescents have the highest rate of sexually transmitted diseases as compared to any age group. Being pregnant is not the desired consequence of sexual activity for most adolescent girls. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Variants of IL-1 beta gene and CD46 gene for diagnosing unexplained recurrent pregnancy loss Inventor(s): Yunis, Edmond J. (Concord, MA), Hill, Joseph A. (Brookline, MA), Anderson, Deborah; (Brookline, MA), Wang, Zhigang C. (West Roxbury, MA) Correspondence: Elizabeth R. Plumer; c/o Wolf, Greenfield & Sacks, P.C. Federal Reserve Plaza; 600 Atlantic Avenue; Boston; MA; 02210; US Patent Application Number: 20030032022 Date filed: September 12, 2001 Abstract: The discovery of an association between two variants of the human interleukin-1 gene (IL1B) beta promoter region and a variant of the CD46 gene intron 1 and T-helper type 1 immunity in unexplained recurrent pregnancy loss (URPL) is disclosed. These two IL1B variants are characterized by a base C at position-511 (IL1B511C) and a base T at position-31 (IL1B-31T) from the transcriptional start site of the IL1B gene. The CD46 gene intron 1 variant is characterized by a change in the HindIII site in this intron. These IL1B promoter variants and CD46 gene intron 1 variants, and reagents for detecting said variants, are useful as diagnostic markers for the diagnosis and management of recurrent pregnancy loss. Accordingly, the invention provides methods and compositions which identify these variants for determining a subject's propensity for having reproductive failure and, particularly, reproductive failure attributed to Th1 cytokines. Excerpt(s): This application claims priority under 35 U.S.C. 119 from Provisional U.S. patent Application Serial No. 60/231,785 filed on Sep. 12, 2000, entitled, Variants of IL-1 Beta Gene Promoter Region for Diagnosing Unexplained Recurrent Pregnancy Loss. The contents of the provisional application are hereby expressly incorporated by reference. The present invention relates to unexplained recurrent pregnancy loss and the identification of variants of the IL-1 beta gene promoter and the CD46 gene intron 1 for the diagnosis, prognosis, and therapy associated with this condition, and as research tools to identify other useful agents for these applications. Methods and compositions useful for these applications are disclosed. Recurrent pregnancy loss (RPL) is a common disorder in early gestation, the cause of which remains unexplained in approximately 50% of cases. Various suggestions have been made for the causes of such pregnancy loss; however, accurate diagnostic tests for identifying women who are prone to RPL have not yet been developed. Accordingly, a need exists to identify genetic markers that are associated with RPL to allow the development of compositions useful for the diagnosis, prognosis and therapy for treating RPL. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Weight loss after pregnancy Inventor(s): Mendel, Carl M; (Short Hill, NJ), Seaton, Timothy B; (Far Hills, NJ), Weinstein, Steve P; (Hartsdale, NY) Correspondence: JOHN D. CONWAY; ABBOTT BIORESEARCH CENTER; 100 RESEARCH DRIVE; WORCESTER; MA; 01605-4314; US Patent Application Number: 20030013735 Date filed: March 17, 2000

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Abstract: A compound of formula I 1or a pharmaceutically acceptable salt thereof in which R.sub.1 and R.sub.2 are independently H or methyl (for example N,N-dimethyl-1[1-(4-chlorophe- nyl)cyclobutyl]-3-methylbutyl amine hydrochloride optionally in the form of its monohydrate) is used for aiding weight loss after pregnancy. Excerpt(s): This invention relates to a method of aiding weight loss after pregnancy. including enantiomers and pharmaceutically acceptable salts thereof, in which R.sub.1 and R.sub.2 are independently H or methyl, is administered in conjunction with a pharmaceutically acceptable diluent or carrier to a human in need thereof. A preferred compound of formula I is N,N-dimethyl-1-[1-(4-chlorophe- nyl)cyclobutyl]-3methylbutylamine or a salt thereof, for example the hydrochloride salt. A preferred form of this hydrochloride is its monohydrate. 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 pregnancy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “pregnancy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on pregnancy. You can also use this procedure to view pending patent applications concerning pregnancy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON PREGNANCY Overview This chapter provides bibliographic book references relating to pregnancy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on pregnancy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “pregnancy” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on pregnancy: •

The PASHA Program Sourcebook : Promising Teen Pregnancy and STD/HIV/AIDS Prevention Programs Contact: Sociometrics Corporation, 170 State St, Ste 260, Los Altos, CA, 94022-2812, (800) 846-3475, http://www.socio.com. Summary: This monograph provides in-depth descriptions of 23 programs, which are included in the Program Archive on Sexuality, Health and Adolescence (PASHA), designed to help prevent primary and secondary pregnancy, the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and other sexually transmitted diseases (STDs) among diverse populations of adolescents. The monograph begins with an introductory chapter that describes the problem of teen pregnancy in the United States, presents different ways of framing the problem, and then outlines possible solutions to the problem. One of the primary solutions presented in this chapter is the replication and re-evaluation of effective prevention programs. Twenty-three of these effective programs comprise the focal point for the remaining

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chapters. Each chapter describes one of the primary pregnancy prevention, secondary pregnancy prevention, or STD/HI/AIDS prevention programs in PASHA, along with a summary of the evidence for their effectiveness. For each of the programs, the monograph provides information about the program's target population, the schedule and nature of activities comprising the intervention, program implementation requirements, and the original program evaluation and results. A materials order form is provided. •

The PASHA Activity Sourcebook : Activities for Educating Teens About Pregnancy and STD/HIV/AIDS Prevention Contact: Sociometrics Corporation, 170 State St, Ste 260, Los Altos, CA, 94022-2812, (800) 846-3475, http://www.socio.com. Summary: This teaching guide contains a diverse array of activities to assist the readers in the education of adolescents about pregnancy and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and other sexually transmitted diseases (STDs). All activities are drawn from the Program Archive on Sexuality, Health and Adolescence (PASHA), which includes 23 programs judged by a Scientist Advisory Panel to be effective in changing sexual risk-taking behavior in youth. The activities in the teaching guide are to be used selectively by the readers to match their pre-set objectives and goals of their own programs and include role playing, group discussions, homework, group activities, teacher-led discussions, videos, and other modalities. These activities educate and encourage adolescents to consider a variety of topics, including the possible physical and emotional side effects of sexual intercourse, condom negotiation and use, partner communication, homosexuality and the status of homosexuals in contemporary society, and risk factors and risk reduction for HIV/AIDS and other STDs. Other topics include the impact of pregnancy, HIV/AIDS, or an STD on an adolescent's life; the choice between sexual abstinence and safer sex; peer pressure and how to resist it; personal values; and ways to prevent pregnancy, HIV/AIDS, and STDs. For each activity, the teaching guide supplies a description of the activity, its goal, the original setting in which it was used, the time needed to complete it, the age level for which it is appropriate, the staff and materials needed for it, and ways in which it can be expanded. The guide also provides information on the original intervention and its developer. An appendix supplies the readers with information on other programs developed by PASHA for primary and secondary pregnancy prevention and HIV/AIDS and STD prevention.

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Adolescent Health: State of the Nation, Monograph Number 2: Pregnancy, Sexually Transmitted Diseases, and Related Risk Behaviors Among U.S. Adolescents Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and, Health Promotion, Division of Adolescent and School Health, 3005 Chambelle Tucker Rd, Atlanta, GA, 30341-3724, (770) 448-3252. Summary: This monograph reports on the consequences of early, unprotected sexual intercourse among adolescents. It is designed to provide state and local education and health agencies with information about priority health outcomes among adolescents aged 10-24 years. The monograph shows changes over time in the rates of pregnancy, abortion, live births, gonorrhea, and chlamydia. In addition, the national and state profiles include data about live birth rates and trends by age group; live birth rates by race/ethnicity; pregnancy rates (both abortion and live births) by age group; gonorrhea rates and trends by age group and sex; chlamydia cases, rates, and trends by sex;

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cumulative AIDS case counts by age group and sex; and related risk behaviors for high school students by sex. •

Reducing the Risk: Building Skills to Prevent Pregnancy, STDs & HIV Contact: Education Training and Research Associates, PO Box 1830, Santa Cruz, CA, 95061-1830, (800) 321-4407, http://www.etr.org. Summary: This teaching guide focuses on building communication skills to help teens avoid the risk of pregnancy, sexually transmitted diseases (STDs), and HIV. The curriculum is designed to enhance teens' skills to resist unprotected sex and to teach them what they need to know to abstain from sex. An introduction includes major teaching concepts, program objectives, information, social skills, how the curriculum was developed, how to use the curriculum, parent notification and permission, and how to follow guidelines. The teaching guide also includes 17 teaching activities on abstinence, sex, and protection; refusals; using refusal skills; delaying tactics; avoiding high-risk situations; getting and using protection; knowing and talking about protection; skills integration; preventing HIV and other STDs; HIV risk behaviors; implementing protection from STD and pregnancy; and sticking with abstinence and protection.

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Sexual Activity, Pregnancy, and Family Formation Source: The Adolescent & Young Adult Fact Book. Contact: Childrens Defense Fund, 25 E St NW, Washington, DC, 20001, (202) 628-8787, http://www.childrensdefense.org. Summary: This article presents the results of data on the sexual activity, pregnancy, and subsequent family structure of U.S. teenagers. The cycle of poverty and associated social and health problems perpetuated by teenage pregnancy is addressed. Teens aged 15 to 19 account for approximately 1 million pregnancies each year. Adolescents are increasingly likely to be sexually experienced, and only a fraction use contraception. About half of all unmarried girls aged 15 to 19 are sexually experienced, and three fourths of all girls aged 18 to 19 are sexually active, regardless of ethnic background. Of all youths, black males are the most likely to begin sexual activity at a young age. More than one-third of all teenage girls used no contraception. Birth rates among unmarried teens continue to climb. Lack of prenatal care has a significant impact on the long-term health and success of the child of a teen parent. The median age for first marriage for men and women in the U.S. has remained about the same from 1890 through the twentieth century. The article concludes with a series of tables that highlight the data on sexual activity and pregnancy outcome by year, gender, and age.

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Drugs Pregnancy and Childcare: A Guide for Professionals Contact: Institute for the Study of Drug Dependence, 1 Hatton Pl, London. Summary: This monograph introduces health-care workers to the problems faced Intravenous drug users (IVDU's) who are either pregnant or already parents. It provides guidelines for policy development in prenatal and social work assessments, and offers practical information on drugs and drug abuse as they relate to the care of the pregnant drug user and her baby. The first section focuses on the drug-using pregnant woman, pointing out some considerations in establishing a prenatal care policy for this population. The second section discusses pre-conception counseling for female drug users, obstetric and fetal complications that can develop as a result of drug abuse, and a medical resume of drug withdrawal regimes during pregnancy. This section also covers

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issues related to labor and childbirth, and neonatal withdrawal syndrome. The final section deals with issues related to drugs and the family, examining the risks to children living in drug-using families. Human immunodeficiency virus (HIV), the etiologic agent of Acquired immunodeficiency syndrome (AIDS), is central if the mother was HIVpositive during pregnancy. The monograph also discusses parental placements in residential rehabilitation houses. •

Gastrointestinal Disorders During Pregnancy Source: Arlington, VA: American College of Gastroenterology. 1994. 80 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. (703) 820-7400. Fax (703) 931-4520. PRICE: Single copy free. Summary: This monograph is designed to help gastroenterologists, obstetricians, and nongastroenterologists understand gastrointestinal related problems that may occur during pregnancy. Seven sections cover gastrointestinal motility disorders in pregnancy; total parenteral nutrition (TPN) and hyperemesis gravidarum; pregnancy and inflammatory bowel disease (IBD); endoscopy in pregnancy; surgical problems in the pregnant patient; chronic liver disease and its effect on fertility and pregnancy; and the liver and pregnancy. Each section is authored by experts in the field and provides information in a concise format, along with extensive references. 521 references.

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Building and Sustaining Systems of Care for Substance - Using Pregnant Women and Their Infants: Lessons Learned Contact: US Department of Health and Human Services, Public Health Service, Health Resources and Services Administration, Maternal and Child Health Bureau, National Maternal and Child Health Clearinghouse, 2070 Chain Bridge Rd Ste 450, Vienna, VA, 22182-2536, (703) 356-1964, http://www.nmchc.org/. Summary: This monograph is based on focus group discussions with the directors of community-based demonstration projects serving pregnant and postpartum women and their infants (PPWI). The monograph summarizes information in three topic areas: case management, care-system building, and program or organizational sustainability. The monograph also compares the experiences of these project directors with published reports. The project directors emphasize the importance of program and service evaluation. Due to government cuts, the future of funding for health care systems for pregnant substance-abusing women and their families is uncertain.

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 “pregnancy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “pregnancy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “pregnancy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):

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1000 Questions About Your Pregnancy: Everything Every Expecting Woman Needs to Know by Jeffrey, Md. Thurston, Jeffrey Thurston M. D. ISBN: 1930819153; http://www.amazon.com/exec/obidos/ASIN/1930819153/icongroupinterna

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101 Essential Tips: Healthy Pregnancy by Elizabeth Fenwick, et al (1996); ISBN: 0789410788; http://www.amazon.com/exec/obidos/ASIN/0789410788/icongroupinterna

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125 Things You Must Know About Being Pregnant by Nina D. Landi (1998); ISBN: 0805058605; http://www.amazon.com/exec/obidos/ASIN/0805058605/icongroupinterna

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A Guide to Effective Care in Pregnancy and Childbirth by James Nelison (Editor), et al; ISBN: 019263173X; http://www.amazon.com/exec/obidos/ASIN/019263173X/icongroupinterna

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A Guy's Guide to Pregnancy : Preparing for Parenthood Together by Frank Mungeam, John Gray (1998); ISBN: 1885223757; http://www.amazon.com/exec/obidos/ASIN/1885223757/icongroupinterna

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A Holistic Guide to Embracing Pregnancy, Childbirth, and Motherhood by Karen N. Salt (2002); ISBN: 1555612822; http://www.amazon.com/exec/obidos/ASIN/1555612822/icongroupinterna

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A Little Pregnant: Our Memoir of Fertility, Infertility, and a Marriage by Linda Carbone, Ed Decker; ISBN: 0802137458; http://www.amazon.com/exec/obidos/ASIN/0802137458/icongroupinterna

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A Natural Guide to Pregnancy and Postpartum Health by Dean Raffelock, et al (2002); ISBN: 1583331387; http://www.amazon.com/exec/obidos/ASIN/1583331387/icongroupinterna

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A Silent Sorrow: Pregnancy Loss - Guidance and Support for You and Your Family by Ingrid Kohn, et al; ISBN: 0415924812; http://www.amazon.com/exec/obidos/ASIN/0415924812/icongroupinterna

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Acupuncture in Pregnancy and Childbirth by Zita West, et al (2000); ISBN: 0443061386; http://www.amazon.com/exec/obidos/ASIN/0443061386/icongroupinterna

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Addiction and Pregnancy : Empowering Recovery through Peer Counseling by Barry R. Sherman (Author), et al (1998); ISBN: 0275959767; http://www.amazon.com/exec/obidos/ASIN/0275959767/icongroupinterna

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Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond by Hilary Flower, Peggy O'Mara (2003); ISBN: 0912500972; http://www.amazon.com/exec/obidos/ASIN/0912500972/icongroupinterna

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Alloimmune Disorders of Pregnancy : Anaemia, Thrombocytopenia and Neutropenia in the Fetus and Newborn by Andrew Hadley (Editor), Peter Soothill (Editor) (2002); ISBN: 0521781205; http://www.amazon.com/exec/obidos/ASIN/0521781205/icongroupinterna

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Annie's Baby: The Diary of Anonymous, a Pregnant Teenager by Anonymous (Author), Beatrice Sparks; ISBN: 0380791412; http://www.amazon.com/exec/obidos/ASIN/0380791412/icongroupinterna

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Before You Conceive: The Complete Prepregnancy Guide by John R. Sussman M.D., B. Blake Levitt (1989); ISBN: 0553347187; http://www.amazon.com/exec/obidos/ASIN/0553347187/icongroupinterna

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Before Your Pregnancy: A 90 Day Guide for Couples on How to Prepare for a Healthy Conception by Amy Ogle, Lisa Mazzullo (2002); ISBN: 034544096X; http://www.amazon.com/exec/obidos/ASIN/034544096X/icongroupinterna

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Better Birthing with Hypnosis : Mindful Pregnancy and Easy Labor Using the LeClaire Method by Michelle Leclaire O'Neill; ISBN: 0658015338; http://www.amazon.com/exec/obidos/ASIN/0658015338/icongroupinterna

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Birth As a Healing Experience: The Emotional Journey of Pregnancy Through Postpartum by Lois Halzel Freedman (1999); ISBN: 1560239409; http://www.amazon.com/exec/obidos/ASIN/1560239409/icongroupinterna

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Books, Babies and School-Age Parents: How to Teach Pregnant and Parenting Teens to Succeed by Jeanne Warren Lindsay, Sharon Githens Enright (1997); ISBN: 1885356218; http://www.amazon.com/exec/obidos/ASIN/1885356218/icongroupinterna

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Bouncing Back After Your Pregnancy: What You Need to Know about Recovering From Labor and Delivery and Caring For Your New Family by Glade B., Md. Curtis, et al (2002); ISBN: 0738206067; http://www.amazon.com/exec/obidos/ASIN/0738206067/icongroupinterna

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Bountiful, Beautiful, Blissful: Experience the Natural Power of Pregnancy and Birth with Kundalini Yoga and Meditation by Gurmukh Khalsa (Author) (2003); ISBN: 0312310870; http://www.amazon.com/exec/obidos/ASIN/0312310870/icongroupinterna

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Breathe: A Guy's Guide to Pregnancy by Mason Brown (2002); ISBN: 0743219708; http://www.amazon.com/exec/obidos/ASIN/0743219708/icongroupinterna

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Carrying a Little Extra: A Guide to Healthy Pregnancy for the Plus-Size Woman by Paula Bernstein, et al (2003); ISBN: 0425188345; http://www.amazon.com/exec/obidos/ASIN/0425188345/icongroupinterna

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Childbirth Instructor Magazine's Guide to Careers in Birth: How to Have a Fulfilling Job in Pregnancy, Labor, and Parenting Support without a Medical Degree by Suzanne B. Robotti (Author), Margaret Ann Inman (Author) (1998); ISBN: 0471162302; http://www.amazon.com/exec/obidos/ASIN/0471162302/icongroupinterna

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City Baby: The Ultimate Guide for New York City Parents from Pregnancy to Preschool by Kelly Ashton, Pamela Weinberg (2003); ISBN: 0789308320; http://www.amazon.com/exec/obidos/ASIN/0789308320/icongroupinterna

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Clinical Aromatherapy for Pregnancy and Childbirth by Denise Tiran (Editor), Sue Mack (Editor) (2000); ISBN: 044306427X; http://www.amazon.com/exec/obidos/ASIN/044306427X/icongroupinterna

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Complementary Therapies for Pregnancy and Childbirth by Denise Tiran, Sue Mack; ISBN: 0702023280; http://www.amazon.com/exec/obidos/ASIN/0702023280/icongroupinterna

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Conception, Pregnancy & Birth by Miriam Stoppard; ISBN: 0789451158; http://www.amazon.com/exec/obidos/ASIN/0789451158/icongroupinterna

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Dada: A Guy's Guide to Surviving Pregnancy, Childbirth, and the First Year of Fatherhood by Michael R. Crider (2002); ISBN: 0595212204; http://www.amazon.com/exec/obidos/ASIN/0595212204/icongroupinterna

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Dear Diary, I'm Pregnant: Teenagers Talk About Their Pregnancy by Annrenee Englander (Compiler), Corinne Morgan Wilks (Editor) (1997); ISBN: 1550374400; http://www.amazon.com/exec/obidos/ASIN/1550374400/icongroupinterna

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Denise Austin's Ultimate Pregnancy Book by Denise Austin; ISBN: 0684802198; http://www.amazon.com/exec/obidos/ASIN/0684802198/icongroupinterna

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Diabetes & Pregnancy: What to Expect by Task Force for the American Diabetes Association Council on Pregnancy, et al; ISBN: 158040071X; http://www.amazon.com/exec/obidos/ASIN/158040071X/icongroupinterna

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Double Duty : The Parents' Guide to Raising Twins, from Pregnancy Through the School Years by Christina Baglivi Tinglof; ISBN: 0809230194; http://www.amazon.com/exec/obidos/ASIN/0809230194/icongroupinterna

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Dr. Guttmacher's Pregnancy, Birth & Family Planning: Completely Updated and Revised by Ronnie Lichtman, et al (2003); ISBN: 0451198891; http://www.amazon.com/exec/obidos/ASIN/0451198891/icongroupinterna

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Dr. Kathryn Schrotenboer's Guide to Pregnancy over 35 by Kathryn Schrotenboer, Kathryn Schroetenboer-Cox (1985); ISBN: 034531347X; http://www.amazon.com/exec/obidos/ASIN/034531347X/icongroupinterna

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Dr. Miriam Stoppard's New Pregnancy & Birth Book by Miriam, Dr Stoppard, Dr Miriam Stoppard (2000); ISBN: 0345437950; http://www.amazon.com/exec/obidos/ASIN/0345437950/icongroupinterna

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Dr. Ruth's Pregnancy Guide for Couples by Ruth K., Dr. Westheimer, Amos Grunebaum M.D. (1999); ISBN: 041591972X; http://www.amazon.com/exec/obidos/ASIN/041591972X/icongroupinterna

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Dr. Spock's Pregnancy Guide: Take Charge Parenting Guides by Marjorie, Md. Greenfield; ISBN: 0743457714; http://www.amazon.com/exec/obidos/ASIN/0743457714/icongroupinterna

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Drugs in Pregnancy and Lactation by Gerald G. Briggs (Editor), et al; ISBN: 0781732034; http://www.amazon.com/exec/obidos/ASIN/0781732034/icongroupinterna

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Easy Exercises for Pregnancy by Janet Balaskas, Anthea Sieveking (Photographer) (1999); ISBN: 0711210489; http://www.amazon.com/exec/obidos/ASIN/0711210489/icongroupinterna

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Eat Right 4 Your Baby: The Individualized Guide to Fertility and Maximum Health During Pregnancy, Nursing, and Your Baby's First Year by Catherine Whitney (Contributor), et al (2003); ISBN: 0399149961; http://www.amazon.com/exec/obidos/ASIN/0399149961/icongroupinterna

•

Eating for Pregnancy: An Essential Guide to Nutrition with Recipes for the Whole Family by Catherine Jones, Rose Ann Hudson (Contributor) (2003); ISBN: 1569245118; http://www.amazon.com/exec/obidos/ASIN/1569245118/icongroupinterna

•

Egg in the Nest: Pregnancy: Simplyshe by Maria Peevey, Stewart Tabori & Chang; ISBN: 1584791802; http://www.amazon.com/exec/obidos/ASIN/1584791802/icongroupinterna

•

Empty Arms: Hope and Support for Those Who Have Suffered a Miscarriage, Stillbirth, or Tubal Pregnancy by Pam Vredevelt (Author); ISBN: 1576738515; http://www.amazon.com/exec/obidos/ASIN/1576738515/icongroupinterna

430 Pregnancy

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Enhancing Fertility Naturally: Holistic Therapies for a Successful Pregnancy by Nicky Wesson; ISBN: 0892818328; http://www.amazon.com/exec/obidos/ASIN/0892818328/icongroupinterna

•

Ever Since I Had My Baby: Understanding, Treating, and Preventing the Most Common Physical After-Effects of Pregnancy and Childbirth by Roger P., Md. Goldberg (2003); ISBN: 0609808729; http://www.amazon.com/exec/obidos/ASIN/0609808729/icongroupinterna

•

Every Pregnant Woman's Guide to Preventing Premature Birth by Barbara Luke (2002); ISBN: 0595238548; http://www.amazon.com/exec/obidos/ASIN/0595238548/icongroupinterna

•

Every Woman's Guide to Eating During Pregnancy by Martha Rose Shulman (Author), Jane M.D. Davis (Author); ISBN: 0395986605; http://www.amazon.com/exec/obidos/ASIN/0395986605/icongroupinterna

•

Everything You Need to Know to Have a Healthy Twin Pregnancy by Gila Leiter, Rachel Kranz (Contributor); ISBN: 0440508789; http://www.amazon.com/exec/obidos/ASIN/0440508789/icongroupinterna

•

Exercising Through Your Pregnancy by James F. Clapp III; ISBN: 1886039593; http://www.amazon.com/exec/obidos/ASIN/1886039593/icongroupinterna

•

Expect the Unexpected When You're Expecting!: A Hilarious Look at the Trials and Tribulations of Pregnancy by Eunice Glick, et al (1995); ISBN: 0060951354; http://www.amazon.com/exec/obidos/ASIN/0060951354/icongroupinterna

•

Expecting You: My Pregnancy Journal by Linda Kranz, Klaus Kranz (Photographer); ISBN: 1555612458; http://www.amazon.com/exec/obidos/ASIN/1555612458/icongroupinterna

•

From Baby to Bikini: Keep Your Midsection Toned Safely During Pregnancy and Flatten Your Abdominals Fast After Your Have Your Baby by Greg Waggoner, et al (1999); ISBN: 0446673986; http://www.amazon.com/exec/obidos/ASIN/0446673986/icongroupinterna

•

Getting Pregnant & Staying Pregnant: Overcoming Infertility and Managing Your High-Risk Pregnancy by Diana Raab, et al; ISBN: 0897932382; http://www.amazon.com/exec/obidos/ASIN/0897932382/icongroupinterna

•

Getting Pregnant Naturally : Healthy Choices To Boost Your Chances Of Conceiving Without Fertility Drugs by Winifred Conkling (Author) (1999); ISBN: 0380796333; http://www.amazon.com/exec/obidos/ASIN/0380796333/icongroupinterna

•

Getting Pregnant: What You Need To Know Right Now by Niels Lauersen (Author), Colette Bouchez (2000); ISBN: 0684864045; http://www.amazon.com/exec/obidos/ASIN/0684864045/icongroupinterna

•

Having Twins And More : A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood by Elizabeth Noble (Author), Leo Sorger (Author) (2003); ISBN: 0618138730; http://www.amazon.com/exec/obidos/ASIN/0618138730/icongroupinterna

•

Having Twins: A Parent's Guide to Pregnancy, Birth, and Early Childhood by Elizabeth Noble; ISBN: 0395291283; http://www.amazon.com/exec/obidos/ASIN/0395291283/icongroupinterna

•

Healing Yourself During Pregnancy by Joy Gardner-Gordon, Joy Gardner; ISBN: 0895942518; http://www.amazon.com/exec/obidos/ASIN/0895942518/icongroupinterna

Books 431

•

Health Journeys: Meditations to Support A Healthy Pregnancy & Successful Childbirth [ABRIDGED] by Belleruth Naparstek; ISBN: 1881405451; http://www.amazon.com/exec/obidos/ASIN/1881405451/icongroupinterna

•

Heart & Hands: A Midwife's Guide to Pregnancy & Birth by Elizabeth Davis, et al (1997); ISBN: 0890878382; http://www.amazon.com/exec/obidos/ASIN/0890878382/icongroupinterna

•

Help, Comfort and Hope After Losing Your Baby in Pregnancy or the First Year by Hannah Lothrop (1997); ISBN: 1555611206; http://www.amazon.com/exec/obidos/ASIN/1555611206/icongroupinterna

•

Herbs for a Healthy Pregnancy: From Conception to Childbirth by Penelope Ody (1999); ISBN: 0879839864; http://www.amazon.com/exec/obidos/ASIN/0879839864/icongroupinterna

•

HIV in Pregnancy and Childbirth by Jane Kennedy (2003); ISBN: 0750653256; http://www.amazon.com/exec/obidos/ASIN/0750653256/icongroupinterna

•

Homeopathy for Pregnancy, Birth, and Your Baby's First Year by Miranda Castro (1993); ISBN: 0312088094; http://www.amazon.com/exec/obidos/ASIN/0312088094/icongroupinterna

•

Homoeopathy for Midwives (and All Pregnant Women) by Peter Webb; ISBN: 0946717702; http://www.amazon.com/exec/obidos/ASIN/0946717702/icongroupinterna

•

Hooray! My Baby Is on the Way: Keepsake Pregnancy Wall Calendar by Graphicbaby Llc (Editor), Graphicbaby (2002); ISBN: 0971533407; http://www.amazon.com/exec/obidos/ASIN/0971533407/icongroupinterna

•

How Men Have Babies: The Pregnant Father's Survival Guide by Alan Thicke (2003); ISBN: 1588720608; http://www.amazon.com/exec/obidos/ASIN/1588720608/icongroupinterna

•

How to Be a Pregnant Father by Peter Mayle, Arthur Robins (Illustrator) (1986); ISBN: 0818403993; http://www.amazon.com/exec/obidos/ASIN/0818403993/icongroupinterna

•

How to Get Pregnant: With the New Technology by Sherman J. Silber (1998); ISBN: 0446674052; http://www.amazon.com/exec/obidos/ASIN/0446674052/icongroupinterna

•

How to Make a Pregnant Woman Happy: Quick and Effective Home Remedies for over 60 of Pregnancy's Most Common Problems (The Sharpman Edge, 4) by Uzzi Reiss, SharpMan Com (2002); ISBN: 0970660030; http://www.amazon.com/exec/obidos/ASIN/0970660030/icongroupinterna

•

How to Pamper Your Pregnant Wife by Ron Schultz, Sam Schultz; ISBN: 0671574957; http://www.amazon.com/exec/obidos/ASIN/0671574957/icongroupinterna

•

How to Prevent Miscarriage and Other Crisis of Pregnancy by Stefan Semchyshyn, Carol Colman (Contributor); ISBN: 0020368550; http://www.amazon.com/exec/obidos/ASIN/0020368550/icongroupinterna

•

Hypnosis for a Joyful Pregnancy and Pain-Free Labor and Delivery by Winifred Conkling, Nancy Barwick (2002); ISBN: 0312270232; http://www.amazon.com/exec/obidos/ASIN/0312270232/icongroupinterna

432 Pregnancy

•

I Got Pregnant, You Can Too!: How Healing Yourself Physically, Mentally and Spiritually Leads to Fertility by Katie Boland (1998); ISBN: 1887424385; http://www.amazon.com/exec/obidos/ASIN/1887424385/icongroupinterna

•

It Could Happen To You: Diary Of A Pregnancy and Beyond by Martha Brockenbrough (2002); ISBN: 0740726854; http://www.amazon.com/exec/obidos/ASIN/0740726854/icongroupinterna

•

KISS Guide to Pregnancy by Felicia Eisenberg Molnar, Miriam Stoppard; ISBN: 0789471884; http://www.amazon.com/exec/obidos/ASIN/0789471884/icongroupinterna

•

Making a Baby: Everything You Need to Know to Get Pregnant by Debra Fulghum Bruce, Samuel S. Thatcher M.D. Ph.D. ISBN: 0345435435; http://www.amazon.com/exec/obidos/ASIN/0345435435/icongroupinterna

•

Making Babies : The Science of Pregnancy by David Bainbridge (2001); ISBN: 0674006534; http://www.amazon.com/exec/obidos/ASIN/0674006534/icongroupinterna

•

Manual of High Risk Pregnancy & Delivery (3rd Edition) by Elizabeth Stepp Gilbert, Judith Smith Harmon; ISBN: 0323017517; http://www.amazon.com/exec/obidos/ASIN/0323017517/icongroupinterna

•

Massage During Pregnancy by Bette L. Waters, Paul St John (Introduction) (2003); ISBN: 0966558448; http://www.amazon.com/exec/obidos/ASIN/0966558448/icongroupinterna

•

Mayo Clinic Complete Book of Pregnancy & Baby's First Year by Mayo Clinic (Author) (1994); ISBN: 0688117619; http://www.amazon.com/exec/obidos/ASIN/0688117619/icongroupinterna

•

Medical Management of Pregnancy Complicated by Diabetes by Lois Jovanovic, American Diabetes Association; ISBN: 1580400132; http://www.amazon.com/exec/obidos/ASIN/1580400132/icongroupinterna

•

Meditations for Your Pregnancy: From Conception to Birth & Beyond by Sheila Lavery, et al; ISBN: 1582380554; http://www.amazon.com/exec/obidos/ASIN/1582380554/icongroupinterna

•

Midlife Motherhood: A Woman-to-Woman Guide to Pregnancy and Parenting by Jann Blackstone-Ford; ISBN: 0312281315; http://www.amazon.com/exec/obidos/ASIN/0312281315/icongroupinterna

•

Mother Massage: A Handbook for Relieving the Discomforts of Pregnancy by Elaine Stillerman, Diana Kurz (Illustrator) (1992); ISBN: 0440507022; http://www.amazon.com/exec/obidos/ASIN/0440507022/icongroupinterna

•

Motherhood Lost: A Feminist Account of Pregnancy Loss in America by Linda L. Layne (2002); ISBN: 0415911486; http://www.amazon.com/exec/obidos/ASIN/0415911486/icongroupinterna

•

Mothering Magazine's Having a Baby, Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth by Peggy O'Mara (Author), Jackie Facciolo (Illustrator) (2003); ISBN: 0743439635; http://www.amazon.com/exec/obidos/ASIN/0743439635/icongroupinterna

•

Multiple Sclerosis and Having a Baby: Everything You Need to Know about Conception, Pregnancy, and Parenthood by Judy Graham; ISBN: 0892817887; http://www.amazon.com/exec/obidos/ASIN/0892817887/icongroupinterna

Books 433

•

My Boys Can Swim!: The Official Guy's Guide to Pregnancy by Ian Davis (1999); ISBN: 0761521674; http://www.amazon.com/exec/obidos/ASIN/0761521674/icongroupinterna

•

My Pregnancy Journal by Anne Geddes (Photographer), Anne Geddes; ISBN: 076832078X; http://www.amazon.com/exec/obidos/ASIN/076832078X/icongroupinterna

•

My Pregnancy Journal by Peters Ryland, et al (2003); ISBN: 184172436X; http://www.amazon.com/exec/obidos/ASIN/184172436X/icongroupinterna

•

My Pregnancy: A Record Book (1998); ISBN: 1579771149; http://www.amazon.com/exec/obidos/ASIN/1579771149/icongroupinterna

•

New Natural Pregnancy: Practical Wellbeing from Conception to Birth by Janet Balaskas, Gayle Petersen (1999); ISBN: 1566563119; http://www.amazon.com/exec/obidos/ASIN/1566563119/icongroupinterna

•

Nine Months and Counting: Bible Promises and Bright Ideas for Pregnancy and After by Alice Zillman Chapin; ISBN: 0842373632; http://www.amazon.com/exec/obidos/ASIN/0842373632/icongroupinterna

•

No More Morning Sickness: A Survival Guide for Pregnant Women by Mariam Erick MSRD, Miriam Erick (1993); ISBN: 0452269830; http://www.amazon.com/exec/obidos/ASIN/0452269830/icongroupinterna

•

Nutrition and Pregnancy : A Complete Guide from Preconception to Postdelivery by Judith E., Phd Brown, Howard N. Jacobson; ISBN: 0737300183; http://www.amazon.com/exec/obidos/ASIN/0737300183/icongroupinterna

•

Nutrition for a Healthy Pregnancy, Revised Edition: The Complete Guide to Eating Before, During, and After Your Pregnancy by Elizabeth Somer; ISBN: 0805069984; http://www.amazon.com/exec/obidos/ASIN/0805069984/icongroupinterna

•

Nutrition In Pregnancy and Lactation by Bonnie S. Worthington-Roberts, et al; ISBN: 0815195222; http://www.amazon.com/exec/obidos/ASIN/0815195222/icongroupinterna

•

Obstetrics: Normal and Problem Pregnancies by Steven G. Gabbe (Editor), et al (2002); ISBN: 0443065721; http://www.amazon.com/exec/obidos/ASIN/0443065721/icongroupinterna

•

Outsmarting the Female Fat Cell-After Pregnancy: Every Woman's Guide to Shaping Up, Slimming Down, and Staying Sane After the Baby by Debra Waterhouse (2003); ISBN: 0786884568; http://www.amazon.com/exec/obidos/ASIN/0786884568/icongroupinterna

•

Pilates for Pregnancy by Michael King, Yolande Green (2002); ISBN: 1569753105; http://www.amazon.com/exec/obidos/ASIN/1569753105/icongroupinterna

•

Pilates for Pregnancy: Gentle and Effective Techniques for Before and After Birth by Anna Selby (2002); ISBN: 0007133146; http://www.amazon.com/exec/obidos/ASIN/0007133146/icongroupinterna

•

Planning for Pregnancy, Birth and Beyond by American College of Obstetricians and Gynecologists, American College of Obstetricians and Gy; ISBN: 0451191757; http://www.amazon.com/exec/obidos/ASIN/0451191757/icongroupinterna

434 Pregnancy

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Planning Your Pregnancy and Birth, Third Edition by American College of Obstetrics & Gynecol (2000); ISBN: 0915473569; http://www.amazon.com/exec/obidos/ASIN/0915473569/icongroupinterna

•

Pregnancy After a Loss: A Guide to Pregnancy After a Miscarriage, Stillbirth or Infant Death by Carol Cirulli Lanham (1999); ISBN: 0425170470; http://www.amazon.com/exec/obidos/ASIN/0425170470/icongroupinterna

•

Pregnancy and Birth: Your Questions Answered by Christof Lees, et al; ISBN: 0789414708; http://www.amazon.com/exec/obidos/ASIN/0789414708/icongroupinterna

•

Pregnancy Bedrest: A Guide for the Pregnant Woman and Her Family by Susan Holyoke Johnston, et al; ISBN: 0805013504; http://www.amazon.com/exec/obidos/ASIN/0805013504/icongroupinterna

•

Pregnancy Chic: The Fashion Survival Guide by Cherie Serota, Jody Kozlow Gardner (1998); ISBN: 0375500278; http://www.amazon.com/exec/obidos/ASIN/0375500278/icongroupinterna

•

Pregnancy Day by Day: The Expectant Mother's Diary, Record Book, and Guide by Sheila Kitzinger, et al (2001); ISBN: 0375709452; http://www.amazon.com/exec/obidos/ASIN/0375709452/icongroupinterna

•

Pregnancy Diary by Tracy Hotchner (Author) (1992); ISBN: 0380765438; http://www.amazon.com/exec/obidos/ASIN/0380765438/icongroupinterna

•

Pregnancy Exercise Book, The : A Step-By-Step Program for Achieving Optimal Fitness Throughout the Trimesters by Judy DiFiore (Author), Ltd Carroll & Brown (Author); ISBN: 0062737341; http://www.amazon.com/exec/obidos/ASIN/0062737341/icongroupinterna

•

Pregnancy Fitness by Fitness Magazine (Editor), Ginny Graves (Contributor) (1999); ISBN: 0609801597; http://www.amazon.com/exec/obidos/ASIN/0609801597/icongroupinterna

•

Pregnancy For Dummies® by Joanne Stone (Author), et al (1999); ISBN: 0764550748; http://www.amazon.com/exec/obidos/ASIN/0764550748/icongroupinterna

•

Pregnancy Nutrition : Good Health for You and Your Baby by The American Dietetic Association (Author), Elizabeth M. Ward (Author); ISBN: 0471346977; http://www.amazon.com/exec/obidos/ASIN/0471346977/icongroupinterna

•

Pregnancy of Convenience (Expecting!) by Sandra Field; ISBN: 0373123299; http://www.amazon.com/exec/obidos/ASIN/0373123299/icongroupinterna

•

Pregnancy the Natural Way by Zita West, Kate Winslet; ISBN: 0789479915; http://www.amazon.com/exec/obidos/ASIN/0789479915/icongroupinterna

•

Pregnancy to Parenthood: Your Personal Step-By-Step Journey Through the Childbirth Experience by Linda Goldberg, et al (2001); ISBN: 0399527338; http://www.amazon.com/exec/obidos/ASIN/0399527338/icongroupinterna

•

Pregnancy Week-by-Week by Amanda Roberts (Author) (1997); ISBN: 0062734830; http://www.amazon.com/exec/obidos/ASIN/0062734830/icongroupinterna

•

Pregnancy, Birth, and the Early Months: The Thinking Woman's Guide by Richard I. Feinbloom M.D., Richard I. Feinbloom (2000); ISBN: 0738201812; http://www.amazon.com/exec/obidos/ASIN/0738201812/icongroupinterna

Books 435

•

Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin, et al (2001); ISBN: 074321241X; http://www.amazon.com/exec/obidos/ASIN/074321241X/icongroupinterna

•

Pregnancy: The Miracle Journey by Jessica Lee Kelly (1999); ISBN: 0836190882; http://www.amazon.com/exec/obidos/ASIN/0836190882/icongroupinterna

•

Pregnant Women on Drugs: Combating Stereotypes and Stigma by Sheigla Murphy, Marsha Rosenbaum (1999); ISBN: 0813526035; http://www.amazon.com/exec/obidos/ASIN/0813526035/icongroupinterna

•

Prenatal Yoga for Conception, Pregnancy and Birth by Doriel Hall, et al (2003); ISBN: 075481064X; http://www.amazon.com/exec/obidos/ASIN/075481064X/icongroupinterna

•

Prolactinomas and Pregnancy by H. S. Jacobs (Editor); ISBN: 0852007701; http://www.amazon.com/exec/obidos/ASIN/0852007701/icongroupinterna

•

Protect Your Pregnancy by Bonnie C. Campos, Jennifer C. Brown; ISBN: 0071408746; http://www.amazon.com/exec/obidos/ASIN/0071408746/icongroupinterna

•

Runner's World Guide to Running and Pregnancy by Chris Lundgren (Author) (2003); ISBN: 1579547478; http://www.amazon.com/exec/obidos/ASIN/1579547478/icongroupinterna

•

Stay Fertile Longer: Planning Now for Pregnancy When You're Ready-In Your 20S, 30S, and 40s or Today by Mary S. Kittel, Deborah, Md. Metzger (2003); ISBN: 1579546242; http://www.amazon.com/exec/obidos/ASIN/1579546242/icongroupinterna

•

Step-By-Step Yoga For Pregnancy : Essential Exercises for the Childbearing Year by Wendy Teasdill; ISBN: 0809225433; http://www.amazon.com/exec/obidos/ASIN/0809225433/icongroupinterna

•

Surviving Teen Pregnancy: Your Choices, Dreams, and Decisions by Perry Bergman (Illustrator), Shirley M. Arthur (1996); ISBN: 1885356064; http://www.amazon.com/exec/obidos/ASIN/1885356064/icongroupinterna

•

Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health (Revised Edition) by Toni Weschler (Author) (2001); ISBN: 0060937645; http://www.amazon.com/exec/obidos/ASIN/0060937645/icongroupinterna

•

Tears of Sorrow, Seeds of Hope: A Jewish Spiritual Companion for Infertility and Pregnancy Loss by Nina Beth Cardin (1999); ISBN: 1580230172; http://www.amazon.com/exec/obidos/ASIN/1580230172/icongroupinterna

•

Tentative Pregnancy: How Amniocentesis Changes the Experience of Motherhood by Barbara Katz Rothman (1993); ISBN: 0393309983; http://www.amazon.com/exec/obidos/ASIN/0393309983/icongroupinterna

•

The Alexander Technique Birth Book: A Guide to Better Pregnancy, Natural Childbirth and Parenthood by Ilana MacHover, et al; ISBN: 0806905603; http://www.amazon.com/exec/obidos/ASIN/0806905603/icongroupinterna

•

The Anxious Parent's Guide to Pregnancy by Gerard M. DiLeo; ISBN: 0071383077; http://www.amazon.com/exec/obidos/ASIN/0071383077/icongroupinterna

436 Pregnancy

•

The Children's Hospital of Philadelphia Book of Pregnancy and Child Care by Jr. Patrick S. Pasquariello (Editor); ISBN: 0471320129; http://www.amazon.com/exec/obidos/ASIN/0471320129/icongroupinterna

•

The Complete Book of Pregnancy & Babycare by Alison MacKonochie, et al (2000); ISBN: 1842150774; http://www.amazon.com/exec/obidos/ASIN/1842150774/icongroupinterna

•

The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger, Marcia May (Photographer) (1996); ISBN: 0679450289; http://www.amazon.com/exec/obidos/ASIN/0679450289/icongroupinterna

•

The Complete Guide to Pregnancy After 30 by Carol Winkelman (2002); ISBN: 158062619X; http://www.amazon.com/exec/obidos/ASIN/158062619X/icongroupinterna

•

The Complete Idiot's Guide to Pregnancy & Childbirth by Michele Isaacs Gliksman, et al; ISBN: 0028631048; http://www.amazon.com/exec/obidos/ASIN/0028631048/icongroupinterna

•

The Complete Mothercare Manual: An Illustrated Guide to Pregnancy, Birth and Childcare Through Age Five by Rosalind Y. Ting, et al; ISBN: 0671789783; http://www.amazon.com/exec/obidos/ASIN/0671789783/icongroupinterna

•

The Essential Guide to Lesbian Conception, Pregnancy, and Birth by Kim Toevs, et al (2002); ISBN: 1555836267; http://www.amazon.com/exec/obidos/ASIN/1555836267/icongroupinterna

•

The Everything Pregnancy Book: What Every Woman Needs to Know Month-ByMonth to Ensure a Worry-Free Pregnancy (Everything Series) by Paula Ford-Martin, Elisabeth A. Aron (Contributor) (2003); ISBN: 1580628087; http://www.amazon.com/exec/obidos/ASIN/1580628087/icongroupinterna

•

The Everything Pregnancy Organizer (Everything) by Marguerite Smolen; ISBN: 1580623360; http://www.amazon.com/exec/obidos/ASIN/1580623360/icongroupinterna

•

The Fastest Way To Get Pregnant Naturally by Christopher D., Md. Williams; ISBN: 0786885564; http://www.amazon.com/exec/obidos/ASIN/0786885564/icongroupinterna

•

The Fat Ladies Club: The Tale of Five Friends Facing the Fearful Prospect of Firsttime Pregnancy by Hilary Gardener, et al; ISBN: 0141007893; http://www.amazon.com/exec/obidos/ASIN/0141007893/icongroupinterna

•

The Father's Almanac: From Pregnancy to Pre-school, Baby Care to Behavior, the Complete and Indispensable Book of Practical Advice and Ideas for Every Man Discovering the Fun and Challenge of Fatherhood by S. Adams Sullivan, et al (1992); ISBN: 0385426259; http://www.amazon.com/exec/obidos/ASIN/0385426259/icongroupinterna

•

The Gift of Health : The Complete Pregnancy Diet for Your Baby's Wellness--from Birth Through Adulthood by Karin B. Michels (Author), Kristine Napier (Author) (2001); ISBN: 0743407490; http://www.amazon.com/exec/obidos/ASIN/0743407490/icongroupinterna

•

The Girlfriends' Guide to Pregnancy by Vicki Iovine (Author) (1995); ISBN: 0671524313; http://www.amazon.com/exec/obidos/ASIN/0671524313/icongroupinterna

Books 437

•

The Girlfriends' Guide to Pregnancy Daily Diary by Vicki Iovine (1996); ISBN: 0671002902; http://www.amazon.com/exec/obidos/ASIN/0671002902/icongroupinterna

•

The Good Housekeeping Illustrated Book Of Pregnancy And Baby Care (Revised Edition): The Complete Guide for New Parents and Parents to-Be, with More Than 800 Color Photographs by Good Housekeeping (Editor) (2001); ISBN: 158816053X; http://www.amazon.com/exec/obidos/ASIN/158816053X/icongroupinterna

•

The Healthy Pregnancy Cookbook: Eating Twice as Well for a Healthy Baby by Jane Middleton (Author), George Rapitis (Author); ISBN: 0764566393; http://www.amazon.com/exec/obidos/ASIN/0764566393/icongroupinterna

•

The High-Risk Pregnancy Sourcebook by Denise M. Chism, Eleanor D. Sabin (1998); ISBN: 1565658582; http://www.amazon.com/exec/obidos/ASIN/1565658582/icongroupinterna

•

The Hip Mama Survival Guide : Advice from the Trenches on Pregnancy, Childbirth, Cool Names, Clueless Doctors, Potty Training and Toddler Avengers by Ariel Gore (1998); ISBN: 0786882328; http://www.amazon.com/exec/obidos/ASIN/0786882328/icongroupinterna

•

The Little Big Book of Pregnancy (Little Big Book (New York, N.Y.), 12.) by Katrina Fried (Editor), et al (2002); ISBN: 094180772X; http://www.amazon.com/exec/obidos/ASIN/094180772X/icongroupinterna

•

The Miraculous World of Your Unborn Baby : A Week-by-Week Guide to Your Pregnancy by Nikki Bradfor, Nikki Bradford; ISBN: 0809229285; http://www.amazon.com/exec/obidos/ASIN/0809229285/icongroupinterna

•

The Mother of All Pregnancy Books: The Ultimate Guide to Conception, Birth, and Everything In Between (U.S. Edition) by Ann Douglas (Author); ISBN: 0764565168; http://www.amazon.com/exec/obidos/ASIN/0764565168/icongroupinterna

•

The Multiple Pregnancy Sourcebook: Pregnancy and the First Days with Twins, Triplets, and More by Nancy A., Rn Bowers; ISBN: 0737303069; http://www.amazon.com/exec/obidos/ASIN/0737303069/icongroupinterna

•

The Natural Pregnancy Book: Herbs, Nutrition and Other Holistic Choices by Aviva Jill Romm, Ina May Gaskin (2003); ISBN: 1587611783; http://www.amazon.com/exec/obidos/ASIN/1587611783/icongroupinterna

•

The Naturally Healthy Pregnancy: The Essential Guide to Nutritional and Botanical Medicine for the Childbearing Years by Shonda Parker; ISBN: 1929125127; http://www.amazon.com/exec/obidos/ASIN/1929125127/icongroupinterna

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The New Well Pregnancy Book by Nancy Samuels (Contributor), et al (1996); ISBN: 0684810573; http://www.amazon.com/exec/obidos/ASIN/0684810573/icongroupinterna

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The Peer Partners Handbook: Helping Your Friends Live Free from Violence, Drug Use, Teen Pregnancy & Suicide: A Guide for Students in Leadership Programs by Jerry Kreitzer, David Levine (1995); ISBN: 0882681958; http://www.amazon.com/exec/obidos/ASIN/0882681958/icongroupinterna

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The Pilates Pregnancy: Maintaining Strength, Flexibility, and Your Figure by Mari Winsor, et al (2001); ISBN: 073820501X; http://www.amazon.com/exec/obidos/ASIN/073820501X/icongroupinterna

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The Political Geographies of Pregnancy by Laura R. Woliver (2002); ISBN: 0252027787; http://www.amazon.com/exec/obidos/ASIN/0252027787/icongroupinterna

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The Pregnancy Bed Rest Book: A Survival Guide for Expectant Mothers and Their Families by Amy E. Tracy, Richard H. Schwarz (2001); ISBN: 0425181669; http://www.amazon.com/exec/obidos/ASIN/0425181669/icongroupinterna

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The Pregnancy Bible: Your Complete Guide to Pregnancy and Early Parenthood by Joanne Stone (Editor), Keith Eddleman (Editor) (2003); ISBN: 1552978486; http://www.amazon.com/exec/obidos/ASIN/1552978486/icongroupinterna

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The Pregnancy Book: Month-by-Month, Everything You Need to Know From America's Baby Experts by Williams, Md. Sears, et al (1997); ISBN: 0316779148; http://www.amazon.com/exec/obidos/ASIN/0316779148/icongroupinterna

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The Pregnancy Cookbook, Revised and Expanded Edition by Hope Ricciotti, Vincent Connelly (2002); ISBN: 0393323110; http://www.amazon.com/exec/obidos/ASIN/0393323110/icongroupinterna

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The Pregnancy Diet: A Healthy Weight Control Program for Pregnant Women by Eileen Behan (1999); ISBN: 0671003933; http://www.amazon.com/exec/obidos/ASIN/0671003933/icongroupinterna

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The Pregnancy Journal; A Day-To-Day Guide to a Healthy and Happy Pregnancy by A. Christine Harris PhD; ISBN: 0811811565; http://www.amazon.com/exec/obidos/ASIN/0811811565/icongroupinterna

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The Pregnancy Map by Barbara Dehn; ISBN: 0972658009; http://www.amazon.com/exec/obidos/ASIN/0972658009/icongroupinterna

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The Pregnancy Prescription: The Success-Oriented Approach to Overcoming Infertility by Hugh D. Melnick, Nancy Intrator (1998); ISBN: 0966041909; http://www.amazon.com/exec/obidos/ASIN/0966041909/icongroupinterna

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The Pregnancy Proposal (Expecting!) by Helen Bianchin; ISBN: 0373123132; http://www.amazon.com/exec/obidos/ASIN/0373123132/icongroupinterna

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The Pregnant Woman's Comfort Book : Self-Nurturing Guide to Your Emotional Well-Being During Pregnancy and Early Mot by Jennifer Louden (Author) (1995); ISBN: 0062511653; http://www.amazon.com/exec/obidos/ASIN/0062511653/icongroupinterna

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The Room Lit by Roses: A Journal of Pregnancy and Birth by Carole Maso (2002); ISBN: 1582432120; http://www.amazon.com/exec/obidos/ASIN/1582432120/icongroupinterna

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The Spirit of Pregnancy : An Interactive Anthology for Your Journey to Motherhood by Bonni Goldberg; ISBN: 0809226154; http://www.amazon.com/exec/obidos/ASIN/0809226154/icongroupinterna

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The Ultimate Guide to Pregnancy for Lesbians: Tips and Techniques from Conception to Birth: How to Stay Sane and Care for Yourself by Rachel Pepper (1999); ISBN: 1573440809; http://www.amazon.com/exec/obidos/ASIN/1573440809/icongroupinterna

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The What to Expect When You're Expecting Pregnancy Organizer by Arlene Eisenberg, et al (1995); ISBN: 1563058723; http://www.amazon.com/exec/obidos/ASIN/1563058723/icongroupinterna

Books 439

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Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss by Ann Douglas, et al (2000); ISBN: 0878331824; http://www.amazon.com/exec/obidos/ASIN/0878331824/icongroupinterna

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Twins! : Expert Advice from two practicing physicians on pregnancy, birth and the first y by Connie Agnew (Author) (1997); ISBN: 0062734601; http://www.amazon.com/exec/obidos/ASIN/0062734601/icongroupinterna

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Unspeakable Losses : Healing From Miscarriage, Abortion, And Other Pregnancy Loss by Kim Kluger-Bell (Author); ISBN: 068817390X; http://www.amazon.com/exec/obidos/ASIN/068817390X/icongroupinterna

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Vegetarian Pregnancy: The Definitive Nutritional Guide to Having a Healthy Baby by Sharon K. Yntema, et al (1994); ISBN: 0935526218; http://www.amazon.com/exec/obidos/ASIN/0935526218/icongroupinterna

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Waiting for Bebe: A Pregnancy Guide for Latinas by Lourdes Alcaniz, et al (2003); ISBN: 0345452119; http://www.amazon.com/exec/obidos/ASIN/0345452119/icongroupinterna

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What Kind of Love? The Diary of a Pregnant Teenager by Sheila Cole (Author) (1996); ISBN: 0380725754; http://www.amazon.com/exec/obidos/ASIN/0380725754/icongroupinterna

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What to Do When Your Baby Is Premature: A Parent's Handbook for Coping with High-Risk Pregnancy and Caring for the Preterm Infant by Joseph A. Garcia-Prats, Sharon Simmons Hornfischer (2000); ISBN: 0812931092; http://www.amazon.com/exec/obidos/ASIN/0812931092/icongroupinterna

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What to Expect Pregnancy Planner: A 42 Week Wall Record Keeper from Conception to Birth by Heidi Murkoff, et al; ISBN: 0761127453; http://www.amazon.com/exec/obidos/ASIN/0761127453/icongroupinterna

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When Pregnancy Isn't Perfect : A Layperson's Guide To Complications In Pregnancy by Laurie A. Rich (1996); ISBN: 0965498506; http://www.amazon.com/exec/obidos/ASIN/0965498506/icongroupinterna

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With Child: Wisdom and Traditions for Pregnancy, Birth and Mothering by Deborah Jackson (1999); ISBN: 0811824004; http://www.amazon.com/exec/obidos/ASIN/0811824004/icongroupinterna

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With You and Your Baby All the Way : Complete Guide to Pregnancy, Childbirth, Recovery, and Baby Care by Jerri Colonero (1998); ISBN: 0923521437; http://www.amazon.com/exec/obidos/ASIN/0923521437/icongroupinterna

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Yoga for Pregnancy by Rosalind Widdowson; ISBN: 086573433X; http://www.amazon.com/exec/obidos/ASIN/086573433X/icongroupinterna

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Yoga for Pregnancy by Francoise Barbira Freedman, Doriel Hall (2003); ISBN: 1844030598; http://www.amazon.com/exec/obidos/ASIN/1844030598/icongroupinterna

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Yoga for Pregnancy: Safe and Gentle Stretches by Sandra Jane Jordan; ISBN: 0312023227; http://www.amazon.com/exec/obidos/ASIN/0312023227/icongroupinterna

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Your Baby's First Year Week by Week (Your Pregnancy Series) by Glade B. Curtis, Judith Schuler; ISBN: 1555612326; http://www.amazon.com/exec/obidos/ASIN/1555612326/icongroupinterna

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Your Fertility Signals: Using Them to Achieve or Avoid Pregnancy Naturally by Merryl Winstein (1991); ISBN: 0961940107; http://www.amazon.com/exec/obidos/ASIN/0961940107/icongroupinterna

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Your Over-35 Week-by-Week Pregnancy Guide: All the Answers to All Your Questions About Pregnancy, Birth, and Your Developing Baby by M. Kelly Shanahan; ISBN: 0761526986; http://www.amazon.com/exec/obidos/ASIN/0761526986/icongroupinterna

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Your Pregnancy after 35 by Glade B. Curtis M.D., et al; ISBN: 1555613195; http://www.amazon.com/exec/obidos/ASIN/1555613195/icongroupinterna

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Your Pregnancy and Newborn Journey: A Guide for Pregnant Teens (Lindsay, Jeanne Warren. Teens Parenting.) by Jeanne Warren Lindsay, et al (1998); ISBN: 1885356307; http://www.amazon.com/exec/obidos/ASIN/1885356307/icongroupinterna

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Your Pregnancy Diary: A Day-By-Day Record of Your Pregnancy by Tilla, Dr Nicolson, Tilla Nicholson; ISBN: 1555612881; http://www.amazon.com/exec/obidos/ASIN/1555612881/icongroupinterna

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Your Pregnancy For The Father-To-Be: Everything You Need To Know About Pregnancy, Childbirth, And Getting Ready For Your New Baby by Glade B., Md. Curtis, et al (2003); ISBN: 1555613454; http://www.amazon.com/exec/obidos/ASIN/1555613454/icongroupinterna

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Your Pregnancy Journal Week by Week: A Keepsake Journal to Chart Your Progress and Thoughts by Glade B., Md Curtis, Judith Schuler (2002); ISBN: 1555613438; http://www.amazon.com/exec/obidos/ASIN/1555613438/icongroupinterna

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Your Pregnancy Month by Month 5e by Clark Gillespie (Author) (1998); ISBN: 006095714X; http://www.amazon.com/exec/obidos/ASIN/006095714X/icongroupinterna

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Your Pregnancy Week by Week by Alison MacKonochie; ISBN: 0831772212; http://www.amazon.com/exec/obidos/ASIN/0831772212/icongroupinterna

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Your Pregnancy Week by Week (Your Pregnancy Series) by Glade B. Curtis, Judith Schuler; ISBN: 1555612601; http://www.amazon.com/exec/obidos/ASIN/1555612601/icongroupinterna

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Your Second Pregnancy: What to Expect This Time by Katie Tamony (1995); ISBN: 1556522347; http://www.amazon.com/exec/obidos/ASIN/1556522347/icongroupinterna

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Your Vegetarian Pregnancy : A Month-by-Month Guide to Health and Nutrition by Holly Roberts (Author); ISBN: 0743224523; http://www.amazon.com/exec/obidos/ASIN/0743224523/icongroupinterna

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You're Pregnant Too, Mate!: The Essential Guide for Expectant Fathers by Gavin Rodgers (2000); ISBN: 1861052774; http://www.amazon.com/exec/obidos/ASIN/1861052774/icongroupinterna

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You're Pregnant!! : A Guide for the Longest Nine Months of Your Life by Kathryn Hammer; ISBN: 0809234726; http://www.amazon.com/exec/obidos/ASIN/0809234726/icongroupinterna

Books 441

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “pregnancy” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Albuminuria in pregnancy. Read before the Union Medical Association of Bennington Co., Vt., July 14, 1880. Author: Lambert, John,; Year: 2002; [Bennington, Vt.?], 1880

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An experimental proof of the melanophore reaction as a pregnancy test [by] R. Bojarski, T. Dominiczak, and E. Kleineder. Author: Bojarski, Ryszard.; Year: 1997; Gdańsk, 1957

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Assessment of the safety of artemisinin compounds in pregnancy: report of two informal consultations convened by WHO in 2002 Author: Global Partnership to Roll Back Malaria.; Year: 1997; Geneva: World Health Organization, 2003

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Atypical endometrial changes associated with ectopic pregnancy. Author: Battaglino, John Joseph,; Year: 2001; [Minneapolis] 1961

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Crack mothers: pregnancy, drugs, and the media Author: Humphries, Drew.; Year: 2000; Columbus: Ohio State University Press, c1999; ISBN: 0814208169 http://www.amazon.com/exec/obidos/ASIN/0814208169/icongroupinterna

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Drugs during pregnancy and lactation: handbook of prescription drugs and comparative risk assessment: with updated information on recreational drugs, diagnostic procedures, vaccinations, poisoning, workplace and environmental contaminants, and breastfeeding during infectious disease Author: Schaefer, Christof.; Year: 1997; Amsterdam: New York: Elsevier, 2001; ISBN: 0444507639 http://www.amazon.com/exec/obidos/ASIN/0444507639/icongroupinterna

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Hemorrhagic disorders in pregnancy, ed. by Fritz K. Beller. The climacteric and the postmenopause, ed. by E. Jürgen Plotz. Author: Beller, Fritz K.; Year: 2004; [New York] Harper; Row [c1964]

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Histamine and histaminase during the last days of pregnancy in the rat. Author: Wiskont-Buczkowska, Halina,; Year: 1894; Gdańsk, Gdańskie Tow. Naukowe, 1962

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Human skin permeability in pregnancy and menstruation. Hyaluronidase inhibition in human pregnancy and menstruation. Author: Ploman, Lennart.; Year: 1865; Copenhagen, Munksgaard, 1953

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Jaundice in pregnancy, a clinical study. [Tr. from the Swedish]. Author: Thorling, Leif.; Year: 1963; Uppsala, 1955

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On intermittent contractions of uterine fibromata and uterus in pregnancy in relation to diagnosis Author: Hicks, J. Braxton.; Year: 2004; London: Adlard and Son, 1894

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

442 Pregnancy

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On the Wassermann and Kahn reactions during pregnancy. Author: Penttinen, Kari,; Year: 1964; Helsinki [Mercators tryckeri] 1946 [cover 1947]

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Pregnancy and tuberculosis. Author: Hedvall, Erik,; Year: 1880; Stockholm [Norstedt] 1953

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Pregnancy; chemistry and management. Author: Berge, Balthazar Simon ten,; Year: 2004; Springfield, Ill., Thomas [c1965]

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The cardio-pulmonal function during pregnancy; a clinical-experimental study with particular respect to ventilation and oxygen consumption among normal cases in rest and after work tests, by Gerhard Widlund. Author: Widlund, Gerhard,; Year: 1961; Uppsala [Almqvist; Wiksells boktryckeri ab] 1945

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Ultrasound screening of normal-risk women for prevention of postterm pregnancy Author: ECRI (Organization). Health Technology Assessment Information Service.; Year: 2003; Plymouth Meeting, PA: ECRI, c2003

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Venous thrombosis in women: pregnancy, the contraceptive pill, and hormone replacement therapy Author: Greer, I. A. (Ian A.),; Year: 1964; New York: Parthenon Pub. Group, 2003; ISBN: 1842142283 http://www.amazon.com/exec/obidos/ASIN/1842142283/icongroupinterna

Chapters on Pregnancy In order to find chapters that specifically relate to pregnancy, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and pregnancy using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “pregnancy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on pregnancy: •

Organ Involvement: Sexual Function and Pregnancy Source: in Clements, P.J. Furst, D.E., Eds. Systemic Sclerosis. Baltimore, MD: Williams and Wilkins. 1996. p. 483-499. Contact: Available from Williams and Wilkins, Special Sales Department. (800) 358-3583. Summary: This chapter for health professionals explores the effect of systemic sclerosis (SSc) on sexual function in males and females. Non pregnancy issues involving patients with SSc are addressed, including gynecologic concerns, breast complications, sex hormone-related issues, and impotence. A model for addressing the sexual concerns of both male and female patients with SSc are described. The issues of contraception and fertility are addressed. The effects of SSc on pregnancy and the effects of pregnancy on SSc are discussed. Organ system problems associated with pregnancy in patients with SSc are examined, focusing on musculoskeletal, gastrointestinal, and cardiovascular problems; thyroid disorders; pulmonary disease; peripheral gangrene; renal disease; and CREST syndrome. The effects of various medications on a pregnant woman and her baby are presented. In addition, postpartum considerations are addressed, including the use of medications while breast feeding. 135 references and 4 tables.

Books 443

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Pregnancy and the Rheumatic Diseases Source: in Maddison, P.J. et al., Eds. Oxford Textbook of Rheumatology. Volume 1. New York, NY: Oxford University Press, Inc. 1993. p. 93-98. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals examines the effects of pregnancy on rheumatic disease and the effects of rheumatic disease on pregnancy and the fetus. Possible reasons why patients with rheumatoid arthritis improve during pregnancy are presented. Studies on the effects of pregnancy on systemic lupus erythematosus are reviewed. Pregnancy-related data on several other rheumatic diseases are highlighted, including data on systemic sclerosis, juvenile chronic arthritis, ankylosing spondylitis, psoriatic arthritis, gonococcal arthritis, gout, relapsing polychondritis, Wegener's granulomatosis, and Sjogren's syndrome. In addition, miscellaneous musculoskeletal problems that women may experience during pregnancy are identified. 80 references and 2 tables.

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Liver in Pregnancy Source: in Sherlock, S. Dooley, J. Diseases of the Liver and Biliary System. Malden, MA: Blackwell Science, Inc. 2002. p.471-479. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $178.95. ISBN: 0632055820. Summary: This chapter on the liver in pregnancy is from a textbook that presents a comprehensive and up-to-date account of diseases of the liver and biliary system. The chapter covers normal pregnancy; liver disease in pregnancy, including hyperemesis gravidarum; liver diseases of late pregnancy, including acute fatty liver of pregnancy, pregnancy toxemias, the HELLP syndrome, toxemia and the HELLP syndrome, hepatic hemorrhage, cholestasis of pregnancy, and Budd-Chiari syndrome; intercurrent jaundice, due to viral hepatitis or biliary tract disease; hepatotoxic (damaging to the liver) drugs and the pregnant woman; the effect of pregnancy on pre-existing chronic liver disease; and pregnancy in liver transplant recipients. 6 figures. 5 tables. 54 references.

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Pregnancy and Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 613-618. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on pregnancy in inflammatory bowel disease (IBD) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as IBD. This chapter focuses on drug therapy and side effects issues in these challenging patients from the point of view of the gastroenterologist; an additional chapter addresses pregnancy in IBD from the perspective of an obstetrician. The author discusses inheritance, fertility, the influence of UC and CD on pregnancy, the activity of

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disease and the influence on pregnancy, and the assessment of disease activity in pregnant patients. The author then summarizes the use of medications in pregnancy, including nonspecific symptomatic agents, sulfasalazine, mesalamine, antibiotics, steroids, immunomodulatory drugs, methotrexate and cyclosporine, and infliximab. The author stresses the importance of physicians communicating clearly to their female patients desiring to get pregnant that their disease should be in remission before attempting to conceive and that medications that are keeping them in remission should not be discontinued either prior to conception or during the first trimester. 12 references. •

Gastrointestinal Disorders in Pregnancy Source: in Rose, S. Gastrointestinal and Hepatobiliary Pathophysiology. Malden, MA: Blackwell Science, Inc. 1998. p. 373-384. Contact: Available from Blackwell Science, Inc. 350 Main Street, Malden, MA 02148. (800) 215-1000 or (781) 388-8250. Fax (781) 388-8270. E-mail: [email protected]. Website: www.blackwellscience. PRICE: $26.00 plus shipping and handling. Summary: This chapter on gastrointestinal disorders in pregnancy is from a textbook that focuses on the pathophysiologic basis of gastrointestinal and hepatobiliary (liver and biliary tract) diseases while encouraging an integrative, problem-solving approach. The chapter begins with a list of learning objectives and an illustrative case study, then covers the normal physiological, biochemical, and morphological changes in pregnancy; motility disorders in pregnancy; the effects of inflammatory bowel disease (IBD) on pregnancy and of pregnancy on IBD; and how to differentiate diseases unique to pregnancy from chronic liver diseases in pregnancy and intercurrent liver diseases during pregnancy. The chapter concludes with a follow up to the case study, a list of review questions, and the answers to the review questions, with brief explanations. 4 tables. 8 references.

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Pregnancy and Fertility in Crohn's Disease Source: in Prantera, C. and Korelitz, B.I. Crohn's Disease. New York, NY: Marcel Dekker, Inc. 1996. p. 413-427. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016-0601. (800) 22-1160 or (212) 696-9000. Fax (212) 685-4540. PRICE: $115.00. ISBN: 0824794109. Summary: This chapter on pregnancy and fertility in Crohn's disease (CD) is from a medical textbook on the diagnosis and management of CD. The author notes that CD occurs predominantly in young adults, with peak occurrences during the main childbearing years; hence, data regarding pregnancy in CD are vital in terms of quality of life issues and medical management. The author reviews current data regarding genetics and inheritance, fertility, influence of inflammatory bowel disease (IBD) on pregnancy, influence of pregnancy on IBD, current medical therapy before and during pregnancy, advice on delivery, and the influence of surgical management on pregnancy in CD. The author concludes that women who are contemplating pregnancy and have CD that is well controlled by medical therapy can look forward to a normal pregnancy with the only risk being the possibility of having a preterm delivery. Women should be counseled that the risk of a flare up of CD during pregnancy is no greater than at any other time unrelated to the pregnancy. Additionally, pregnancy does not cause exacerbation of inactive CD and exacerbation of CD during pregnancy can usually be treated effectively with aggressive medical management including the use of 5-ASA

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drugs and corticosteroids, if necessary. Enteral and parenteral nutrition can also be used safely and efficiently during pregnancy. 54 references. (AA-M). •

Pregnancy and Nursing Source: in Peppercorn, M.A., ed. Therapy of Inflammatory Bowel Disease: New Medical and Surgical Approaches. New York, NY: Marcel Dekker, Inc. 1990. p. 213-224. Contact: Available from Marcel Dekker, Inc. P.O. Box 5005, Monticello, NY 12701-5185. (800) 228-1160 or (212) 696-9000. Fax (914) 796-1772. E-mail: [email protected]. PRICE: $190.00. ISBN: 0824781694. Summary: Several recent studies have examined in detail the effects of inflammatory bowel disease (IDB) and its treatment on fertility and the outcome of pregnancy, as well as the effects of pregnancy on the activity of the IBD. This chapter, from a book about the medical and surgical approaches to the therapy of IBD, considers the medical management of IBD during pregnancy. Separate sections of the chapter discuss pregnancy and IBD interactions; drug therapy, specifically corticosteroids, sulfasalazine, metronidazole, immunosuppressives, and antidiarrheal agents; total parenteral nutrition; and pregnancy with an ileostomy or ileal pouch-anal anastomosis. The author concludes that the majority of pregnant women with IBD will have a normal infant, but active disease requiring drug treatment at the time of conception or during pregnancy is associated with a higher rate of complication. Overall, patients with Crohn's disease do less well than those with ulcerative colitis. 69 references.

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Parasitic Disease in Pregnancy. Source: in Sweet, R.L. and Gibbs, R.S. Infectious Diseases of the Female Genital Tract. Baltimore, MD: Williams and Wilkins. 1990. p. 383-406. Contact: Available from Williams and Wilkins. Book Order Department, 428 East Preston Street, Baltimore, MD 21202. (800) 638-0672. PRICE: $68 (shipping $6.90). ISBN: 0683080393. Summary: This chapter, from a book about infectious diseases of the female genital tract, discusses parasitic disease in pregnancy. Topics covered include protozoan infections, including amebiasis, giardiasis, and malaria; and helminth infections, including ascariasis and trichinosis. While the prevalence of parasitic diseases during pregnancy is lower in the United States and other Western industrialized nations, the wide accessibility to rapid foreign travel has resulted in a rather large at-risk pool of tourists exposed to a multitude of protozoan and helminth infections during their travels. The authors note that the response to parasitic infection by nonresident visitors to endemic areas may be more severe than that of the local inhabitants who have acquired immunity to these agents. The authors conclude that in general, the majority of parasitic infections that occur in pregnancy do not require treatment until after delivery. However, if severe symptoms, anemia, and/or malabsorption occur, treatment should be initiated. In addition, certain parasitic infections, including symptomatic amebiasis, severe giardiasis, malaria, and ascariasis, should always be treated during pregnancy. 2 figures. 4 tables. 83 references.

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Sex, Pregnancy, and Hypoglycemia Source: in Lincoln, T.A. Eaddy, J.A. Beating the Blood Sugar Blues. Alexandria, VA: American Diabetes Association. 2001. p.86-90.

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Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 plus shipping and handling. ISBN: 1580400485. Summary: Diabetes can have an effect on a person's sexual health, both in their ability to physically enjoy sexual relations and in feeling like enjoying it. Good glucose control prevents the nerve and circulation damage that can interfere with a man's ability to have an erection and a woman's ability to have an orgasm. Good glucose control also can improve one's health and emotional state. This chapter on sex, pregnancy, and hypoglycemia (low blood glucose levels) is from a book that offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the dayto-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. In this chapter, the authors discuss the physiology of health sexuality, the impact of sexual activity on blood glucose levels (which is similar to other physical activities), the reluctance of patients to discuss sexuality with their physicians, the importance of preventing hypoglycemia during pregnancy (even before conception), the role of selfmonitoring of blood glucose (SMBG) during pregnancy, post childbirth considerations for mothers with diabetes, and the importance of careful planning, before and after the baby is born. 1 table. •

Pregnancy: Preconception to Postpartum Source: in Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 4th ed.: (Volume 4) Diabetes in the Life Cycle and Research. Chicago, IL: American Association of Diabetes Educators (AADE). 2001. p. 31-70. Contact: Available from American Association of Diabetes Educators. AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 338-3633. Fax (312) 424-2427. Website: www.diabeteseducator.org. PRICE: Individual volume $45.00 for members and $60.00 for nonmembers; complete 4-volume set $149.95 for members and $199.95 for nonmembers; plus shipping and handling. ISBN: 188187608X (Volume 4); 1881876098 (4-volume set). Summary: The outlook for pregnant women with diabetes and their children has improved dramatically over the past 25 years due to improvements in diabetes care such as the use of self monitoring of blood glucose (SMBG) and intensive insulin therapy to normalize maternal metabolism throughout the gestation period, better fetal monitoring, and advances in neonatal intensive care. This chapter on pregnancy (preconception to postpartum) is from a book that is the fourth in a series of four texts that make up a Core Curriculum, designed primarily to help educators prepare for the Certified Diabetes Educator (CDE) exam. Topics include definitions of gestational diabetes, type 1 diabetes, and type 2 diabetes; risk factors associated with a poor outcome in a pregnancy complicated by diabetes; normal maternal metabolism during pregnancy; neonatal (newborn) complications; potential maternal complications; the relationship between preconception glucose control and the incidence of congenital anomalies and spontaneous abortions; potential maternal complications for the patient with pregestational diabetes; blood glucose guidelines for pregnancy; topics to discuss during preconception counseling; strategies to achieve blood glucose levels; specific patient education needed for self management during pregnancy; and postpartum care and education for women with diabetes. The chapter lists the learning objectives for that chapter, presents information in outline and bulleted format, summarizes the key educational considerations, offers self review questions and questions for discussion,

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presents illustrative case reports, and concludes with a list of references. A post-test and the answers to the post-test questions are appended to the chapter. 1 figure. 8 tables. 114 references. •

Nutrition Therapy for Pregnancy and Lactation Source: in Franz, M.J. and Bantle, J.P., eds. American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 229-248. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $39.95 for members; $49.95 for nonmembers; plus shipping and handling. ISBN: 158040006X. Order number 561601. Summary: This chapter focuses on nutrition issues associated with pregnancy and breastfeeding. Nutrition related concerns during pregnancy include weight gain and caloric requirements, adequate nutrients, and possible need for vitamin and mineral supplements such as iron and folic acid. The problems associated with pregnancy in women with diabetes include an increased risk for fetal birth defects and increased spontaneous abortion rates. Nutrition therapy for women who have prior onset type 1 or type 2 diabetes begins with a prenatal meal plan before attempting conception so that they can attempt to achieve glycemic control and optimal body weight. The goal of medical nutrition therapy (MNT) in a pregnancy with diabetes is to maintain normal blood glucose levels while meeting the nutritional needs of pregnancy. Regular meals and snacks are very important to avoid hypoglycemia during pregnancy. Breastfeeding is recommended for women who have diabetes, and a postpartum meal plan must account for the energy demands of breastfeeding as well as its lowering effects on blood glucose. For women who develop gestational diabetes mellitus (GDM), MNT is used to achieve optimal blood glucose control with adequate nutrition for both mother and fetus. Intensive nutrition therapy, along with daily blood glucose monitoring and an exercise program, may be an alternative to insulin therapy in women who develop GDM. Breastfeeding is also encouraged in women who have GDM. Women should not follow a hypocaloric diet until lactation is terminated. 1 figure. 6 tables. 63 references.

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Pregnancy and the Bladder Source: in Blaivas, J.G. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York, NY: Plenum Publishing Corporation. 1998. p. 107-113. Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. PRICE: $26.95. ISBN: 0306458640. Summary: This chapter on pregnancy and the bladder is from a book for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. The author notes that although pregnancy can be a time of great joy and exhilaration, it usually means additional work for the bladder. By the ninth month of pregnancy, most women are urinating every hour or two during the day and getting up three or more times at night to urinate. Over a third of pregnant women have stress incontinence, and many women complain of urinary urgency, urge incontinence, weak stream, and a

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feeling of incomplete bladder emptying. This chapter discusses urinary tract infection (UTI) in pregnant women and other lower urinary tract symptoms that may occur during pregnancy. During pregnancy, the biggest threat to the health of the mother and the baby from the lower urinary tract is UTI. Approximately 5 percent of pregnant women develop asymptomatic bacteriuria (urinary bacteria present without signs of infection). Untreated, over a third of these women will go on to develop kidney infections and even more will develop bladder infections. For this reason, it is standard practice to screen all pregnant women for bacteriuria and to treat it when it is found. •

Is Chronic Renal Disease a Contraindication to Pregnancy? Source: in Andreucci, V.E., and Fine, L.G., eds. International Yearbook of Nephrology Dialysis Transplantation. 1995. p. 35-44. Contact: Available as a supplement to Nephrology Dialysis Transplantation, Volume 10. Oxford University Press, 2001 Evans Road, Cary, NC 27513-2009. (800) 334-4249. ISBN: 0192626493. Summary: This chapter of the International Yearbook of Nephrology, Dialysis, and Transplantation focuses on chronic renal disease and pregnancy. Topics include the limits of current knowledge of renal disease in pregnancy; primary renal disease; the role of hypertension; controversial renal diseases; IgA nephropathy; reflux nephropathy; membranous glomerulonephritis (MGN); membranoproliferative glomerulonephritis (MPGN); pregnancy outcomes; systemic diseases, including diabetes mellitus, systemic lupus erythematosus (SLE), scleroderma, and other collagen vascular diseases; pregnancy with end-stage renal disease (ESRD); and pregnancy following renal transplantation. 74 references.

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Kidney in Pregnancy Source: in Greenberg, A., et al., eds. Primer on Kidney Diseases. New York, NY: National Kidney Foundation. 1994. p. 237-242. Contact: Available from Academic Press. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 321-5068. PRICE: Paperback $49.95 (paper). ISBN: 0122992318. OR $99 (hardback). ISBN: 012299230X. Summary: This chapter, from a comprehensive textbook of clinical nephrology, focuses on the kidney in pregnancy. Topics include changes in renal function during pregnancy; renal disease with urinary tract infection; hypertension and its complications; proteinuria; pregnancy in women with renal disease and good renal function; pregnancy in women with chronic renal insufficiency; diabetic nephropathy; lupus nephritis; dialysis; pregnancy in transplant recipients; acute renal failure (ARF) in pregnancy; and types of pregnancy-associated ARF, including obstruction, preeclampsia-eclampsia, acute tubular necrosis and cortical necrosis, hemolytic uremic syndrome, and acute fatty liver of pregnancy. 15 references.

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Pregnancy and Renal Disease Source: in Schrier, R.W. and Gottschalk, C.W. Diseases of the Kidney, Boston, MA: Little, Brown and Company. 1992. p. 2287-2310. Contact: Available from Little, Brown and Company. Order department, 200 West Street, Waltham, MA 02154. PRICE: $400 for 3 volumes, plus $15 shipping and handling if not prepaid. ISBN: 0316775010.

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Summary: This chapter, from a medical reference book about diseases of the kidney, discusses pregnancy and renal disease. Topics include changes in urinary tract anatomy and physiology during pregnancy; hypertensive disease in pregnancy; kidney disease in pregnancy, including urinary tract infection, renal tuberculosis, renal calculi and urinary tract obstruction, chronic interstitial nephritis, polycystic kidney disease, acute renal failure, glomerulonephritis, nephrotic syndrome, systemic lupus erythematosus, diabetic nephropathy, and sickle cell trait and disease; and pregnancy in women on dialysis. The authors conclude that women with renal disease and well-preserved renal function tolerate pregnancy well, especially if blood pressure is normal or well controlled. 11 figures. 2 tables. 167 references. •

Hemolytic Uremic Syndrome in Association with Pregnancy Source: in Kaplan, B.S., Trompeter, R.S., and Moake, J.L., eds. Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura. New York, NY: Marcel Dekker, Inc. 1992. p. 241-254. Contact: Available from Marcel Dekker, Inc. P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (212) 696-9000. Fax (914) 796-1772. E-mail: [email protected]. PRICE: $215.00. ISBN: 0824786637. Summary: This chapter, from a medical text on hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), discusses HUS in association with pregnancy. The authors provide a classification system of three main clinical entities and stress that patient management depends in part on a classification that is as precise as possible. Topics include postpartum HUS, its clinical presentation, histological findings, evolution, and etiology; TTP, its clinical presentation, evolution, and differential diagnosis; severe pre-eclampsia; the HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count); acute fatty liver of pregnancy (AFLP); bilateral renal cortical necrosis; the pathophysiology of TTP/HUS, regardless of the triggering factor; and treatment options, including supportive therapy and specific therapy. A number of tables summarize the case reports in the literature. 5 tables. 41 references.

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Renal Complications of Pregnancy Source: in Suki, W.N. Massry, S.G., eds. Therapy of Renal Diseases and Related Disorders, 2nd ed. Hingham, MA: Kluwer Academic Publishers. 1991. p. 495-532. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018. (617) 871-6600. PRICE: $315. ISBN: 0792306767. Summary: This lengthy chapter, from a medical text on the therapy of renal disease and related disorders, discusses the renal complications of pregnancy. Topics include the kidney in normal pregnancy; asymptomatic bacteriuria; acute symptomatic urinary tract infection; nontraumatic rupture of the urinary tract; acute renal failure; forms of acute renal failure found in pregnancy; important considerations in the management of renal disease in pregnancy; renal function and the impact of pregnancy; a general management plan for renal disease in pregnancy; management regimens for hypertension in pregnancy; the management of pregnancy in patients undergoing chronic hemodialysis or peritoneal dialysis; and the management of pregnancy in renal transplant patients. 7 figures. 11 tables. 267 references.

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Renal Disease and Hypertension in Pregnancy Source: in Levine, D.Z. Care of the Renal Patient. Orlando, FL: W.B. Saunders Company. 1991. p. 85-96. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 782-4479. PRICE: $46.95 plus shipping and handling. ISBN: 0721630561. Summary: This chapter, from a comprehensive medical textbook about the care of the renal patient, discusses renal disorders and hypertension in pregnant women. The authors first review the anatomic and physiologic changes in gestation and their clinical relevance to detecting and managing disease. A section on the kidneys is devoted to acute renal failure and chronic parenchymal diseases, including allograft recipients. A section on high blood pressure is primarily devoted to preeclampsia and essential hypertension. 2 figures. 5 tables. 11 references.

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Sex, Fertility, Contraception, and Pregnancy Source: in Gabriel, R. Patient's Guide to Dialysis and Transplantation. 4th ed. Hingham, MA: Kluwer Academic Publishers. 1990. p. 116-121. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station. Hingham, MA 02018. (617) 871-6600. PRICE: $24.50. ISBN: 0792389506. Summary: This chapter, from a general patient guide to the treatment of renal failure, considers the issues of sex, fertility, contraception, and pregnancy for the patient with kidney disease. The author discusses the interplay of self-esteem and sexuality, the changing levels of fertility for a woman on dialysis, the types of contraception that may be appropriate for renal patients, and the problems inherent in pregnancy for the woman with kidney failure. The author also briefly considers pregnancy in the posttransplant woman.

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Needs assessment and data collection. In Brindis, C. D. with Pittman, K., Reyes, P., and Adams-Taylor, S. Adolescent pregnancy prevention: A guidebook for communities (pp. 113-151) Source: Stanford, CA: Health Promotion Resource Center, Stanford Center for Research in Disease Prevention. 1991. 39 pp. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524- 9335 / e-mail: [email protected] / Web site: http://www.ncemch.org. Available for loan. Summary: This paper discusses what needs assessment is and what it can do, what makes a target community, the components and scope of a needs assessment, sources of data, developing a work plan for conducting the assessment, and using the data gathered to create an implementation plan. An appendix gives guidance on needs assessment data collection. The authors use sexually active adolescents as the basis of the sample needs assessment in the document.

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Pregnancy and Breast-Feeding Source: in Little, J.W., et al. Dental Management of the Medically Compromised Patient. 5th ed. St. Louis, MO: Mosby, Inc. 1997. p. 434-442.

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Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $48.00 plus shipping and handling. ISBN: 0815156340. Summary: A working knowledge of the multitude of compromised health states is essential for dental professionals, as the majority of medically compromised patients need or want oral health care. This chapter on pregnancy and breastfeeding is from a text that provides the dental practitioner with an up to date reference work describing the dental management of patients with selected medical problems. In this chapter, the authors note that the pregnant patient, while not 'medically compromised' per se, poses a unique set of management considerations for the dentist. Therapeutic dental care must be given to the pregnant woman without adversely affecting the developing fetus. Additional considerations arise during breastfeeding, notably drug considerations (to avoid exposure of the infant to the drugs). The authors discuss the physiology of pregnancy and complications, and the dental management of this population, notably preventive programs, treatment timing, dental radiographs (x-rays), drug administration, and anticipated oral complications of pregnancy (notably pregnancy gingivitis, or gum inflammation). 3 figures. 3 tables. 32 references. •

Behind the Scene: Pregnancy Source: in Greenberg, K.B. Complete Guide to Children's Dental Care: From Prenatal Through Teens. Southampton, NY: Health Monitor Press. 1993. p. 31-39. Contact: Available from Health Monitor Press. P.O. Box 2700, Southampton, NY 11969. (516) 287-3140; Fax (516) 287-3136. PRICE: $14.95 plus shipping and handling. ISBN: 0963599801. Summary: This chapter on pregnancy is from a book designed to provide parents with a comprehensive overview of how to care for their children's teeth, from infancy through adolescence. Topics covered include the emotional and physical changes of pregnancy, nutritional needs, factors affecting eating patterns, minerals and drugs, and exaggerated oral conditions associated with pregnancy, including pregnancy gingivitis and pregnancy tumor. The author focuses on providing practical information and answers to common questions that expectant parents pose.

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Oral Changes in Pregnancy Source: in Bork, K., et al. Diseases of the Oral Mucosa and the Lips. Orlando, FL: W.B. Saunders Company. 1993. p. 8-9. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 352-3445; http://www.wbsaunders.com. PRICE: $99.00 plus shipping and handling. ISBN: 0721640397. Summary: This chapter on oral changes in pregnancy is from a textbook on diseases of the oral mucosa and the lips. The chapter briefly describes pregnancy gingivitis, pregnancy tumor, angiomas, and gingival pigmentation. The chapter describes the clinical features, etiology, and therapy of pregnancy gingivitis, a problem found in nearly 20 percent of all pregnancies. The term pregnancy tumor (epulis gravidarum) is applied to tumor-like granulomatous tissue arising in pregnancy, isolated or associated with pregnancy gingivitis. Cherry angiomas or small vascular dilations can increase in pregnancy; they typically occur on the neck, but may be seen elsewhere, including the tongue. 1 figure. 2 references. (AA-M).

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Pregnant Patient with Liver Disease Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 961-969. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Liver diseases encountered in pregnant patients include those present before conception, those that occur coincident with pregnancy, and those that are unique to pregnancy. This chapter on the pregnant patient with liver disease is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. The author describes the features of liver diseases unique to pregnancy and briefly discusses the pregnant patient with viral hepatitis. Evaluation of pregnant patients with abnormal liver test results is similar to that of nonpregnant patients suspected of having liver disease; however, attention to the stage of pregnancy and the obstetric history is important. Diseases discussed include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, pregnancy induced hypertension (high blood pressure, previously called preeclampsia), HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), acute fatty liver of pregnancy, hepatic rupture, and viral hepatitis. In each section, the author reviews the epidemiology and risk factors, the pathogenesis, the clinical features, maternal and fetal outcome, and patient care management. 2 figures. 7 tables. 17 references.

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Carbohydrate, Lipid, and Amino Acid Metabolism in the Nonpregnant Patient Source: in Reece, E.A. Coustan, D.R., eds. Diabetes Mellitus in Pregnancy. 2nd ed. New York, NY: Churchill Livingstone. 1995. p. 35-58. Contact: Available from Churchill Livingstone. 300 Lighting Way, Secaucus, NJ 07094. (800) 553-5426. PRICE: $92.00. ISBN: 0443089795. Summary: This chapter, from a medical textbook on diabetes mellitus in pregnancy, describes carbohydrate, lipid, and amino acid metabolism in the nonpregnant patient. The authors introduce the chapter with a discussion of insulin secretion and insulin resistance in diabetes and the metabolic effects of insulin. They go on to discuss body fuel metabolism in normal subjects, including the postabsorptive state, metabolic adaptation during short-term starvation, exercise, glucose ingestion, protein ingestion, fat metabolism, and the role of gender in glucose homeostasis. The next section describes body fuel metabolism in individuals with diabetes, covering the same topics plus glucose counterregulation, the effect of intensive insulin therapy on body fuel metabolism, and the role of insulin-like growth factor 1 (IGF-1) deficiency. The authors reiterate that insulin's critical role in the pathophysiology of diabetes derives from its central role in regulating the storage and release of metabolic fuels, namely, glucose, fat, and amino acids. 15 figures. 4 tables. 105 references.

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Preeclampsia in Pregnant Women with Chronic Hypertension and Renal Disease Source: Belfort, M.A. Thornton, S. Saade, G.R., eds. Hypertension in Pregnancy. Monticello, NY: Marcel Dekker, Inc. 2003. p.117-139. Contact: Available from Marcel Dekker, Inc. P.O. Box 5005, Monticello, NY 12701-5185. (800) 228-1160 or (212) 696-9000. Fax (845) 796-1772. E-mail: [email protected].

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Website: www.dekker.com. ISBN: 082470827X. PRICE: $000.00 plus shipping and handling. Summary: Preeclampsia (acute hypertension, proteinuria, and edema) is an important cause of maternal and fetal morbidity (complications) and mortality (death), complicating 5 to 10 percent of all pregnancies. This chapter on preeclampsia in pregnant women with chronic hypertension and renal (kidney) disease is from a textbook on hypertension (high blood pressure) in pregnancy. The authors note that there are major diagnostic difficulties in distinguishing preeclampsia, chronic hypertension, renal disease, and combinations of these separate entities. The chapter focuses on defining hypertension in pregnancy in relation to preexisting pathology, identifying the pitfalls in the detection and diagnosis of preeclampsia in women with chronic hypertension or renal disease (or both), and highlighting the controversies surrounding the prenatal care and obstetric problems in these women. 1 figure. 7 tables. 104 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to pregnancy have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 •

Alcohol, tobacco, and other drugs resource guide: Teenage pregnancy Source: Rockville, MD: Center for Substance Abuse Prevention, U.S. Department of Health and Human Services. 1993. 18 pp. Contact: Available from National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345. Telephone: (301) 468-2600 or (800) 729-6686 or (800) 487-4889 TDD / fax: (301) 468-6433 / e-mail: [email protected] / Web site: http://www.health.org. Available at no charge. Summary: This annotated bibliography lists materials focusing on preventing the use of alcohol and other drugs by pregnant adolescents; it was assembled for the use of health professionals. The entries include terms of availability, and information on the format, length, topic, target audience, setting, readability, and annotations; citations are given for print and audiovisual materials. A resource list of groups, programs, and organizations working on adolescent pregnancy is also included.

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Substance abuse treatment programs for pregnant and parenting women: A program guide Source: Chicago, IL: National Center on Child Abuse Prevention Research. 1992. 25 pp. Contact: Available from National Center on Child Abuse Prevention Research, National Committee for Prevention of Child Abuse, 332 South Michigan Avenue, Suite 1600, Chicago, IL 60604. Telephone: (312) 663-3520. $2.00.

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

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Summary: This guide provides information about current publicly-funded substance abuse programs specifically for pregnant or parenting women, in 16 states which responded to a survey. •

Directory of drug and alcohol abuse treatment services for pregnant women in Rhode Island Source: Providence, RI: Rhode Island Department of Health. 1990. 10 pp. Contact: Available from Tricia Leddy, Program Director, Rhode Island Department of Health, RIte Start, Cannon Building, Room 302, 75 Davis Street, Providence, RI 02908. Telephone: (800) 346-1004. Available at no charge. Request publication by mail only. Summary: The purpose of this directory is to assist maternity care providers in referring pregnant women to the appropriate drug and/or alcohol treatment program in Rhode Island. This directory was developed by the RIte Start Program, Rhode Island Department of Health, with information from the Division of Substance Abuse in the Rhode Island Department of Mental Health, Retardation and Hospitals, and the Rhode Island Council on Alcoholism. The RIte Start Program provides comprehensive maternity care for uninsured women, living in Rhode Island, who are not eligible for medical assistance and who meet income guidelines.

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Guide to California state resources for school-based pregnant and parenting teen programs Source: Sacramento, CA: California State Department of Education. 1990. 58 pp. Contact: Available from Jenny Wilson, Employment Training Network, 560 J Street, Room 385, Sacramento, CA 95814. Telephone: (916) 323-8054. $10.00. Summary: This directory provides information on state agency programs in California providing services solely targeting pregnant and lactating students and supplemental services (Home Economics) which enroll pregnant and parenting adolescents as well as other students. The directory was developed for administrators, educators, school-based program staff, and others who are interested in state agency level program information. It provides a listing of California State Department of Education programs, resource centers, other state agency programs, and related coalitions and committees.

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Prevention of perinatal substance use: Pregnant and Postpartum Women and Their Infants Demonstration Grant Program: Abstracts of active projects, FY 19__ Source: Arlington, VA: National Center for Education in Maternal and Child Health. 1993-. annual. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524- 9335 / e-mail: [email protected] / Web site: http://www.ncemch.org. Available for loan. Summary: This directory describes all 147 demonstration grant projects funded under the Pregnant and Postpartum Women and Their Infants initiative. This program focuses on the development of innovative, community-based models of drug prevention, education, and/or treatment. Most of the projects also provide direct services such as case management, parenting classes, and referrals to drug and alcohol programs. Many of these model programs have developed outreach strategies and community networks of providers. Numerous projects are also involved in training providers and offering

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prevention education at the community level. [Funded by the Maternal and Child Health Bureau]. •

Did you know: Help is available with the costs of health care for pregnant women and children with special health needs: A guide to the funding sources that will pay for medical services Source: Charleston, WV: Office of Maternal and Child Health, West Virginia Department of Health and Human Resources. n.d. 73 pp. Contact: Available from West Virginia Department of Health and Human Resources, Office of Maternal and Child Health, 1411 Virginia Street, East, Charleston, WV 25301. Telephone: (304) 558-0030 / fax: (304) 558-2183. Single copies available at no charge. Summary: This directory identifies programs administered by the West Virginia state government that provide financial support for pregnant women and children with special health needs; it is for the use of intermediaries that assist families find financial assistance. The entries are arranged topically under the administering agency; each provides an overview of the types of services provided and contact information. Services described include: EPSDT, pediatric health services, the early intervention project, the Right from the Start Project, Medicaid, and Supplemental Security Income for Children with Disabilities, among others. Other chapters address common questions about billing and support services for families of children with special needs.

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CHAPTER 8. MULTIMEDIA ON PREGNANCY Overview In this chapter, we show you how to keep current on multimedia sources of information on pregnancy. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on pregnancy is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “pregnancy” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, 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 “Videorecording (videotape, videocassette, etc.).” Type “pregnancy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on pregnancy: •

Project SNAPP: Skills and Knowledge for AIDS and Pregnancy Prevention for the Middle Grades Contact: Education Training and Research Associates, PO Box 1830, Santa Cruz, CA, 95061-1830, (800) 321-4407, http://www.etr.org. Summary: This is an eight-session pregnancy- and HIV-prevention curriculum targeted to seventh-grade students. The curriculum uses a variety of interactive methods to provide information about HIV and pregnancy and allows students to practice communication, refusal. and negotiation skills. Each session is approximately 45 minutes long and based on theories of social learning. The primary goal of the curriculum is to prevent unintended pregnancy and HIV infection among participating students. In the initial sessions multiple activities are used to enable students to explore the risks and consequences of adolescent sex and pregnancy. Students are then asked to make an anonymous decision about what is best for them in terms of sexual behavior. Finally students learn additional skills to help them overcome identified barriers.

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Contraceptive methods are displayed and discussed and community-based resources for health and social services are offered. A videotape accompanies the curriculum. •

At Issue Straight Talk: Teen Sexuality, Pregnancy, and AIDS Contact: League of Women Voters of Bucks County, 123 S Main St, Doylestown, PA, 18901, (215) 230-9986. Summary: In this videorecording, adolescents at several Bucks County, PA high schools were interviewed and expressed their perceptions on sexuality and adolescent sexual behavior, in particular. They emphasize that teens are sexually active and that ignoring that fact will hinder any educational efforts in sex education. The teens discussed their and their peers risk behaviors; smoking, drinking alcohol and using drugs, and participating in sexual intercourse in the context of the "immortality myth" or the belief that nothing bad will ever happen to them. The video also provides information about HIV-infection in the adolescent population. The video concludes with recommendations from the adolescents themselves: 1) better communication between parent and adolescent; 2) earlier and more comprehensive education; and 3) more responsible behaviors by the adolescents.

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Ignoring the Risks: Teenage Pregnancy and AIDS Contact: Films for the Humanities and Sciences, PO Box 2053, Princeton, NJ, 08543, (800) 257-5126. Summary: This videorecording contains an edited version of "The Phil Donahue Show" that addresses the problems of adolescent pregnancy and HIV. It consists of interviews with six young adolescents who are pregnant or who have recently become mothers, and, in two cases, their boyfriends and the fathers-to-be. The young women discuss their unique circumstances and their plans for the future. One young mother reveals that she is HIV-positive, that her first child is negative, but that she does not know about her infant. Statistics are presented on the incidence of HIV infection in adolescents.

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Women and HIV: Pregnancy and Beyond Contact: New York University, New York - Caribe AIDS/SIDA, AIDS Mental Health Project, 532 Shimkin Hall, 50 W 4th St, New York, NY, 10003, (212) 998-5330. Summary: This videotape is an educational program for health care providers on women who are pregnant and HIV positive. Practitioners from three inner city New York, NY, hospitals discuss their experiences, present approaches to working with HIVinfected women, and provide strategies for working with their colleagues in the health delivery system. Eight areas of concern are presented in the videotape: patient trust, drug abuse and sexual practices, HIV antibody testing, social work services, elective termination, drug abuse rehabilitation, medical management, and postnatal considerations. A discussion guide is included.

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Beverly's Story: Pregnancy and the Test for the AIDS Virus Contact: New York Department of Health, Public Affairs Group, Bureau of Community Relations, PO Box 2000, Albany, NY, 12220-2000, (518) 474-5370, http://www.health.state.ny.us. Summary: This videorecording urges women who are pregnant or considering getting pregnant to get tested for the Human immunodeficiency virus (HIV). It stresses the risks of HIV transmission from sex partners who are drug abusers and share IV needles. It

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also portrays the fears that women experience regarding testing and how counseling allays them. Safer sexual conduct, particularly monogamy, is advocated. •

Smoking, Pregnancy and Babies: Just the Facts Source: St. Louis, MO: SIDS Resources, Inc. 1998. Contact: Available from SIDS Resources, Inc., 143 Grand Avenue, St. Louis, MO 63122. (314) 822-2323, (800) 421-3511, (314) 822-2098 (Fax), [email protected] (Email), http://www.sidsresources.org (Web Site). $25.00 plus $3.00 shipping and handling. Summary: This video presents a talk by Dr. Laura Hillman of SIDS Resources, Inc. on the adverse effects of smoking during and after pregnancy. Smoking can cause prematurity, low birthweight, and many respiratory problems in infants. In addition, smoking greatly increases the risk of sudden infant death syndrome. Hillman recommends that expectant mothers stop smoking and that they make sure no one smokes around their baby after birth.

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Parent, it's up to you!: Oral health manual for Pregnancy, Education, and Parenting Program Source: Austin, TX: Bureau of Dental Health Services, Texas Department of Health. 1996. ca. 90 pp., 3 videotapes (VHS 1/2 inch). Contact: Available from Sandra Tesch, R.D.H., M.S.H.P., Texas Department of Health, Bureau of Dental Health Services, 1110 West 49th Street, Austin, TX 78756-3199. Telephone: (512) 458-7323 / fax: (512) 458-7249 / e- mail: [email protected] / Web site: http://www.tdh.state.tx.us. Available at no charge; written requests only. Summary: This teaching guide is designed for use with adolescent parents enrolled in the Pregnancy, Education, and Parenting Program in schools in Texas. The guide covers the skills needed by the students to assure their personal oral hygiene and that of their children. Each lesson plan includes background materials and instructions for teaching the class. Three lessons cover the mother's health during the prenatal and perinatal period and the oral health of infants and preschool-age children. The guide also includes resource materials, transparency masters, and the videotapes Looking to Keep Decay Away and Healthy Teeth: A Guide for Parents of Pre-Schoolers. The videotapes are provided in English and Spanish.

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Pregnancy at time of diagnosis Source: New York, NY: Patient Education Media, Time Life Medical. 1996. 1 videotape (VHS, color, 30 minutes), 1 booklet (21 pp.). Contact: Available from Available in pharmacies nationwide. Telephone: (800) 588-9959. $19.95. Summary: This videotape and consumer booklet (called a personal workbook) comprise one of a series of educational materials on health topics developed by Time Life Medical under the direction of C. Everett Koop. The videotape presents a news magazine-style educational program for patients and families. The personal workbook gives highlights of the program, resources for additional information, and blank pages for the consumer's personal medical journal. Topics in the videotape include understanding the diagnosis, what happens next, treatment and management, and issues and answers.

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This package covers how pregnancy occurs, development of the embryo, prenatal tests, prenatal care, and other topics. •

University of Minnesota instructional video: Nutrition for adolescent pregnancy Source: Minneapolis, MN: Division of Epidemiology, University of Minnesota. 1996. 2 videotapes (VHS, 1/2 inch, 17:32 minutes and 15:49 minutes). Contact: Available from Margie Konopliv, University of Minnesota, Public Health Nutrition, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015. Telephone: (612) 626-7933 / fax: (612) 624-0315 / e-mail: [email protected]. $30.00 includes shipping and handling; prepayment required. Summary: These videotapes give nutrition information for pregnant adolescent girls. One, called Nutrition for Adolescent Pregnancy, is aimed at healthcare personnel, and nutrition and dietetics students. It is accompanied by a 3-page teaching guide. The other, called Hey Baby, is to be shown to the adolescents.

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Baby to be: The video guide to pregnancy Source: [Santa Barbara, CA]: Poly Health Media. 1996. 1 videotape (55 minutes, VHS 1/2 in.). Contact: Available from Alvin Fiering, Poly Health Media, 2766 Puesta Del Sol, Santa Barbara, CA 93105. Telephone: (805) 569-8784 / fax: (805) 682-2826 / e-mail: [email protected]. $24.95 plus $4.00 shipping and handling. Summary: This videotape presents information on managing the discomforts of pregnancy, as well as offering emotional reassurance and support. Its 10 chapters explain how to have a healthy pregnancy including prenatal care, the growing baby, body changes, eating for two, safety, fitness, enjoying pregnancy, dads, calling the doctor, and taking care of yourself. A poster guide with space for emergency phone numbers and an on-screen index for quickly finding information accompany the videotape. The videotape is also available in Spanish.

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HIV, pregnancy and AZT: Your health, your baby, your decision Source: Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services. 1995. 1 videotape (9:45 minutes, VHS 1/2 inch), 1 audiocassette (8:00 minutes). Contact: Available from HIV/AIDS Treatment Information Service, P.O. Box 6303, Rockville, MD 20849. Telephone: (800) 448-0440 or (800) 243-7012 TTY / fax: (703) 8212098. Summary: This item is available as an audiocassette or a videotape; it provides information about the efficacy of using AZT with women who are pregnant and who have HIV. The patient education materials are available in Spanish and English. In Spanish, the title is 'VIH, el embarazo y AZT: Su salud, su bebe, su decision.' Much of the information is based on work performed by the Northern Manhattan Women and Children HIV Demonstration Project at the School of Public Health, Columbia University, which was funded by the Maternal and Child Health Bureau.

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A pregnancy and HIV prevention curriculum for middle school students Source: Los Angeles, CA: Division of Adolescent Medicine, Children's Hospital Los Angeles. 1994. 1 curriculum (88 pp.), 1 videotape (13:25 minutes, VHS 1/2 inch).

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Contact: Available from Customer Service, ETR Associates , P.O. Box 1830, Santa Cruz, CA 95061-1830. Telephone: (831) 438-4060 or (800) 321-4407 / fax: (831) 438-4284 / Web site: http://www.etr.org. $45.00 plus $4.50 shipping and handling; prepayment required. Summary: This teaching guide contains an eight session curriculum and a videotape that focus on pregnancy and HIV prevention for use with adolescents in middle schools. The curriculum provides the rationale for its development, enumerates its goals and objectives, includes an overview, and suggests ways to use the curriculum. It includes outlines, suggestions, and materials for each session. The topics covered include an introduction to pregnancy and HIV; the risks and realities of pregnancy and HIV; overcoming social, media, and peer pressure to have sex; sexual decision-making and norms; abstinence; protective behaviors; and resources and referrals within the community. The videotape includes role playing scenarios that focus on peer pressure and sexual decision-making. The curriculum was developed for Project SNAPP: Skills and kNowledge for AIDS and Pregnancy Prevention. •

Pregnancy, birth and you Source: Lafayette, CA: D.R. Press. 1992. 97 pp. Contact: Available from Linda B. Jenkins, R.N., D. R. Press, Nine Cabernet Court, Lafayette, CA 94549. Telephone: (510) 284-2220 / fax: (510) 284-5446. $12.95, bulk discounts for 10 or more copies; first two videos $75 each plus $5 handling per video, third video $150 plus $5 handling; all three videos $275 plus $10 handling. Summary: This guide to pregnancy answers practical questions about labor, delivery, and Lamaze breathing techniques, as well as intimacy during pregnancy and parentinfant bonding. Ideally the book would be used in conjunction with a prepared childbirth class; however, an expectant mother without access to a class would be able to use this manual as a self help tool. It is available in English and Spanish. Three videotapes in Spanish are also available. 'Practicando Para Dar La Luz' (Practicing for Birth) features three Hispanic couples being given instructions in relaxation, breathing and pushing. 'Durante el Parto' (During Labor and Delivery) deals with medication used in labor and delivery, fetal monitoring, forceps, cesarean sections and vacuum extractors. 'Dar a Luz con Amor' (Giving Birth with Love) shows an office prenatal care visit and support from the family for the laboring woman.

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Alcohol and pregnancy: Fetal alcohol syndrome and fetal alcohol effects Source: Chatsworth, CA: AIMS Media. 1992. 1 videotape (20 minutes), 1 flyer (1 p.). Contact: Available from AIMS Media, 9710 DeSoto Avenue, Chatsworth, CA 913114409. Telephone: (800) 367-2467 / fax: (818) 341-6700. $295, rental $75, previews available at no charge. Summary: This videotape is intended to be a tool for the prevention of fetal alcohol syndrome/fetal alcohol effects. It covers physical, mental, and behavioral abnormalities of children who have fetal alcohol syndrome or fetal alcohol effects. It briefly covers ways in which alcohol causes such abnormalities; and, at the end, strongly advises against alcohol intake during pregnancy. It includes numerous interviews and photographs of affected children that serve to illustrate the range and extent of abnormalities. For some of these, the caregiver (usually accompanied by the child) or affected child describes the child's problems. Two women tell about the adverse effects of their drinking during pregnancy; both are African American. After the first one

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admits that she didn't know that what she was doing was harmful, a warning label is displayed with audio indicating that information about the danger is right on the label of all alcoholic beverages. Other than advice to say 'No' to alcohol for the sake of the baby, methods of dealing with an alcohol problem are not addressed. The videotape is intended for high school to adult audiences. •

Drugs, alcohol, and pregnancy: What you should know Source: Pleasantville, NY: Human Relations Media. 1992. 1 videotape (25 minutes, VHS), 1 booklet (25 pp.). Contact: Available from HRM Video, 175 Tompkins Avenue, Pleasantville, NY 10570. Telephone: (800) 431-2050 or (914) 769-7496. $189.00 plus five percent shipping and handling. Summary: This videotape discusses the effects of substance abuse during pregnancy including undersized, unresponsive babies with nerve damage, seizures, deformities, impaired motor skills, and behavior and learning disabilities. The program details the toxic consequences of drugs on the fetus, including cocaine, nicotine, marijuana, and over-the-counter drugs, such as cold remedies, sleep aids, laxatives, and acutane. The program also includes a visit to a high school with a question and answer session. Many of the students' misconceptions are addressed and students are told about the basics of proper nutrition, rest, and exercise for expectant mothers.

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Discovering the child within: A workbook on abuse during pregnancy Source: Cobourg, Ontario: Northumberland Services for Women. 1992. 90 pp., 1 videotape (30 minutes). Contact: Available from Northumberland Services for Women, P.O. Box 935, Cobourg, Ontario, Canada K9A 4W4. Telephone: (905) 372-0746 / fax: (905) 373-4800. $75.00. Summary: Written for women who were battered during pregnancy and for people who work with battered women, this workbook offers step-by-step information for forming a support group and week-by -week suggestions of activities; facts, statistics and legal information about abuse; and suggestions for professionals helping abused women. The workbook includes the personal stories of formerly battered women throughout. It also offers sample forms for support groups and a directory of women's shelters in Canada. It is accompanied by a videotape.

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Project future: Teenage pregnancy, childbirth and parenting Source: Cambridge, MA: Vida Health Communications. 1991. 6 videotapes (VHS 1/2 inch), 1 brochure (2 pp.). Contact: Available from Vida Health Communications, Six Bigelow Street, Cambridge, MA 02139. Telephone: (617) 864-4334. One program $275.00 plus $5.00 shipping and handling, two programs $395.00 plus $7.00 shipping and handling, three programs $595.00 plus $9.00 shipping and handling. Summary: This videotape series was developed as a teaching aid for use by educators and health care professionals working with pregnant and parenting adolescents in hospitals, clinics, high schools, social service agencies, and alternative programs. It follows the lives of 12 adolescent males and females during pregnancy and through the first three months of parenthood. These adolescents tackle the challenging problems confronting all adolescent parents and serve as departure points for introducing

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practical information about pregnancy, parenting, and future family planning. Topics discussed include prenatal care; general health during pregnancy; emotional, social, and practical life issues surrounding pregnancy; a guide through labor and delivery documenting an uncomplicated vaginal birth and a planned Cesarean delivery; an overview of essential parenting skills; and the changes and challenges following birth. •

Teen pregnancy: Children having children Source: Seattle, WA: Intermedia. n.d. 1 videotape (25 minutes, VHS 1/2 inch). Contact: Available from Intermedia, 1300 Dexter Avenue North, Seattle, WA 98109. Telephone: (800) 553-8336 or (206) 284-2995. $195.00. Summary: This videotape provides a prevention-education program dealing with adolescent pregnancy. Aimed at making adolescents realize the consequences of sexual activity, young people who have experienced adolescent pregnancy firsthand share their stories with the audience. Television personalities, public health professionals, as well as counselors, are used to impress upon adolescents the importance of considering the possible outcomes related to sexual activity. The program makes a strong plea for abstinence, but reinforces the need for contraception if one chooses to be sexually active.

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Pregnancy: It'll never happen to me Source: Grand Junction, CO: Young Parents' Program, Resource Center. n.d. 1 videotape (26 minutes, VHS 1/2 inch), 1 guide (75 pp.). Contact: Available from Young Parents' Program, Resource Center, 1129 Colorado Avenue, Grand Junction, CO 81501. Telephone: (970) 243-0190. $43.95 includes shipping and handling. Summary: This videotape and the corresponding teacher's guide are designed to be used with adolescents to encourage them to think about the impact that an adolescent pregnancy will have on their lives. The teacher's guide describes the course organization, includes lesson plans, and a glossary and list of resources. Topics covered include medical risks involved in pregnancy, pregnancy prevention, economic ramifications of adolescent pregnancy, the role of the adolescent father, adolescent development, and refusal skills.

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Pregnancy Source: Oakland, CA: Oakland Healthy Start, and Studio Three, Samuel Merritt College. n.d. 1 videocassette (11:12 minutes, VHS 1/2 inches). Contact: Available from Francell K. Haskins, Oakland Healthy Start, 1850 Fairway Drive, San Leandro, CA 94577. Telephone: (510) 618-3452 / fax: (510) 483-6038. Available at no charge. Summary: This parent education videotape provides information on physical changes of pregnancy, medical tests, and preparing the home before the baby's arrival. Also included is advice on maintaining good health and eating nutritional foods during the pregnancy. [Funded by the Maternal and Child Health Bureau].

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She's pregnant and she's a junkie Source: New York, NY: Select Media. 1993. 1 videotape (43 minutes).

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Contact: Available from Select Media, 225 Lafayette Street, Suite 1102, New York, NY 10012. Telephone: (212) 431-8923 / fax: 212-431-8946. $165.00 plus $10.00 shipping and handling. Summary: This videotape documents the lives of three pregnant drug addicts and the support network of care providers and family members who treat them and their newborns. It raises the complex issues and challenges of meeting the health, social, and educational needs of drug-affected families. The videotape was developed for general audiences and professionals involved with substance abuse rehabilitation, prevention, and treatment. •

For baby's sake: The challenges of being pregnant in the 90s Source: Sherman Oaks, CA: BEST Foundation for a Drug-Free Tomorrow. 1992-1993. 2 videotapes (VHS 1/2 inch, 24 minutes), 2 booklets, 12 pp.), 1 teaching guide (41 pp.). Contact: Available from BEST Foundation for a Drug-Free Tomorrow, 13701 Riverside Drive, Suite 700, Sherman Oaks , CA 91423. Telephone: (800) 421-5055. Summary: This videorecording and teaching guide are part of a program designed to stress to expectant mothers and their partners the importance of developing a sound health care plan during pregnancy with an emphasis on avoiding drugs and alcohol and proper nutrition. The videorecording explains how to prepare for a healthy baby by eating the correct foods and avoiding behaviors which could be harmful to the growing fetus. The teaching guide provide instructors with an outline of key ideas, lesson plans and activities, creative homework ideas, and a list of resources for further guidance. An accompanying appendix provides materials for the activities and worksheets with keys.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, 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 “Sound Recordings.” Type “pregnancy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on pregnancy: •

Listen Carefully Contact: Emory University, School of Medicine, Department of Gynecology/Obstetrics, 1462 Clifton Rd, Atlanta, GA, 30322, (404) 589-3556. Summary: This cassette contains information in a question-and-answer format about birth control pills and other forms of contraception. Special instructions for beginning oral contraceptives are given, as well as instructions on steps to be taken if pills are missed. Side effects and danger signs are also explained. While oral contraceptives are effective in preventing pregnancy, condoms are urged as an effective means of preventing sexually transmitted diseases (STD's), including HIV and AIDS.

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AIDS and the Internist -- Part II Contact: California Medical Association, Audio Digest Foundation, 1577 E Chevy Chase Dr, Glendale, CA, 91206, (213) 245-8505.

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Summary: This sound recording contains the transcripts of talks in the second part of the program on the role of the internist in managing patients with HIV infection. In this segment, Dr. Constance Wofsy discusses the epidemiology and concerns of HIV infection in women. Transmission and diagnosis are examined; gynecological issues and pregnancy are explored. Dr. Harry Hollander discusses neurological syndromes and dementia in HIV disease. He presents information on AIDS dementia complex, progressive multifocal leukoencephalopathy, toxoplasmosis, cerebral ischemia, vacuolar myelopathy, tropical spastic parapesis and CMV polyradiculopathy. Meningitis and HIV-related neuropathies are also discussed. •

AIDS and HIV in Obstetrics and Gynecology Contact: California Medical Association, Audio Digest Foundation, 1577 E Chevy Chase Dr, Glendale, CA, 91206, (213) 245-8505. Summary: This sound recording contains the transcripts of speeches given to educate physicians on HIV and AIDS patient management in obstetrics and gynecology. Dr. Constance Wofsy discusses statistics on an AIDS diagnosis in women; transmission risks; and the predominant clinical manifestations of HIV infection in women. Dr. Mary Jo O'Sullivan of the University of Miami School of Medicine and Dr. Sebastian Faro of the Baylor School of Medicine discuss HIV and AIDS in the obstetric patient; presenting diseases and screening, laboratory evaluation, patient management; perinatal transmission and prognosis for the infected infant. Counseling for the pregnant pateint is also expressed. Dr. Donna E. Sweet considers risk factors indicating testing, factors increasing risk of transmission to the neonate, the administration of azidothymidine (AZT) in pregnancy, progression to AIDS, and treatment goals.

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Babies: Drugs, Alcohol, & AIDS Contact: Sunrise Media, 96 Inverness Dr E, Englewood, CO, 80112, (303) 792-3822. Summary: This sound recording offers a panel discussion dealing with problems involving mothers who are dependent on drugs or alcohol during pregnancy and after their babies are born. A growing number of these women are infected with the Human immunodeficiency virus (HIV), which they may pass on to their infants. The first speaker is an attorney, who analyzes the legal problems such mothers may face in retaining custody of their children. They also face grave difficulties finding treatment programs which will accept them, and child care to attend any they do find. Poor and Black women are the ones who most frequently lose custody of their children. The next two speakers are legislators who discuss new treatment approaches for such women and their children. Innovative funding for such programs is also examined.

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

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Colorado PRAMS. surveillance report Pregnancy Risk Assessment Monitoring System. Year: 9999; Denver, Colo.: Colorado Department of Public Health and Environment, Center for Health and Environmental Information and Statistics, Health Statistics Section, 2000-

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Conservative management of tubal pregnancy [motion picture] Source: a Billy Burke production; presented by Southern California Permanente Medical Group and Kaiser Foundation Hospitals, Los Angeles; by Jack Godfrey Hallatt; Year: 1967; Format: Motion picture; United States: The Group and The Hospitals, [1967]

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Diabetes in pregnancy [videorecording] Source: Academy of Health Sciences; Year: 1973; Format: Videorecording; Fort Sam Houston, Tex.: The Academy, [1973]

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Hematologic problems in pregnancy [videorecording] Source: Emory University School of Medicine; Year: 1973; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network, [1973]

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

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Medical complications of pregnancy [sound recording] Source: American College of Obstetricians and Gynecologists; produced by Audio-Digest Foundation; Year: 1974; Format: Sound recording; Chicago: The College; [Glendale, Calif.: for sale by AudioDigest Foundation], p1974

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Pregnancy, birth and the newborn [filmstrip] Source: Concept Media; Year: 1973; Format: Filmstrip; Costa Mesa, Calif.: Concept Media, c1973

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Radical operation for carcinoma of the vulva during pregnancy [motion picture] Source: Denis Cavanagh, Hervy E. Averette, Allan G. W. McLeod; produced by A-V Corporation; Year: 1967; Format: Motion picture; [Norwich, N. Y.: Eaton: [for loan by Norwich-Eaton Pharmaceuticals, Film Library], 1967]

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Toxemia of pregnancy [motion picture] Source: produced by Mervin W. La Rue, Inc. produced under the auspices of Irwin, Neisler & Company; by N.S. Assali, S.T. Garber, R.D. Bryant; Year: 1952; Format: Motion picture; United States: The Company, 1952

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CHAPTER 9. PERIODICALS AND NEWS ON PREGNANCY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover pregnancy.

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

Second HIV test during late pregnancy a cost-effective intervention Source: Reuters Industry Breifing Date: October 03, 2003 http://www.reutershealth.com/archive/2003/10/03/business/links/20031003publ001 .html

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UK warns about prescribing sodium valproate in pregnancy Source: Reuters Industry Breifing Date: September 30, 2003

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Maternal hypothyroxinemia during pregnancy delays infant neurodevelopment Source: Reuters Medical News Date: September 25, 2003

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Ginseng use during pregnancy may hurt baby Source: Reuters Health eLine Date: September 25, 2003

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Turner syndrome may confer high risk of aortic rupture during pregnancy Source: Reuters Medical News Date: September 16, 2003

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Asthma severity predicts asthma morbidity during pregnancy Source: Reuters Medical News Date: September 05, 2003

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Oral and vaginal metronidazole equally effective for vaginosis during pregnancy Source: Reuters Industry Breifing Date: August 29, 2003

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DHA use during pregnancy does not improve vision maturation in infants Source: Reuters Medical News Date: August 29, 2003

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Weight does not affect pregnancy rates in donor eggs recipients Source: Reuters Medical News Date: August 19, 2003

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Obesity doesn't hinder pregnancy with donated eggs Source: Reuters Health eLine Date: August 19, 2003

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Obesity increases risk of pregnancy complications Source: Reuters Health eLine Date: August 11, 2003

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Obese glucose-tolerant women at high risk for pregnancy complications Source: Reuters Medical News Date: August 11, 2003

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Birth problems follow short-spaced pregnancies Source: Reuters Health eLine Date: August 08, 2003

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Short interpregnancy interval tied to adverse neonatal outcomes Source: Reuters Medical News Date: August 07, 2003

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

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Bacterial vaginosis early in pregnancy a strong risk factor for preterm delivery Source: Reuters Medical News Date: August 04, 2003

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Blood test can predict diabetes during pregnancy Source: Reuters Health eLine Date: August 01, 2003

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Seatbelts reduce fetal deaths in auto accidents involving pregnant women Source: Reuters Medical News Date: July 31, 2003

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Pregnant Hong Kong women need HIV education Source: Reuters Health eLine Date: July 22, 2003

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Better HIV education needed for pregnant women in Hong Kong Source: Reuters Medical News Date: July 22, 2003

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Pre-diabetes during pregnancy affects babies Source: Reuters Health eLine Date: July 14, 2003

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Women with hypertrophic cardiomyopathy can generally tolerate pregnancy Source: Reuters Medical News Date: July 04, 2003

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Long interval between pregnancies ups stillbirth risk, but very short interval safe Source: Reuters Medical News Date: July 02, 2003

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Safe use of chemotherapy in pregnancy reported Source: Reuters Industry Breifing Date: July 01, 2003

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More evidence chemo during pregnancy can be safe Source: Reuters Health eLine Date: July 01, 2003

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Long gap between pregnancies ups stillborn risk Source: Reuters Health eLine Date: June 30, 2003

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Electrical stimulation of median nerve relieves nausea, vomiting of pregnancy Source: Reuters Industry Breifing Date: June 30, 2003

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Pregnancy safe in most women with AS, but severe disease may require surgery Source: Reuters Medical News Date: June 25, 2003

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Good breast cancer outcomes attainable in pregnant women Source: Reuters Medical News Date: June 20, 2003

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UN: Hideous pregnancy disease enveloped in silence Source: Reuters Health eLine Date: June 18, 2003

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Contraceptive implant maker targeted in Dutch court for unwanted pregnancies Source: Reuters Medical News Date: June 17, 2003

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

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Exercise may reduce risk of pregnancy complication Source: Reuters Health eLine Date: June 10, 2003

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Smoking during pregnancy affects sons' sperm count Source: Reuters Health eLine Date: June 09, 2003


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Maternal smoking during pregnancy affects sons' sperm counts Source: Reuters Medical News Date: June 09, 2003

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Inverness, Pfizer settle pregnancy test lawsuit Source: Reuters Industry Breifing Date: June 09, 2003

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Breastfeeding may counter harmful effects of smoking in pregnancy Source: Reuters Medical News Date: May 29, 2003

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Breastfeeding counters harm of smoking in pregnancy Source: Reuters Health eLine Date: May 29, 2003

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Budesonide use not tied to adverse pregnancy outcomes Source: Reuters Industry Breifing Date: May 26, 2003

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One in five women depressed during pregnancy: study Source: Reuters Health eLine Date: May 23, 2003

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Intake of mercury-containing fish during pregnancy does not harm fetus Source: Reuters Medical News Date: May 16, 2003

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Eating fish in pregnancy does not harm fetus: study Source: Reuters Health eLine Date: May 16, 2003

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Aggressive treatment indicated for drug-resistant TB during pregnancy Source: Reuters Medical News Date: May 16, 2003

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Pregnant teens' dairy intake affects fetal bones Source: Reuters Health eLine Date: May 08, 2003 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

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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 “pregnancy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “pregnancy” (or synonyms). If you know the name of a company that is relevant to pregnancy, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. 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 “pregnancy” (or synonyms).

Newsletters on Pregnancy Find newsletters on pregnancy 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 “pregnancy.” 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 “pregnancy” (or synonyms) into the “For these words:” box. The following list was generated using the options described above:


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IBD Should Not Be Deciding Factor in Pregnancy Source: Crohn's and Colitis Foundation of America, Inc., CCFA News. p. 2. Summer 1992. Contact: Available from CCFA. Greater Washington D.C. Chapter, 901 King Street, Suite 101-A, Alexandria, VA 22314. (703) 739-2548. Summary: A large percentage of patients initially diagnosed with Crohn's disease or ulcerative colitis are in the reproductive years. This brief newsletter article stresses that recent reports are relatively favorable regarding the effects of pregnancy on inflammatory bowel disease (IBD). The author also considers whether IBD adversely affects the outcome of the pregnancy and provides information about drug therapy for IBD during pregnancy.

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Adolescent pregnancy prevention in the South: Newsletter Source: Washington, DC: Southern Center on Adolescent Pregnancy Prevention. 1993 -. quarterly?. Contact: Available from Southern Center on Adolescent Pregnancy Prevention, 444 North Capitol Street, N.W., Suite 200, Washington, DC 20001. Telephone: (202) 624-5897. Summary: This newsletter provides information about pregnancy prevention programs and services available in the Southern United States. Each issue also provides statistics on various aspects of the adolescent pregnancy problem in the South.

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A young mother's guide to pregnancy and parenting Source: Prospect, KY: Care Comm. 1994. 19 pp. Contact: Available from Mary Anne Arnold, Care Comm, 2901 Wayzata Boulevard, Minneapolis, MN 554052. Telephone: (502) 228-4650 or (800) 328-4650 / fax: (502) 2282187 / e-mail: Care C [email protected]. Contact publisher for cost information. Summary: This newsletter lets pregnant adolescent girls know what they can expect during pregnancy, labor, and delivery. It also lets them learn about prenatal health and how to best care for themselves before delivery. Newborn care basics and parenting skills that help prevent child abuse and neglect after birth are also mentioned in the newsletter.

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Disability, pregnancy and parenthood international: A forum for professionals and parents to exchange information and experience Source: London, England: Arrowhead Publications. 1993-. quarterly. Contact: Available from Arrowhead Publications, 51 Thames Village, London W4 3UF , UK. Sterling 20 pounds if ordering in the UK; 25 pounds if ordering outside the UK. Summary: This newsletter is designed for those interested in promoting better awareness and support for persons with disabilities in pregnancy and parenthood. It provides information on pioneering projects, new research, books and audiovisual materials, and the expertise and experience of parents with disabilities.

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PPT express: A newsletter for teachers and others working with pregnant and parenting teens Source: Buena Park, CA: Morning Glory Press. 1991-. quarterly.

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Contact: Available from Morning Glory Press, 6595 San Haroldo Way, Buena Park, CA 90620-3748. Telephone: (714) 828-1998 / fax: (714) 828-2049. One year subscription $15.00, two year subscription $25.00, $4.00 past issues. Summary: This quarterly newsletter features relevant book reviews; national legislative updates; upcoming conferences; model curriculum, program ideas, and evaluations; a reader's write-in column answering questions; resource updates from Morning Glory Press and other publishers; and case studies.

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 “pregnancy” (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 pregnancy: •

Lupus and Pregnancy: Can They Go Together? Source: Lupus News. 20(5): 8-11. Winter 2000. Contact: Available from Lupus Foundation of America. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-9292. Fax (301) 670-9486. Website: www.lupus.org/lupus. Summary: This newsletter article uses a question and answer format to provide women who have lupus with information on managing a pregnancy. Lupus is more common among women than men, and it is often diagnosed during the childbearing years. Therefore, women with lupus are faced with the difficult decision of whether or not to become pregnant. Most women who have lupus can have successful pregnancies. One of the most common questions women who have lupus ask is how pregnancy will affect their lupus. Although recent studies show that lupus flares are common in pregnancy, most are mild or moderate and are manageable. Women who have lupus nephritis appear to be at more risk during pregnancy than women without kidney disease, and recent studies support this observation. However, most women with lupus nephritis, particularly women with well controlled lupus nephritis, have a satisfactory pregnancy outcome. Another issue of concern to women with lupus is how it will affect them and their baby during pregnancy. Pregnancy loss is one complication. Women who have antiphospholipid syndrome are at particular risk for pregnancy loss. Preeclampsia is a common complication in all pregnancies, but some patients with lupus are at greater risk for this complication than others, including women using steroids, women with kidney damage, and women with lupus nephritis. Other complications that women or their baby may experience include preterm birth, fetal growth impairment, and neonatal lupus erythematosus. Women with lupus may also be concerned about the effect of the drugs used to treat lupus on their pregnancy. Drugs that may safely be used to treat lupus during pregnancy are glucocorticoids. A final issue of concern to women with lupus is prenatal care. The article offers guidelines for prepregnancy, prenatal, and postnatal care and care during labor and delivery.


•

Antirheumatic Drug Therapy During Pregnancy Source: Bulletin on the Rheumatic Diseases. 46(2):2-4; April 1997. Contact: Arthritis Foundation. 1330 West Peachtree Street, Atlanta GA 30309. (404) 8727100. Fax (404) 872-9559. Summary: This newsletter article for health professionals discusses the pharmacologic management of rheumatic disease in pregnant women. The effects of various drug therapies during pregnancy are examined, focusing on aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarial drugs, sulfasalazine, gold salts, penicillamine, methotrexate, azathioprine, cyclophosphamide, and cyclosporine. The article concludes that, although drug therapy for pregnant women with active rheumatic disease is limited, low to moderate doses of corticosteroids are generally safe and effective. In addition, certain NSAIDs, hydroxychloroquine, sulfasalazine, and azathioprine may be used for severe or life-threatening disease. 11 references.

•

Antiphospholipid Antibodies and Pregnancy Problems Source: In Touch. (166):6; April 1996. Contact: East Tennessee Chapter of the Lupus Foundation of America, Inc., 5612 Kingston Pike, Suite 5, Knoxville, TN 37919. (423) 584-5215. Summary: This newsletter article for individuals with systemic lupus erythematosus (SLE) discusses the relationship between the presence of antiphospholipid antibodies in the blood of women with SLE and pregnancy problems, particularly miscarriages. Approaches that have been used to prevent pregnancy problems in pregnant SLE patients with antiphospholipid antibodies are highlighted, including taking aspirin alone, aspirin plus prednisone, aspirin plus heparin, and heparin alone. Studies on pregnancy loss in women with lupus anticoagulant and anticardiolipin antibodies and on the prevention of pregnancy loss using aspirin plus prednisone are briefly reviewed.

•

Drug Therapy for IBD During Pregnancy Source: Foundation Focus. p. 16-17. April 1997. Contact: Available from National Headquarters, Crohn's and Colitis Foundation of America. 386 Park Avenue South, New York, NY 10016-8804. (800) 932-2423 or (212) 685-3440. E-mail: [email protected]. Web site: http://www.ccfa.org. Summary: This article reviews recommendations for drug therapy for inflammatory bowel disease (IBD) during pregnancy. The authors note that the ability to get pregnant (fertility) is normal in women with ulcerative colitis (UC) and nearly normal in those with Crohn's disease. The main factor determining whether a pregnant woman with IBD will deliver a healthy baby is whether the disease is active or inactive. If the pregnant woman is experiencing a flareup of disease, she is at greater risk for miscarriage or premature delivery, and the baby is at greater risk for having a low birth weight. Emergency surgery for severe IBD during pregnancy is particularly dangerous for both the woman and the fetus. For these reasons, taking medications during pregnancy to maintain remission of IBD or to treat a flareup is recommended. Pregnant women with IBD can be safely treated with sulfasalazine and this drug can be safely continued throughout the pregnancy to maintain remission. Other drugs discussed include Asacol, Pentasa, Dipentum, and Rowasa, which all contain 5-ASA, the active ingredient in sulfasalazine; steroids; azathioprine (Imuran) and 6-mercaptopurine (Purinethol);

476 Pregnancy

methotrexate; and antibiotics. The authors provide recommendations for the use of each of these drugs before and during pregnancy, and during breastfeeding. (AA-M). •

Exercise During Pregnancy Source: Running and Fitnews. (18)11:2. November 2000. Contact: The American Running Association. 4405 East West Hwy., Number 405, Bethesda, MD 20814, 800/776-2732, www.americanrunning.org. Summary: New research evidence continues to show multiple benefits of exercise during pregnancy for both mother and baby. Benefits for the mother include improved cardiovascular function, improved mood and attitude, less weight gain, easier and less complicated labor, quicker recovery, and improved fitness. Benefits for the baby include improved stress tolerance and advanced neurobehavioral maturity. Unless there is a problem that calls for restricting activity, pregnant women should maintain prepregnancy exercise levels. The article concludes that although pregnant women should discuss exercise plans with their physician, the evidence keeps accumulating that exercise is good for both mothers and babies.

•

Pregnant Women With Lupus: The Role of Rheumatologist, Obstetrician, and Family Source: Minnesota Lupus News. 118:3-5; October/November 1996. Contact: Minnesota Chapter of the Lupus Foundation of America, Inc., International Market Square-19., 275 Market st. Minneapolis, MN 55405-1602. (612) 375-1131. Summary: This newsletter article for individuals with lupus addresses medical, social, and financial issues relevant to pregnant women with lupus. Women with lupus should discuss medical issues with their rheumatologist prior to pregnancy, including determining how to manage their lupus during pregnancy; consider social and financial issues; and prepare for the possibility of a premature birth. Women with lupus should be referred to an obstetrician with experience in managing high risk pregnancies, and they need to have a support system in place prior to delivery. Other issues that they need to consider are breast feeding and contraception.

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

477

CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for pregnancy. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with pregnancy. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

478 Pregnancy

following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to pregnancy: Acitretin •

Systemic - U.S. Brands: Soriatane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203365.html

Antidiabetic Agents, Sulfonylurea •

Systemic - U.S. Brands: Amaryl; DiaBeta; Diabinese; Dymelor; Glucotrol; Glucotrol XL; Glynase PresTab; Micronase; Orinase; Tolinase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202742.html

Antifungals, Azole •

Vaginal - U.S. Brands: FemCare; Femizol-M; Femstat 3; Gyne-Lotrimin; GyneLotrimin Combination Pack; Gyne-Lotrimin3; Gyne-Lotrimin3 Combination Pack; Miconazole-7; Monistat 1; Monistat 3; Monistat 3 Combination Pack; Monistat 5 Tampon; Monistat 7; Monistat 7 Combination Pack; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202294.html

Ascorbic Acid (Vitamin C) •

Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html

Calcium Supplements •

Systemic - U.S. Brands: Alka-Mints; Amitone; Calcarb 600; Calci-Chew; Calciday 667; Calcilac; Calci-Mix; Calcionate; Calcium 600; Calglycine; Calphosan; CalPlus; Caltrate 600; Caltrate Jr; Chooz; Citracal; Citracal Liquitabs; Dicarbosil; Gencalc 600; Liquid Cal-600; Liquid-Ca http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202108.html

Carboprost •

Systemic - U.S. Brands: Hemabate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202116.html

Choriogonadotropin Alfa •

Systemic - U.S. Brands: Ovidrel http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500249.html

Chorionic Gonadotropin •

Systemic - U.S. Brands: A.P.L. Pregnyl; Profasi http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202266.html

Clindamycin •

Vaginal - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202700.html

Researching Medications 479

Clomiphene •

Systemic - U.S. Brands: Clomid; Milophene; Serophene http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202151.html

Copper Supplements •

Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202164.html

Dinoprostone •

Cervical/Vaginal - U.S. Brands: Cervidil; Prepidil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202198.html

Estrogens and Progestins Oral Contraceptives •

Systemic - U.S. Brands: Alesse; Brevicon; Demulen 1/35; Demulen 1/50; Desogen; Estrostep; Estrostep Fe; Genora 0.5/35; Genora 1/35; Genora 1/50; Intercon 0.5/35; Intercon 1/35; Intercon 1/50; Jenest; Levlen; Levlite; Levora 0.15/30; Lo/Ovral; Loestrin 1.5/30; Loestrin 1/20; Lo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202228.html

Finasteride •

Systemic - U.S. Brands: Propecia; Proscar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202649.html

Fluoroquinolones •

Systemic - U.S. Brands: Avelox; Cipro; Cipro I.V. Floxin; Floxin I.V. Levaquin; Maxaquin; Noroxin; Penetrex; Tequin; Zagam http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202656.html

Folic Acid (Vitamin B 9 ) •

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

Follitropin Alfa •

Systemic - U.S. Brands: Gonal-F http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203454.html

Follitropin Beta •

Systemic - U.S. Brands: Follistim http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203453.html

Fructose, Dextrose, and Phosphoric Acid •

Oral - U.S. Brands: Emetrol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202251.html

Hepatitis B Vaccine Recombinant •

Systemic - U.S. Brands: Engerix-B http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202281.html

480 Pregnancy

Iron Supplements •

Systemic - U.S. Brands: DexFerrum; Femiron; Feosol; Feostat; Feostat Drops; Feratab; Fer-gen-sol; Fergon; Fer-In-Sol Capsules; Fer-In-Sol Drops; Fer-In-Sol Syrup; Fer-Iron Drops; Fero-Gradumet; Ferospace; Ferralet; Ferralet Slow Release; Ferralyn Lanacaps; Ferra-TD; Ferretts; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202305.html

Isotretinoin •

Systemic - U.S. Brands: Accutane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202309.html

Laxatives •

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.html

Lindane •

Topical - U.S. Brands: Bio-Well; GBH; G-well; Kildane; Kwell; Kwildane; Scabene; Thionex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202329.html

Magnesium Supplements •

Systemic - U.S. Brands: Almora; Chloromag; Citroma; Concentrated Phillips' Milk of Magnesia; Mag-200; Mag-L-100; Magonate; Mag-Ox 400; Mag-Tab SR; Magtrate; Maox; MGP; Phillips' Chewable Tablets; Phillips' Milk of Magnesia; Slow-Mag; Uro-Mag http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202644.html

Medroxyprogesterone and Estradiol •

Systemic - U.S. Brands: Lunelle http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500255.html

Menotropins •

Systemic - U.S. Brands: Humegon; Pergonal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202347.html

Mifepristone •

Systemic - U.S. Brands: Mifeprex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500217.html

Molybdenum Supplements •

Systemic - U.S. Brands: Molypen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202619.html

Mumps Virus Vaccine Live •

Systemic - U.S. Brands: Mumpsvax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202382.html


Niacin (Vitamin B 3 ) •

Systemic - U.S. Brands: Endur-Acin; Nia-Bid; Niac; Niacels; Niacor; Nico-400; Nicobid Tempules; Nicolar; Nicotinex Elixir; Slo-Niacin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202405.html

Nicotine •

Systemic - U.S. Brands: Habitrol; Nicorette; Nicotrol; Prostep http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202407.html

Oxytocin •

Systemic - U.S. Brands: Pitocin; Syntocinon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202434.html

Penicillins •

Systemic - U.S. Brands: Amoxil; Bactocill; Beepen-VK; Betapen-VK; Bicillin L-A; Cloxapen; Crysticillin 300 A.S. Dycill; Dynapen; Geocillin; Geopen; Ledercillin VK; Mezlin; Nafcil; Nallpen; Omnipen; Omnipen-N; Pathocil; Pen Vee K; Pentids; Permapen; Pfizerpen; Pfizerpen-AS; Pi http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202446.html

Phosphates •

Systemic - U.S. Brands: K-Phos M. F. K-Phos Neutral; K-Phos No. 2; K-Phos Original; Neutra-Phos; Neutra-Phos-K; Uro-KP-Neutral http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202463.html

Potassium Supplements •

Systemic - U.S. Brands: Cena-K; Effer-K; Gen-K; Glu-K; K+ 10; K+ Care; K+ Care ET; K-8; Kaochlor 10%; Kaochlor S-F 10%; Kaon; Kaon-Cl; Kaon-Cl 20% Liquid; Kaon-Cl-10; Kato; Kay Ciel; Kaylixir; K-Dur; K-Electrolyte; K-G Elixir; K-Ide; KLease; K-Lor; Klor-Con 10; Klor-Con 8; Kl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202473.html

Progesterone Intrauterine Device •

Iud) - U.S. Brands: Progestasert http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202774.html

Progestins for Contraceptive Use •

Systemic - U.S. Brands: Depo-Provera Contraceptive Injection; Micronor; NORPLANT System; Nor-QD; Ovrette; Plan B http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202757.html

Progestins for Noncontraceptive Use •

Systemic - U.S. Brands: Amen; Aygestin; Crinone; Curretab; Cycrin; DepoProvera; Gesterol 50; Gesterol LA 250; Hy/Gestrone; Hylutin; Megace; Prodrox; Prometrium; Pro-Span; Provera http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202758.html

482 Pregnancy

Pyridoxine (Vitamin B 6 ) •

Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202493.html

Rh O (D) Immune Globulin •

Systemic - U.S. Brands: MICRhoGAM; RhoGAM http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202720.html

Ritodrine •

Systemic - U.S. Brands: Yutopar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202513.html

Selenium Supplements •

Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202633.html

Sodium Fluoride •

Systemic - U.S. Brands: Fluoritab; Fluorodex; Flura; Flura-Drops; Flura-Loz; Karidium; Luride; Pediaflor; Pharmaflur; Phos-Flur http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202527.html

Sodium Iodide •

Systemic - U.S. Brands: Iodopen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202621.html

Spermicides •

Vaginal - U.S. Brands: Advantage 24; Because; Conceptrol Contraceptive Inserts; Conceptrol Gel; Delfen; Emko; Emko Pre-Fil; Encare; Gynol II Extra Strength Contraceptive Jelly; Gynol II Original Formula Contraceptive Jelly; Koromex Cream; Koromex Crystal Clear Gel; Koromex Fo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202531.html

Sulfonamides •

Vaginal - U.S. Brands: AVC; Sultrin; Trysul http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202541.html

Tamoxifen •

Systemic - U.S. Brands: Nolvadex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202545.html

Thiamine (Vitamin B 1 ) •

Systemic - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html

Urofollitropin •

Systemic - U.S. Brands: Fertinex; Metrodin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202586.html


Vitamin B 12 •

Systemic - U.S. Brands: Alphamin; Cobex; Cobolin-M; Crystamine; Crysti-12; Cyanoject; Cyomin; Hydrobexan; Hydro-Cobex; Hydro-Crysti-12; HydroxyCobal; LA-12; Nascobal; Neuroforte-R; Primabalt; Rubramin PC; Shovite; Vibal; Vibal LA; Vitabee 12 http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202596.html

Vitamin D and Related Compounds •

Systemic - U.S. Brands: Calciferol; Calciferol Drops; Calcijex; Calderol; DHT; DHT Intensol; Drisdol; Drisdol Drops; Hectorol; Hytakerol; Rocaltrol; Zemplar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202597.html

Vitamin E •

Systemic - U.S. Brands: Amino-Opti-E; E-Complex-600; Liqui-E; Pheryl-E http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202598.html

Yellow Fever Vaccine •

Systemic - U.S. Brands: YF-Vax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202689.html

Zidovudine •

Systemic - U.S. Brands: Retrovir http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202602.html

Zinc Supplements •

Systemic - U.S. Brands: Orazinc; Verazinc; Zinc 15; Zinc-220; Zinca-Pak; Zincate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202622.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by

484 Pregnancy

brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to pregnancy by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “pregnancy” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for pregnancy: •

Reviparin Sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1124

•

Reviparin Sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1125

•

Reviparin sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1202

•

Progesterone http://www.rarediseases.org/nord/search/nodd_full?code=427

•

Human immunodeficiency virus immune globulin http://www.rarediseases.org/nord/search/nodd_full?code=765


If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

489

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 Institute13: •

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

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

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

13

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Physician Resources 491

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 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:15 •

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

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

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

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

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

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

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

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

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

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

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

14

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

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

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

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “pregnancy” using the “Detailed Search” option. Go directly to the following hyperlink: 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 the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “pregnancy” (or synonyms) into the “For these words:” box. The following is a sample result: •

Preventing Teenage Pregnancy, Childbearing, and Sexually Transmitted Diseases: What the Research Shows Contact: Child Trends, 4301 Connecticut Ave NW Ste 100, Washington, DC, 20008, (202) 362-5580, http://www.childtrends.org. Summary: This report discusses results of studies on adolescent reproductive health and presents a table of specific programs and approaches that have been successful in improving positive reproductive health behaviors. The report examines the factors that lead to positive reproductive health behaviors including the adolescent's gender, age, race and ethnicity, attitudes, involvement in activities and academic performance, family, the role of peers, the adolescent's partners, the school, and neighborhood and community contexts. Programs and approaches that have been successful are those that focus on early childhood development, that combine sexuality education for older children with positive activities, and those that send nurses to visit teenage mothers with reducing the likelihood of having another child during the teen years as one of their goals.

•

Guidelines for Use of HIV Antiretroviral Therapy in Pregnancy Contact: National Pediatric and Family HIV Resource Center, 30 Bergen St ADMC #4, Newark, NJ, 07107, (973) 972-0410, http://www.pedhivaids.org. Summary: This guideline describes the prenatal, postpartum, and neonatal care for pregnant women with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) to prevent the transmission of the virus to their infants. The guideline outlines the goals of such treatment and the factors that qualify a pregnant woman for treatment with antiretroviral (ARV) therapeutic drugs. It recommends that the readers treat pregnant women with HIV/AIDS with a three part regimen with zidovudine (AZT). The guideline advises the readers how to conduct this ARV therapy regimen during each trimester of pregnancy. It provides an overview of postpartum and neonatal ARV treatments for pregnant women with HIV/AIDS and their infants, covering issues such as dosages and regimen schedules.


•

HIV in Pregnancy : A Review Contact: World Health Organization, Joint United Nations Programme on HIV/AIDS, 20 Avenue Appia, CH-1211 Geneva, http://www.unaids.org. Summary: This report, which consists of three sections, presents information about the perinatal transmission of the human immunodeficiency virus (HIV) from mothers to their infants. The first section consists of a summary of what is known about HIV in pregnancy, transmission of HIV from mother to child, and interventions to prevent transmission (i.e., antiretroviral therapy, immune therapy, nutritional interventions, mode of delivery, vaginal cleansing, and modification of infant feeding practice). The second section provides suggestions on the appropriate management of HIV-positive women during pregnancy (i.e., obstetrical management, examination and investigations, medical treatment during pregnancy, and antiretroviral therapy), delivery, and postpartum, and the third section lists guidelines for infection control and safe working conditions with regard to HIV in pregnancy. Other specific topics include voluntary HIV counseling and testing in pregnancy, care of neonates, universal precautions, and management of needlestick injuries and other accidental blood exposure.

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National Perinatal Association Adolescent Sexuality/Pregnancy in America Preconference Workshop, November 16, 1995 Source: [Tampa, FL: National Perinatal Association?]. 1995. 7 items. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524- 9335 / e-mail: [email protected] / Web site: http://www.ncemch.org. Available for loan. Summary: This folder contains materials collected at the National Perinatal Association conference held in 1995. Included in this folder are the following materials: Summary: The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families; order form for the publication, Adolescent Pregnancy Prevention: A Compendium of Programs; Facts at a Glance handout; Advocates for Youths' Adolescent Sexual Behavior, Pregnancy, and Parenthood fact sheet; American College of Obstetricians and Gynecologists' (ACOG) fact sheet on Adolescent Pregnancy; ACOG's issue paper on Adolescent Pregnancy Prevention Programs; and the National Adolescent Health Information Centers' paper on Trends in Adolescent Pregnancy.

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U.S. Public Health Service Recommendations for Use of Antiretroviral Drugs During Pregnancy for Maternal Health and Reduction of Perinatal Transmission of Human Immunodeficiency Virus Contact: HIV/AIDS Treatment Information Service, PO Box 6303, Rockville, MD, 208496303, (800) HIV 0440, http://www.hivatis.org. Summary: This draft includes a request for comments on proposed guidelines for use of antiretroviral drugs in HIV-1-infected pregnant women for maternal health indications and reduction of perinatal HIV-1 transmission. The guidelines are being developed for health care providers to use when discussing antiretroviral drugs with their pregnant patients. The guidelines represent a consensus of 35 expert consultants and are an update and revision of previous guidelines adopted in February 1994. Since 1994 there have been major advances in understanding the pathogenesis of HIV-1 infection and in treating and monitoring HIV disease. These updated recommendations reflect that new understanding and have important implications for maternal and fetal health. The

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announcement summarizes: special considerations regarding the use of antiretroviral drugs by HIV-1-infected pregnant women and their infants, updates on Pediatric AIDS Clinical Trials Group protocol 076 (PACTG 076) results and other studies relevant to ZDV chemoprophylaxis of perinatal HIV-1 transmission, perinatal HIV-1 transmission and maternal HIV-1 RNA copy number, general principles regarding use of antiretrovirals in pregnancy, and recommendations for antiretroviral chemoprophylaxis to reduce perinatal HIV transmission. •

Pregnancy, HIV, and You: A Handbook for Women With HIV Contact: New Jersey Women and AIDS Network, 5 Elm Row Ste 112, New Brunswick, NJ, 08901, (732) 846-4462. Summary: This handbook contains information and guidance for HIV-positive women who are considering becoming pregnant, especially women of low socioeconomic status. The book considers a variety of pregnancy-related issues, including abortion, the risk of infection from mother to child, testing, disease progression, prenatal care; treatment options including AZT and ACTG 076, anti-retroviral medications, and clinical trials for pregnant women. Proper care of a newborn, breast feeding, and pharmacologic treatment of infants are summarized.

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Free Teens: HIV/AIDS, STDs and Pregnancy Prevention Program Contact: Free Teens, U.S.A., Center for Educational Media, PO Box 97, Westwood, NJ, 07675, (201) 358-1504. Summary: This report, for educators, advocates, and parents, compares comprehensive sex education to abstinence-only education and clears up current misconceptions as to which educational approach is effective in impacting teen sexual values and behavior. It provides an overview of the human immunodeficiency syndrome (HIV)/acquired immunodeficiency syndrome (AIDS) and family life education programs in the United States including sexually transmitted disease (STD) transmission; the Swedish model for sex education; behavior change; the influence of the media on attitudes towards sex; the effect of contraceptive distribution; comprehensive sex education in elementary schools; the impact of teen sex on mental health and grades; monogamy and marriage; and teen communication with parents. The report also provides an introduction to the 'Free Teens' slide presentation; an intensive HIV/AIDS, STD, and pregnancy prevention program used in public and private junior and senior high schools nationwide.

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Safe Passage for African-American and Latino Passengers by Preventing Pregnancy, HIV/AIDS and Violence : A Blueprint for Action Contact: Health Watch Information and Promotion Service Incorporated, 3020 Glenwood Rd, Brooklyn, NY, 11210, (718) 434-5411, http://www.hwatch.com. Summary: This report provides information on a videoconference on the prevention of pregnancy, the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and violence in African-American and Latino (Hispanic) teenagers, which included the participation of service providers, health and medical experts, and community leaders and organizations and was sponsored by Health Watch Information and Promotion Service. The goals of the videoconference were (1) to increase the awareness, understanding, and motivation of leaders and organizations regarding prevention strategies with African-American and Latino teens; (2) to examine key factors contributing to the prevalence of these problems in these populations; and (3) to identify and prioritize culturally appropriate approaches and strategies needed to


decrease the impact of the targeted problems. The report includes key conference findings; factors identified as contributing to teen violence, HIV/AIDS, and pregnancy; strategies and approaches recommended to prevent teen violence, HIV/AIDS, and pregnancy; and solution keys. The videoconference agenda and a list of videoconference products are included. •

HIV and Pregnancy: Information for Service Providers Contact: New Jersey Women and AIDS Network, 5 Elm Row Ste 112, New Brunswick, NJ, 08901, (732) 846-4462. Summary: This report presents a review of the literature on pregnancy and HIV. The report explains that transmission is multifactorial and there are multiple approaches to reducing transmission risk, including understanding the impact of viral load, vitamin A deficiency, and limiting invasive procedures during birth. The report covers the following subject areas: transmission rates; how HIV is transmitted from mother to child; factors associated with vertical transmission; the effect of HIV on pregnancy outcome, the effect of pregnancy on the course of HIV; counseling the seropositive pregnant woman; management of seropositive pregnancies; clinical trials; and diagnosis of HIV infected infants.

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Clinical Guidelines for the Use of Zidovudine Therapy in Pregnancy to Reduce Perinatal Transmission of HIV Contact: New York Department of Health, AIDS Institute, Empire State Plz, Corning Tower Rm 1483, Albany, NY, 12237-0684, (518) 473-7238, http://www.health.state.ny.us/nysdoh/aids/hivtesti.htm. Summary: This booklet contains guidelines for the use of zidovudine (ZDV), a drug that has been found to substantially reduce perinatal HIV transmission. Based on findings from a randomized, placebo-controlled clinical trial, the authors recommend a regimen that combines antepartum, intrapartum, and newborn ZDV treatment for women with clinical profiles similar to that of the trial participants. These guidelines recommend: the identification of pregnant women with HIV infection; documentation of maternal HIV antibody status and/or maternal HIV therapies;, ZDV therapy for the interruption of mother-to-child HIV transmission in pregnant women who have not received prior antiretroviral therapy; ZDV therapy for the interruption of mother-to-child HIV transmission in pregnant women with past or present antiretroviral therapy; implementation/coordination of health care service programs; and the registration of all pregnant women who receive ZDV therapy with the Antiretroviral Pregnancy Registry.

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Commitments of the Heart: Conversations Between Parents and Teenagers About Sexuality, Pregnancy and AIDS Contact: League of Women Voters of Bucks County, 123 S Main St, Doylestown, PA, 18901, (215) 230-9986. Summary: This manual is designed to help parents talk about sensitive sexual subjects with their teenagers. It lists the many dimensions of sexuality beyond physical behavior, discusses the need for parents to help their children make complex sexual decisions, and analyzes the barriers to communicating with teens about sex. A section on how to talk with teens emphasizes teachable moments rather than one comprehensive discussion, and suggests the acronym FIVE as an aid to deciding what to include in conversations: Feelings, Information, Values, and Encouragement of questions. Specific information is given on the topics of adolescent sexuality, pregnancy, and parenthood; substance abuse

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and sexual risk; sexually transmitted diseases; and AIDS and HIV. Interspersed throughout the chapters are questions for parents to consider to help them define their own sexual values and to clarify the information they wish to pass on to their children. Also included are a discussion leader's guide for use in group conversations and a list of resources. •

Bucks County Teen Pregnancy Task Force: Report of the Working Group Conference on Teen Pregnancy Prevention Contact: League of Women Voters of Bucks County, 123 S Main St, Doylestown, PA, 18901, (215) 230-9986. Summary: This report identifies the Bucks County Teen Pregnancy Task Force, summarizes its background, and lists the discussion priorities. It highlights four questions addressing how to encourage abstinence, consistent use of effective contraception, more effective pregnancy prevention by teen males, and more productive links between teens, authority figures, institutions and agencies to foster teen pregnancy prevention. The report discusses participant responses as they relate to the areas of message, self esteem, education, and responsibility. It outlines the resultant action plan.

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Teens Talk: Preventing Adolescent Pregnancy Contact: League of Women Voters of Bucks County, 123 S Main St, Doylestown, PA, 18901, (215) 230-9986. Summary: This report presents the results of a conference at which teen participants discussed issues regarding prevention of teen pregnancy. Attended by representatives from high schools in Bucks County, PA, the conference consisted of small discussion groups led by facilitators. The groups considered questions on the following main issues: 1) encouragement of abstinence; 2) encouragement of consistent contraceptive use among teens who are having intercourse: 3) effective involvement of teen males in pregnancy prevention efforts; and 4) recognition of the value of delayed childbearing. Supplemental questions considered the potential value of parental involvement, institutional linkages, and effects from the conference. The report discusses the "teen commitment plans" each participant filled out at the end. A list of recommendations generated include: educate parents on communication with children; educate to develop self-esteem, social skills, and decision-making; support abstinence as an option, but make contraceptives affordable and readily available; and promote male and media responsibility. An appendix contains excerpts from the participants' personal commitment plans.

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Sexuality, AIDS, Substance Abuse and Pregnancy, and Family Life Education Materials: Annotated Bibliography of Curricula and Resources Contact: Catholic Family Service, 2537 S University, Fargo, ND, 58103, (701) 235-4457. Summary: This annotated bibliography reviews sexuality education curricula, AIDS education resources, and substance abuse and pregnancy resources. Each listing contains the title, address of producer, brief description, and commentary on the material's strengths and limitations. The bibliography recommends guidelines for review and selection of a sexuality education program, including: 1) teaching positive communication skills to strengthen family bonds; 2) encouragement of self-control and self-discipline in adolescent sexual relationships; 3) promotion of adoption as a positive option; and 4) involvement of parents in the educational process. Not all of the material reviewed meets the stated guidelines, but they form the basis for the critiques and


endorsements. Also included are a catalog of brochures, ordering instructions for the material, and a list of rental fees for the curricula. •

Augmentation Cystoplasty and Ileal Conduits in Pregnancy Source: International Urogynecology Journal. 6(1): 37-40. 1995. Contact: Available from Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6372. Summary: In this article, the authors report a case of successful pregnancy following augmentation cystoplasty in a patient who had refractory interstitial cystitis (IC). A review of the literature discusses the incidence of pyelonephritis, premature delivery, impaired urinary drainage, renal insufficiency, and the need for Cesarean section in pregnant patients who have had ileal conduits and augmentation cystoplasties. The authors conclude that careful urologic monitoring of such patients after urinary diversion or augmentation cystoplasty should result in a successful pregnancy. 2 tables. 21 references.

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Progress pending: How to sustain and extend recent reductions in teen pregnancy rates Source: Washington, DC: National Campaign to Prevent Teen Pregnancy. 2003. 39 pp. Contact: Available from National Campaign to Prevent Teen Pregnancy, 1776 Massachusetts Avenue, N.W., Suite 200, Washington, DC 20036. Telephone: (202) 4788500 / e-mail: [email protected] / Web site: http://www.teenpregnancy.org. $10.00, plus $4.95 shipping and handling. Summary: This publication reports on a roundtable held June 6-7, 2002 to discuss why some areas and groups continue to have high adolescent pregnancy rates and to share strategies that seem effective in reducing too-early-childbearing. The report reviews characteristics of successful programs and identifies examples of programs that have been successful in a variety of community income levels, and race, ethnicity, age, and sexual experience of program participants. The appendices include contact information for programs discussed, the roundtable agenda, and a list of roundtable participants.

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HIV Infection and Pregnancies in Sexual Partners of HIV - Seropositive Hemophilic Men - United States Source: Morbidity and Mortality Weekly Report; Vol. 36, no. 35. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Massachusetts Medical Society, Medical Publishing Group, CSPO Box 9121, Waltham, MA, 02254, (800) 843-6356. Summary: This report look at the rates of Human immunodeficiency virus (HIV) infection and its effects on pregnancy in sex partners of men with hemophilia and HIV infection. It looks at the results of a survey that determined whether sex partners were being tested for HIV, the seroprevalence rate among those who had been tested, and the extent of compliance with recommendations for preventing sexual and perinatal HIV transmission.

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U.S. Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1--Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United Source: Morbidity and Mortality Weekly Report Recommendations and Reports November 22, 2002;51(RR-18):1-40. Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: These recommendations update the February 4, 2002 guidelines developed by the U.S. Public Health Service for the use of zidovudine (ZDV) to reduce the risk of perinatal human immunodeficiency virus type 1 (HIV-1) transmission. This report provides health care providers with information for discussion with HIV-1-infected pregnant women to enable such women to make an informed decision regarding the use of antiretroviral drugs during pregnancy and use of elective cesarean delivery to reduce perinatal HIV-1 transmission. Various circumstances that commonly occur in clinical practice are presented, and the factors influencing treatment considerations are highlighted. The results of Pediatric AIDS Clinical Trials Group (PACTG) Protocol 076 documented that ZDV chemoprophylaxis can reduce perinatal HIV-1 transmission by nearly 70%. Epidemiologic data have confirmed the efficacy of ZDV for reduction of perinatal transmission and have extended this efficacy to children of women with advanced disease, low CD4 T-lymphocyte counts, and prior ZDV therapy. Also, advances in the understanding of the pathogenesis of HIV-1 infection and in treatment and monitoring of persons with HIV-1 disease have resulted in changes in standard antiretroviral therapy for HIV-1 infected adults. The report recommends that standard antiretroviral therapy should be offered to HIV-1-infected pregnant women and ZDV chemoprophylaxis should be incorporated into the antiretroviral regimen, to prevent perinatal transmission. Both treatments should be accompanied by a discussion of the known and unknown short- and long-term benefits, and risks to the mother and infant.

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Understanding the Debate : Pregnant Women and HIV Counseling and Testing Contact: AIDS Alliance for Children Youth and Families, 918 16th St NW Ste 201, Washington, DC, 20006, (202) 785-3564, http://www.aidspolicycenter.org. Summary: This report, for health professionals, government agencies, and organizations, reviews the public policy debate surrounding routine and universal counseling and voluntary HIV testing for pregnant women with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The report discusses the debates surrounding the mandatory testing of pregnant women and newborns, the AIDS Clinical Trial Group (ACTG) 076 study, and the Institute of Medicine's (IOM) recommendations. The AIDS Alliance's annual meeting Voices 99 is discussed in detail. The report outlines the AIDS Alliance recommendations for health care providers about pre-service and continuing education, and for policy makers and advocates regarding HIV/AIDS antibody testing and counseling of pregnant women and their newborns.

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Counselling and Voluntary HIV Testing for Pregnant Women in High HIV Prevalence Countries : Elements and Issues Contact: World Health Organization, Joint United Nations Programme on HIV/AIDS, 20 Avenue Appia, CH-1211 Geneva, http://www.unaids.org.


Summary: This report presents information about the perinatal transmission of the human immunodeficiency virus (HIV) from mothers to their infants and the role that HIV counseling and voluntary testing can play in its reduction, particularly in countries in which HIV/acquired immune deficiency syndrome (AIDS) rates are high. It discusses the content of HIV counseling and operational issues, cost considerations, and potential difficulties in setting up and maintaining such a service. •

'Creating a Circle of Care' : Comprehensive Service Delivery to HIV/Positive Pregnant Women and Their Newborns : A Manual on Best Practices Contact: Health Resources and Services Administration Information Center, PO Box 2910, Merrifield, VA, 22116, (888) 275-4772, http://www.ask.hrsa.gov. Summary: This report, written for health professionals, government agencies, and organizations, can be used as a resource to plan and develop services for pregnant women with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The report shares the results of insights gained from case studies of successful Health Resources and Services Administration (HRSA's) Title III Ryan White CARE Act grantee programs. It identifies the range of services that are needed and characteristics of successful programs and offers recommendations on how to organize and deliver the array of services needed to provide comprehensive care. The report includes a self-assessment checklist for the readers to use to improve their health care services for HIV-positive pregnant women.

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Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected With HIV-1 for Maternal Health and Reducing Perinatal HIV-1 Transmission in the Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Morbidity and Mortality Weekly Report Series, 1600 Clifton Rd NE M/S C-08, Atlanta, GA, 30333, (404) 332-4555, http://www.cdc.gov. Summary: This report discusses the use of antiretroviral drugs on pregnant women who have the human immunodeficiency virus (HIV), to reduce the risk of perinatal transmission. It examines several aspects of this type of treatment for HIV-positive pregnant women, such as nucleoside analogue reverse transcriptase inhibitors, protease inhibitors, and non-nucleoside analogue reverse transcriptase inhibitors. It recommends the use of antiretroviral drugs during pregnancy, presenting four different scenarios. These scenarios are HIV-positive pregnant women with no prior experience with antiretroviral drugs, HIV-positive women who have been taking antiretroviral therapy during pregnancy, HIV-positive women who are in labor and have had no previous antiretroviral medications, and infants born to mothers who had no antiretroviral medications before or during birth. It includes information about maternal-child surveillance while taking antiretroviral treatment.

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Comprehensive Services for HIV-Infected Pregnant Women and Their Newborns : Seven Case Studies Contact: US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Community Based Programs, HIV/AIDS Dental Reimbursement Program, 5600 Fishers Ln Rm 7-74, Rockville, MD, 20857, (301) 443-9051, http://www.hrsa.gov/hab.

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Summary: This report uses seven case studies to examine the overall state of health care for women and their children with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The report assess the composition of each program's or company's clientele, and summarizes the health care services available to women and children with HIV/AIDS. The report includes analysis of how each program or company utilizes its budget, the health education programs offered, outreach programs, and other miscellaneous services offered. The report discusses the utilization patterns of each service, quality assurance measurements employed, and how they overcame barriers to care. The report examines the community's and the client's perspectives on the HIV care for women and children. •

Nutritional Healing: A Guide for Pregnant Women, Infants, and Children Contact: Gods Love We Deliver, 166 Ave of the Americas, New York, NY, 10013-1207, (212) 294-8100, http://www.godslovewedeliver.org. Summary: This booklet provides information on nutrition for HIV-positive pregnant women, infants, and children. The food guides, recipes, and menu plans in the booklet identify the foods that are the best sources of energy, growth, and protection. General nutrition and healthy lifestyle suggestions are presented, including exercise, medical care, and vitamin supplements. Suggestions for coping with nausea, vomiting, and diarrhea are presented along with tips for shopping, safe food handling, and safe food preparation.

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Homeless Pregnant and Parenting Adolescents; Service Delivery Strategies Contact: National Center for Education in Maternal and Child Health, 2000 Fifteenth St N Ste 701, Arlington, VA, 22201-2617, (703) 821-8955, http://www.ncemch.org. Summary: This report describes the health problems faced by pregnant and parenting homeless adolescents. It looks at pregnancy outcomes, model service strategies, community mobilization, and field outreach. The paper says the Sexually transmitted disease (STD) rate among this population is high. (STD's include Acquired immunodeficiency syndrome (AIDS)).

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HIV Screening of Pregnant Women and Newborns Contact: National Academy Press, 2101 Constitution Ave NW, Box 285, Washington, DC, 20055, (202) 334-3313. Summary: This report presents the findings of the Committee on Prenatal and Newborn Screening for HIV Infection of the Institute of Medicine, following a conference held May 14-15, 1990. The committee concludes that all individuals, including women and children, have the right to consent to, or refuse, testing for Human immunodeficiency virus (HIV) antibodies, except when such testing is conducted anonymously for epidemiological purposes. It also opposes any HIV screening of pregnant women based on racial or ethnic background, but it does recommend voluntary HIV screening, with informed consent, for all pregnant women in high-prevalence areas. The committee opposes any mandatory newborn or prenatal HIV-screening program. Also, given the present uncertainty of benefits, and lack of knowledge abut the risks, of early intervention for asymptomatic HIV-infected infants, the committee concludes that insufficient medical benefits have been demonstrated to justify newborn HIV screening. However, it does endorse the continuation of anonymous newborn HIV screening for surveillance purposes. Although the committee opposes mandatory testing, it does conclude that screening pregnant women for the purpose of early diagnosis and


treatment is a beneficial objective; and given the health risks inherent in deferring treatment for severely immunosuppressed pregnant women, the benefits from treatment outweigh the potential risks to the fetus. It is also recommended that prenatal HIV screening policy be implemented as a medical-practice standard, rather that regulated by legislation, and ultimately, the woman must decide whether or not to continue a pregnancy in the face of HIV. Also, a voluntary partner notification system should be part of a prenatal HIV screening program. The committee also finds the current health services delivery and financing system for women and children to be inadequate, and that women and children are often discriminated against in the provision of health-care service. Health-care providers have an obligation to give appropriate treatment, or make an appropriate referral. In addition to information on present and potential screening programs, the committee based its findings on the epidemiology of HIV and AIDS among women and children.

The NLM Gateway16 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.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “pregnancy” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 523927 10000 2379 3759 276 540341

HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 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

16

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

17

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

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

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AHRQ’s Put Prevention Into Practice.20 Simply search by “pregnancy” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists21 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.22 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.23 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/.

The Genome Project and Pregnancy In the following section, we will discuss databases and references which relate to the Genome Project and pregnancy.

20

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. 21 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 22

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. 23 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.


Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).24 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “pregnancy” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for pregnancy: •

Cholestasis, Intrahepatic, of Pregnancy Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?147480

•

Hypertension, Early-onset, Autosomal Dominant, with Severe Exacerbation in Pregnancy Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?605115

•

Pregnancy Zone Protein Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?176420

•

Pregnancy-associated Plasma Protein a Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?176385

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Pregnancy-induced Growth Inhibitor Okl38 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?607975

•

Pregnancy-specific Beta-1-glycoprotein 1 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?176390

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•


•


•


•


•


•


24

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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Pregnancy-specific Beta-1-glycoprotein, X-linked Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?312030

•

Pruritic Urticarial Papules and Plaques of Pregnancy Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?178995 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease,


Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html •

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

•

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

•

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

•

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

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PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

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To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “pregnancy” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database25 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database26 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “pregnancy” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

25

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 26 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on pregnancy can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to pregnancy. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to pregnancy. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “pregnancy”:

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Other guides High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Infections and Pregnancy http://www.nlm.nih.gov/medlineplus/infectionsandpregnancy.html Pregnancy Loss http://www.nlm.nih.gov/medlineplus/pregnancyloss.html Prenatal Care http://www.nlm.nih.gov/medlineplus/prenatalcare.html Teenage Pregnancy http://www.nlm.nih.gov/medlineplus/teenagepregnancy.html

Within the health topic page dedicated to pregnancy, the following was listed: •

General/Overviews Especially for Teens: Having a Baby Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZFV0TF97C& sub_cat=6 Having a Healthy Pregnancy Source: Nemours Foundation http://kidshealth.org/teen/sexual_health/girls/pregnancy.html When Children Have Children Source: American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/factsfam/pregnant.htm

•

Diagnosis/Symptoms JAMA Patient Page: How Do I Know if I'm Pregnant? Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZL1R1TESC&s ub_cat=2005

•

Coping Pregnancy in Your Teens Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00033 When Your Teen Is Having a Baby Source: Nemours Foundation http://kidshealth.org/parent/positive/talk/teen_pregnancy.html

•

Specific Conditions/Aspects Can a Girl Get Pregnant if She Has Sex During Her Period? Source: Nemours Foundation http://kidshealth.org/teen/sexual_health/girls/sex_during_period.html

Patient Resources 509

Pregnancy Choices: Raising the Baby, Adoption and Abortion Source: American College of Obstetricians and Gynecologists http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZHSWH G97C.html&soc=ACOG&srch_typ=NAV_SERCH Talking Back: Ten Things Teens Want Parents to Know about Teen Pregnancy Source: National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org/resources/reading/tips/talk_back.asp Test Your Knowledge Source: National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org/resources/teens/quiz/default.asp Why Some Teens Want to Get Pregnant Source: Adolescent Wellness and Reproductive Education Foundation http://www.awarefoundation.org/aware/articles/teen_pregnancy.asp Your First Ob-Gyn Visit Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZM8HN5HQ C&sub_cat=6 •

Lists of Print Publications Adolescent Prenatal Care Source: National Center for Education in Maternal and Child Health http://www.ncemch.org/databases/action.lasso?-database=Biblio&layout=Web&-response=automated_search_results.lasso&-MaxRecords=all&DoScript=auto_search_adolprenatal&-search

•

Organizations Adolescent Wellness and Reproductive Education Foundation http://www.awarefoundation.org/ March of Dimes Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/ National Center for Education in Maternal and Child Health http://www.ncemch.org/ National Institute of Child Health and Human Development http://www.nichd.nih.gov/

•

Prevention/Screening Birth Control: What You Need to Know Source: Nemours Foundation http://kidshealth.org/teen/sexual_health/contraception/contraception.html Ten Tips for Parents to Help Their Children Avoid Teen Pregnancy Source: National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org/resources/reading/tips/tips.asp

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Thinking about the Right-Now: What Teens Want Other Teens to Know about Preventing Pregnancy Source: National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org/resources/reading/tips/right_now.asp •

Research Dads Make a Difference Source: National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org/resources/reading/fact_sheets/fatherfs.asp Sharing Medication Among Teenage Girls: Potential Danger to Unplanned/Undiagnosed Pregnancies http://www.cdc.gov/ncbddd/factsheets/pediatrics/Pediatrics_Meds_sharing.pdf

•

Statistics Facts You Should Know about Teenage Pregnancy Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/professionals/681_1159.asp FASTATS: Teen Births Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/teenbrth.htm HHS Report Shows Teen Birth Rate Falls to New Record Low in 2001 Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r020606.htm Teen Birth Rates Decline in All States During the 1990s Source: National Center for Health Statistics http://www.cdc.gov/nchs/releases/02facts/teenbirths.htm U.S. Birth Rate Reaches Record Low: Births to Teens Continue 12-Year Decline; Cesarean Deliveries Reach All-Time High Source: National Center for Health Statistics http://www.cdc.gov/nchs/releases/03news/lowbirth.htm

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 pregnancy. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search


options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Pregnancy and HIV Contact: Project Inform, National HIV/AIDS Treatment Hotline, 205 13th St Ste 2001, San Francisco, CA, 94103, (415) 558-8669, http://www.projectinform.org. Summary: This pamphlet discusses the prevention of perinatal transmission of HIV/AIDS. It provides information about the importance of prenatal care for pregnant women with HIV/AIDS, the elements involved in prenatal care, how domestic violence can affect a pregnancy, and the types of prenatal care available for HIV-positive women. It discusses anti-HIV medical treatment administered during pregnancy; prenatal procedures to avoid if not medically necessary; opportunistic infection (OI) prevention and treatment during pregnancy; the type of delivery; neonatal care options that may be administered during childbirth; and topics related to breastfeeding and additional factors that could affect HIV transmission.

•

Treatment of Latent Tuberculosis Infection (LTBI) in Pregnancy/Postpartum Contact: Charles P Felton National Tuberculosis Center at Harlem Hospital, 2238 5th Ave, New York, NY, 10037-2127, (212) 939-8254. Summary: This pamphlet provides health professionals with information on the treatment of latent tuberculosis infection (LTBI) in pregnant and postpartum women. The pamphlet discusses recommended treatments for LTBI in pregnancy/postpartum, candidates for treatment, the monitoring of patients on treatment for LTBI in pregnancy/postpartum, and drug regimen information.

•

HIV, STDs and Pregnancy: 50 Things You Should Know About Condoms: Protect Yourself Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 95061-8466, (831) 4231400, http://www.promotehealth.com. Summary: This pamphlet discusses condoms as a means of helping to prevent the pregnancy as well as human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). The pamphlet explains how to use condoms properly, the differences between condoms made of various materials, what types of lubricants should be used with condoms, and how to store them.

•

A Healthy Pregnancy : HIV and Pregnancy : Ten Things You Should Know : For You and Your Baby Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 95061-8466, (831) 4231400, http://www.promotehealth.com. Summary: This brochure, written for women who are pregnant or are planning on becoming pregnant, provides information about the relationship between pregnancy and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). HIV can be passed from a mother to her infant during pregnancy. High-risk behaviors often associated with HIV transmission include unprotected sex and the sharing of needles for injection drug use. Women who are or who want to become pregnant should be tested for HIV and discuss HIV with their health care providers. Individuals can get tested at a confidential or anonymous testing facility and should talk with their health care providers about their test results. By taking the drug zidovudine

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(AZT) and having a cesarean section birth, women can lower the risk of perinatal and neonatal transmission of HIV to their infants. Those women who are HIV-negative can prevent HIV by practicing safer sex with condoms correctly during each sexual encounter and by not sharing needles for injection drug use. Safer sex should be practiced, even during pregnancy to prevent HIV. To increase the chances that their infants will be born healthy, women should make sure to get good prenatal care. The brochure provides contact information for services from which individuals can learn more about HIV/AIDS. •

Pregnancy and HIV : Caring for Yourself and Your Baby Contact: New York Department of Health, AIDS Institute, Room 359, Corning Tower, Albany, NY, 12237, (518) 486-1383. Summary: This brochure, for pregnant women with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), discusses ways to prevent the perinatal transmission of HIV. The brochure recommends that pregnant women start taking zidovudine (ZDV, AZT) during pregnancy, early in labor, and right after birth to help to prevent mother-to-child transmission (MTCT) of HIV. Studies have shown that childbirth via C-section can also help to further reduce the likelihood of MTCT of HIV. The best time to start AZT to lower the chance of passing HIV to your baby is the beginning of the fourth month of pregnancy. The brochure discusses the possible side effects individuals may experience taking AZT and the effects this therapeutic drug may have on their infants. The brochure states that all infants born to women with HIV will test positive at birth with the routine HIV test, but, if uninfected, infants may test negative as early as a month after birth. The brochure reviews the steps HIV-positive women need to take to ensure that they have a safe pregnancy and a healthy infant.

•

A Healthy Pregnancy: STDs and Pregnancy: Ten Things You Should Know: For You and Your Baby Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 95061-8466, (831) 4231400, http://www.promotehealth.com. Summary: This pamphlet provides information about the relationship between sexually transmitted diseases (STDs) and pregnancy. The pamphlet discusses how STDs are transmitted, how they may be passed from a mother to her child during pregnancy, the problems they may cause during pregnancy or childbirth, how STDs can be prevented, and why it is important for women who are or are thinking about becoming pregnant to get tested for STDs.

•

Pregnancy: HIV Testing and Pregnancy Contact: American College of Obstetricians and Gynecologists, Committee on Patient Education, 409 12th St SW, Washington, DC, 20024-2188, (202) 638-5577. Summary: This brochure, for pregnant women, provides information on testing for the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). It discusses HIV transmission and the perinatal transmission of HIV, its treatment, how to reduce the risk for contracting HIV, and who is at high risk for contracting this disease. Information on pre-test counseling, the HIV antibody test, and the meaning of positive test results.


•

Pregnancy and the HIV Test : For All Women of Childbearing Age Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. Summary: This brochure, written for women who are pregnant, discusses the human immunodeficiency virus (HIV) testing. HIV is a virus that weakens the immune system and eventually develops into the acquired immune deficiency syndrome (AIDS), a disease for which there is no cure. If a pregnant woman has HIV, it can pass to her baby in the womb, during birth, or after birth through breastfeeding. Most women with HIV do not pass the virus to their babies; however, the likelihood of this type of transmission is still relatively high. To help lower the chance of transmission, mothers with HIV/AIDS can take zidovudine (AZT) while pregnant. Women who are or are thinking of becoming pregnant should get tested so that if they learn that they are HIV-negative they can take steps to make sure they don't get it. Similarly, if they learn they are HIVpositive, women can take steps to lower the chances that they will pass the virus to their infants. Women who test positive can get early treatment to slow the damage that HIV does to their immune system. Individuals who have been tested before may need to be tested again if they have practiced any unsafe behaviors or are unsure of the risk behaviors practiced by their partners. Women can help to protect themselves and their infants from HIV by talking with their partners about HIV/AIDS and other sexually transmitted diseases (STDs), practicing safer sex with condoms during all penetrative sexual activities, avoiding sharing needles for injection drug use, and seeking early treatment if HIV-positive. The brochure provides contact information for services from which individuals can learn more about HIV/AIDS and STDs.

•

HIV and Pregnancy : What You Need to Know Contact: Massachusetts Department of Public Health, HIV and AIDS Bureau, 150 Tremont St 9th Fl, Boston, MA, 02111, (617) 727-0368. Summary: This brochure, written for women who are or who are thinking about becoming pregnant, discusses the prevention of the perinatal transmission of the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The brochure recommends that these women should be tested for HIV so that they can begin treatment if they are infected and explains the HIV testing process. Infants born to infected mothers test positive for HIV until they are about eighteen months old, because they get HIV antibodies from their mothers. By the time they are three to six months old, the test will show whether or not the baby is infected. To lower the chances for the perinatal transmission of HIV, women should take the drug zidovudine (AZT or ZDV); AZT should be taken after the tenth to twelfth week of pregnancy until birth and then afterwards if needed to maintain the health of the women. The side effects experienced by pregnant women with HIV on AZT are often similar to those experienced by individuals not on AZT. Women who already are taking drugs to treat HIV should discuss whether to continue taking them during the beginning of their pregnancy. Women who do not take AZT while pregnant should take AZT and/or nevirapine during childbirth. More research is needed to determine whether or not taking antiretrovirals during pregnancy can harm infants. HIV-positive pregnant women need to discuss their options with their doctors.

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Pregnancy, HIV and Your Baby Contact: New York Department of Health, AIDS Institute, Empire State Plz, Corning Tower Rm 1483, Albany, NY, 12237-0684, (518) 473-7238, http://www.health.state.ny.us/nysdoh/aids/hivtesti.htm. Summary: This brochure, written for women who are pregnant or thinking about becoming pregnant, discusses the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and the use of the drug, zidovudine (AZT). Women should get tested for HIV because the sooner they know their serostatus, the sooner they can begin to make decisions for the health of their babies. In the state of New York (NY) all babies are tested for HIV; despite this fact, it is still important for women to get tested prior to pregnancy or during pregnancy, so that if they are HIVpositive, they can help to prevent the spread of the virus to their infants. HIV can be transmitted to an infant before, during, or after birth (through breastmilk). Even HIVnegative infants may carry HIV antibodies for up to a year after birth. Women with HIV can help to prevent the perinatal transmission of HIV to their infants by taking AZT. The brochure discusses AZT, when to take AZT during pregnancy, the New York State Health Department's recommendations about taking AZT during pregnancy, possible side effects of AZT for the mother and the infant, and AZT use during labor. Recommendations are made about how women can make the best and most informed decisions regarding HIV/AIDS, HIV testing, and HIV care during pregnancy.

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HIV and AIDS in Pregnancy Contact: March of Dimes Resource Center, PO Box 1657, Wilkes Barre, PA, 18703, (800) 663-4637, http://www.modimes.org. Summary: This fact sheet, for women who are or are thinking about becoming pregnant, provides information about the effects of the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) on pregnant women. It discusses how most women contract HIV/AIDS; who should be tested for HIV; the treatments available for HIV-positive pregnant women to help them prevent the perinatal transmission of the virus; and the symptoms of HIV/AIDS in infants. Information on where individuals can be tested for HIV is provided.

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Programs at a Glance : HIV/STD and Teen Pregnancy Prevention Programs for Young Women of Color Contact: Advocates for Youth, National Adolescent, AIDS and HIV Prevention Initiative, 1025 Vermont Ave NW, Ste 210, Washington, DC, 20005, (202) 347-5700. Summary: This fact sheet presents information about designing and implementing a human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention program for minority women and presents examples of effective programs in this area. The fact sheet examines the epidemiology of HIV/AIDS among minority women and the relationship between pregnancy prevention and reductions in HIV incidence rates among young minority females. To encourage self-protective behaviors among young women, interventions must match the culture of the audience targeted. The fact sheet identifies the factors and elements that should be considered and included in HIV/AIDS prevention programs designed for young women of color to help to make the programs effective. An overview is provided of some successful educational, contraceptive access, and multi-faceted HIV/AIDS prevention programs for young minority women. The programs profiled include AIDS Prevention and Health Promotion Among Women, Be Proud! Be Responsible!, Youth AIDS Prevention Project


(YAPP), The Fenix Project, Girl Talk, Girls Incorporated Preventing Adolescent Pregnancy, School/Community Program for Sexual Risk Reduction Among Teens, The Self Center, Children's Aid Society Teen Pregnancy Prevention Program, Teen Outreach Program (TOP), and I Have a Future. •

TB and Pregnancy Contact: New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, PO Box 74, New York, NY, 10013-0061, (212) 788-4155, http://www.ci.nyc.ny.us/nyclink/html/doh/html/tb/tb.html. Summary: This information sheet discusses treatment of tuberculosis (TB) in pregnant women. The sheet advises immediate drug treatment for pregnant women who test positive for TB and indicates which drugs should be used and which avoided because of danger to the fetus or other reasons. It suggests no treatment for latent TB infection (LTBI) until two to three months after delivery except for women with HIV infection or behavioral risk factors for HIV infection, or pregnant women who have been in close contact with an individual with smear positive pulmonary TB. If a woman taking isoniazid (INH) or rifampin (RIF) for LTBI becomes pregnant, the medications should be stopped and started again two to three months after delivery. Breast feeding is allowed during TB drug treatment, except if the mother is HIV positive, because of the chance of HIV transmission to the child.

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Tuberculosis in Pregnancy and Lactation Contact: Center for Pulmonary and Infectious Disease Control, University of Texas Health Center at Tyler, 11937 US Hwy 271, Tyler, TX, 75708-3154, (903) 877-7790, http://research.uthct.edu/cpidc/. Summary: This fact sheet presents information for pregnant women and mothers about tuberculosis (TB). Active TB must be treated immediately with prescribed to prevent its spread to children or infants. Children and infants are at a high risk for TB infection, which can cause brain damage or death. During pregnancy, a slightly different regimen of drugs is used that is not likely to affect the baby. Breastfeeding is not affected by the medications for TB, specifically, Isoniazid (INH), and it is best to continue breastfeeding when on anti-TB medicines. A positive skin test for TB infection means that the immune system recognizes a previous infection with TB. Testing during pregnancy is recommended in some cases. Treatment with INH may be postponed until a few months after delivery due to the possible effect of medication on the mother's liver. Women infected with the human immunodeficiency virus (HIV) are at special risk for TB, and infants born to mothers with HIV may be predisposed to TB. However, it is extremely rare for TB to be transferred to an infant in the womb.

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How Do HIV, STD and Unintended Pregnancy Prevention Work Together? Contact: University of California San Francisco, Center for AIDS Prevention Studies, 74 New Montgomery St Ste 600, San Francisco, CA, 94105, (415) 597-9100, http://www.caps.ucsf.edu/capsweb. Summary: This fact sheet discusses how human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), sexually transmitted disease (STD), and unintended pregnancy prevention are connected. The fact sheet provides background information such as the epidemiology of HIV and STDs, and statistical data about unintended pregnancies in the United States (US). The fact sheet explains the dangerous relationship between HIV and STDs, and describes how HIV and STD

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prevention/intervention strategies are and are not related. The fact sheet explores the prevention/intervention strategies used around the world that combine HIV, STD, and unintended pregnancy prevention message and makes recommendations about how these strategies can be further combined to be more effective. •

Child Sexual Abuse II: A Risk Factor for HIV/STDs and Teen Pregnancy Contact: Advocates for Youth, 1025 Vermont Ave NW Ste 200, Washington, DC, 20005, (202) 347-5700, http://www.advocatesforyouth.org. Summary: The focus of this fact sheet is child sexual abuse as a risk factor for the transmission of HIV and other sexually transmitted diseases (STDs). It emphasizes that while still under-reported, child sexual abuse is widespread in the United States. Prevention programs using skills-based approaches need to recognize that abuse survivors have difficulty making choices to prevent negative sexual outcomes, since they often feel powerless. The authors urge including sexual abuse prevention in any adolescent sexual health program.

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El Embarazo, el VIH y su Bebe. [Pregnancy, HIV and Your Baby] Contact: New York Department of Health, AIDS Institute, Empire State Plz, Corning Tower Rm 1483, Albany, NY, 12237-0684, (518) 473-7238, http://www.health.state.ny.us/nysdoh/aids/hivtesti.htm. Summary: This brochure, written for women who are pregnant or thinking about becoming pregnant, discusses the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and the use of the drug, zidovudine (AZT). Women should get tested for HIV because the sooner they know their serostatus, the sooner they can begin to make decisions for the health of their babies. In the state of New York (NY) all babies are tested for HIV; despite this fact, it is still important for women to get tested prior to pregnancy or during pregnancy, so that if they are HIVpositive, they can help to prevent the spread of the virus to their infants. HIV can be transmitted to an infant before, during, or after birth (through breastmilk). Even HIVnegative infants may carry HIV antibodies for up to a year after birth. Women with HIV can help to prevent the perinatal transmission of HIV to their infants by taking AZT. The brochure discusses AZT, when to take AZT during pregnancy, the New York State Health Department's recommendations about taking AZT during pregnancy, possible side effects of AZT for the mother and the infant, and AZT use during labor. Recommendations are made about how women can make the best and most informed decisions regarding HIV/AIDS, HIV testing, and HIV care during pregnancy.

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Sexuality, HIV, Pregnancy: Birds, Bees, Disease.?! Contact: Ripple Effects Incorporated, 333 Bryant St Ste 110, San Francisco, CA, 94107, (415) 227-1669, http://www.rippleeffects.com. Summary: This information kit provides a curriculum for enacting behavior change in adolescents to help them prevent adolescent pregnancy and the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The information kit identifies factors that may lead to difficulty accessing pregnancy and HIV/AIDS prevention information and services, discusses the emotional and physical consequences of adolescent pregnancy and HIV/AIDS, and the benefits of sexual abstinence and safer sex with condoms.


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A Comprehensive Approach to Reduce Pregnancy and the Spread of HIV: An Advocacy Kit Contact: American School Health Association, PO Box 708, Kent, OH, 44240-0708, (330) 678-1601, http://www.ashaweb.org. Summary: This kit provides materials and guidelines for planners implementing schoolor community-based pregnancy- and HIV-prevention programs. The programs offer youth information, skills, and services necessary to avoid unintended pregnancies and the spread of HIV and other sexually transmitted diseases. The first chapter contains a program overview and discusses the factors that influence early sexual behaviors. Chapter 2 contains a set of transparency masters with a script that can be used to inform and motivate various groups to take an active role in developing a comprehensive program. Optional transparencies will help tailor the presentation to parents, board members, nurses, teachers, and community members. The kit also includes masters for two handouts to use immediately following the presentation. Chapter 3 outlines the general steps needed to organize a Health Coordinating Council or Prevention Coalition.

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Pregnancy and Diabetes: Clinical Information Packet Source: Sylmar, CA: Mini Med Technologies. 1991. 53 p. Contact: Available from Mini Med Technologies. 12744 San Fernando Road, Sylmar, CA 92143. (800) 933-3322. PRICE: Single copy free. Summary: This clinical information packet provides a brief accumulation of data related to the treatment of insulin-dependent diabetes during pregnancy, focusing on the use of a pump to deliver continuous subcutaneous insulin during pregnancy. After a brief background chapter on pregnancy and diabetes, the text is presented in two sections: metabolism in diabetic pregnancy, including glucose metabolism, metabolic disorders that may affect the fetus, and complications of pregnancy and diabetes; and the management of diabetic pregnancy, including preconception, glucose control during pregnancy, the initiation of pump therapy, the diagnosis and management of gestational pregnancy, and insulin requirements during pregnancy. An additional section summarizes various clinical studies in this area. The packet concludes with a set of commonly asked practical questions and answers concerning pump therapy. 65 references.

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Promoting maternal mental health during pregnancy Source: Seattle, WA: Nursing Child Assessment Satellite Training, University of Washington. 2001. 7 items. Contact: Available from University of Washington, School of Nursing, NCAST Box 357920, Seattle, WA 98195. Telephone: (206) 543-8528 / fax: (206) 685-3284 / e-mail: [email protected] / Web site: http://www.son.washington.edu. $69.95; plus $10.00 shipping and handling. Summary: This packet includes the following items: (1) a book titled Promoting Maternal Mental Health During Pregnancy: Theory, Practice and Intervention, by J. E. Solchany; (2) a plastic card titled Topics to Assess During Pregnancy; (3) a shrinkwrapped set of 56 intervention handouts and worksheets; (4) a pregnancy intervention tracking form; (5) a pregnancy assessment form; (6) recommendations for getting started, and (7) an order form. The materials are intended primarily for use by individuals with health training (e.g., physicians, midwives, nurses) and experience in

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the basic management of pregnancy and are designed to address emotional and psychological challenges new parents experience. •

Beginnings: A practical guide through your pregnancy Source: Seattle, WA: Practice Development. 2000. 10 items. Contact: Available from Practice Development, 2821 Second Avenue, Suite 1601, Seattle, WA 98121. Telephone: (800) 444-8806 or (206) 441-7046 / fax: (206) 728-1926 / e-mail: [email protected]. Available at no charge. Summary: This set of pamphlets was designed for physicians to give to pregnant women during prenatal visits. The pamphlets cover six stages: early pregnancy, fourth month, fifth month, sixth month, last three months, and first weeks at home. The packet also includes an 8 1/2x11 poster that lists keys for a healthy baby, a small card listing warning signs of preterm labor, and an order form for these and additional materials. The materials are contained in a folder that provides information about readability and suitability ratings by experts. The material has been favorably reviewed by the American Academy of Family Physicians Foundation. The materials are available in English and Spanish. A program coordinator's handbook for managing a prenatal education program is also available.

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Teen pregnancy prevention: A legislator's guide Source: Washington, DC: National Conference of State Legislatures. 1999. 8 items. Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202. Telephone: (303) 830-2200 or (303) 830-2054 book order line / fax: (303) 863-8003 / e-mail: [email protected] / Web site: http://www.ncsl.org. Summary: This compilation of materials is to be used as a means to educate legislators on the topic of adolescent pregnancy. It contains information about the prevalence of adolescent pregnancy in the United States, resources and national organizations, approaches to prevention, effects of adolescent pregnancy, stories from adolescents, and who pays for adolescent pregnancy and prevention efforts. The publication was funded under a cooperative agreement with the U.S. Centers for Disease Control and Prevention, Division of Adolescent and School Health.

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Teen plus: A DHR interdivisional teen pregnancy prevention initiative Source: Atlanta, GA: Teen Plus Project, Georgia Department of Human Resources. 1998. 13 items. Contact: Available from Michele Ozumba, Georgia Department of Human Resources, Teen Plus, Two Peachtree Street, N.W., Eighth Floor, Suite S- 206, Atlanta, GA 303033142. Telephone: (404) 656-6679. Summary: This information package contains resource materials for the adolescent pregnancy prevention initiative in Georgia called Teen Plus. The package contains a volunteer recruitment card; a description and history of Teen Plus; issue briefs about welfare reform as it relates to marriage and sexual behavior, and adolescents' right to consent to reproductive health care; a brochure for parents to help their children avoid adolescent pregnancy; and fact sheets on issues and answers about adolescent pregnancy prevention, community and male involvement, adolescent pregnancy and births in Georgia, parental consent and reproductive health services for minors, and sexually transmitted diseases and adolescents in Georgia.


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Free Teens HIV/AIDS, STD and pregnancy prevention program. (5th ed.) Source: Westwood, NJ: Center for Educational Media. 1997. 4 items (various pagings). Contact: Available from Center for Educational Media, P.O. Box 97, Westwood, NJ 07675-0097. Telephone: (201) 358-1504 / fax: (201) 358- 9013. $10.00; $40.00 for 5 copies; plus shipping and handling. Summary: This information package includes a guide, student workbook, product list, and sample newsletter. The guide presents an overview of HIV/AIDS, sexually transmitted diseases (STDs), and pregnancy prevention programs in the United States, as well as the script of the Free Teens slide presentation promoting adolescent sexual abstinence, and a list of educational activities. The student workbook provides exercises for students to complete after viewing the slide presentation, to help them explore and discuss the information presented. The product list provides brief descriptions and price information on print materials, slide presentations, and videotapes available from the Center for Educational Media. The newsletter, which costs $12.00 for a one-year subscription, highlights the activities of the Free Teens organization and national and international developments related to HIV, AIDS, STDs, and pregnancy prevention. The Free Teens program is used in junior and senior high schools in the United States and abroad.

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Nutrition for pregnancy: Focus on healthy outcomes: An educational module for health care professionals. (Rev. ed.) Source: White Plains, NY: March of Dimes Birth Defects Foundation. 1994. 85 pp., 39 color slides. Contact: Available from Fulfillment Center, March of Dimes Birth Defects Foundation, 1275 Mamaroneck Avenue, White Plains, NY 10605. Telephone: (914) 428-7100 or (888) MODIMES or (914) 997-4764 TTY / e-mail: [email protected] / Web site: http://www.modimes.org. $25.00 plus $4.50 shipping and handling. Summary: This information package provides materials for teaching health care professionals about the importance of nutrition during pregnancy. It includes a leader's guide, a participant's guide, and a list of reference materials; it also contains instructional materials such as handouts and slides. The leader's guide suggests ways to prepare for a session, highlights topics to be emphasized, and provides an outline for the session which coordinates the use of the handouts and slides. The participant's guide outlines the objectives and suggests ways to prepare for the session. These materials were revised at the National Center for Education in Maternal and Child Health with support from a grant from the March of Dimes Birth Defects Foundation.

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Nutrition screening, assessment, and guidance during pregnancy: An educational module for health care professionals. (Rev. ed.) Source: White Plains, NY: March of Dimes Birth Defects Foundation. 1994. 99 pp., 1 brochure (27 pp.), 1 brochure (29 pp.). Contact: Available from Fulfillment Center, March of Dimes Birth Defects Foundation, 1275 Mamaroneck Avenue, White Plains, NY 10605. Telephone: (914) 428-7100 or (888) MODIMES or (914) 997-4764 TTY / e-mail: [email protected] / Web site: http://www.modimes.org. $25.00 plus $4.50 shipping and handling. Summary: This information package contains materials needed in an educational module for health care professionals on nutrition assessment, nutrition screening, and

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counseling during pregnancy. It contains a leader's guide, a participant's guide, reference materials which contain a bibliography and selected readings, and provides instructional materials which include originals for making transparencies, handouts, and two brochures. The leader's guide provides an overview of the session, suggests ways to prepare for the session, and includes an outline indicating how to use the instructional materials during the session. The participant's guide presents the objectives of the session and suggests steps to take to prepare for it. These materials were revised at the National Center for Education in Maternal and Child Health with support from a grant from the March of Dimes Birth Defects Foundation. •

Pregnancy, health and fitness Source: New York, NY: Women's Sports Foundation. n.d. 33 pp. Contact: Available from Women's Sports Foundation, Eisenhower Park, East Meadow, NY 11554. Telephone: (516) 542-4700 or (800) 227-3988 / fax: (516) 542-4716 / e-mail: [email protected] / Web site: http://www.lifetimetv.com/WoSport. Available at no charge. Summary: This packet of information provides materials on pregnancy, diet during pregnancy, exercise, tips for pregnant women runners, and a list of organizations and publications for further information.

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HIV Testing in Pregnancy Contact: British Columbia Ministry of Health and Ministry Responsible for Seniors, PO Box 9050 STN PROV GOVT, Victoria, (250) 952-3456, http://www.gov.bc.ca/hlth/. Summary: This fact sheet, for women, discusses the need to get tested for the human immunodeficiency virus (HIV) early in a pregnancy. It discusses how combination therapy using anti-HIV medications can help prevent the perinatal transmission of HIV to infants; it provides epidemiological data regarding how HIV testing has helped eliminate the perinatal transmission of HIV in British Columbia (BC); and it discusses how and when pregnant women should be tested for HIV. Contact information for services in BC for individuals to learn more about HIV and HIV testing is provided.

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Does HIV Get Passed to the Baby During Pregnancy? Contact: Canadian Public Health Association, Canadian HIV/AIDS Clearinghouse, 4001565 Carling Ave Ste 400, Ottawa, (613) 725-3434, http://www.cpha.ca. Summary: This fact sheet provides women who are or are thinking about becoming pregnant with information on the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The fact sheet recommends that individuals get tested for HIV if they have practiced unsafe behaviors and lists the options available to pregnant women who find out that they are HIV-positive. The fact sheet recommends that HIV-positive women avoid breastfeeding their infants and HIV-positive persons who are thinking of having a baby talk to their doctor.

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Teenage Pregnancy and Sexually Transmitted Diseases in Latin America Contact: Advocates for Youth, 1025 Vermont Ave NW Ste 200, Washington, DC, 20005, (202) 347-5700, http://www.advocatesforyouth.org. Summary: This fact sheet presents information on the incidence and prevalence of sexually transmitted diseases and teenage pregnancies in Latin America. The various


factors that are affecting this epidemiological trend are addressed, and they include falling age of menstruation, high rates of sexual activity, misinformation, and low condom use. Teens in Latin America tend to rely on natural contraceptive methods that have high failure rates, and there is limited access to birth control and sex education. Overall, 8 percent of teenage women ages 15-19 give birth each year in Latin America; 15 percent by age 18, and 50 percent by age 20. Except for Brazil and Mexico, the majority of these babies are born to unwed mothers. Latin American teenage girls are also at risk for the health consequences of illegal and clandestine abortions. Finally, the lack of sex education and condom use put this population at risk for HIV and other sexually transmitted disease. HIV is already widespread in the Latin American homosexual population, and millions of street children are especially at risk because of sexual exploitation. •

Adolescent Sexuality, Pregnancy and Parenthood Contact: Advocates for Youth, 1025 Vermont Ave NW Ste 200, Washington, DC, 20005, (202) 347-5700, http://www.advocatesforyouth.org. Summary: This fact sheet lists and describes statistics related to the incidence and prevalence of teenage pregnancy, sexuality, and parenthood, and the consequences of teen pregnancies. Teens in the United States have sexual intercourse at the average age of 16.2 for girls and 15.7 for boys. Forty-one percent of the 15- to 19-year old girls surveyed in a recent study reported not using condoms, and 75 percent of all unintended pregnancies occur to adolescents who do not use contraception. There are more than one million adolescent pregnancies each year. Thirty percent of teens who first give birth at age 16 or younger have a second child within 2 years. During pregnancy, teenagers are at a high risk of serious medical complications, including anemia, pregnancy-induced hypertension, cervical trauma, and premature delivery. Prenatal care is often not sought until the third trimester. Teen girls who give birth are much less likely to complete high school. They earn less money and are more likely to live in poverty.

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How Retailers Can Help Prevent Teenage Pregnancy and AIDS. Five Steps Toward Greater Profit and Prevention Contact: Advocates for Youth, 1025 Vermont Ave NW Ste 200, Washington, DC, 20005, (202) 347-5700, http://www.advocatesforyouth.org. Summary: This fact sheet recommends five measures that retail store owners and managers can take to make contraceptives more accessible to teenagers to help them protect themselves from unwanted pregnancies and Sexually transmitted diseases (STD's), including Human immunodeficiency virus (HIV). Recommendations include placing aisle signs to mark where contraceptives are located and placing contraceptives where young people can buy them without having to ask for them. Recommendations are based on a survey of stores in the District of Columbia.

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Back Pain During Pregnancy: What To Expect While You're Expecting Source: LaGrange, IL: North American Spine Society (NASS). 2001. 1 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Tear-off pads of 25 for $15.00

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(members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color handout provides pregnant women with information on back pain during pregnancy. Back pain develops during pregnancy because of added weight and the carriage of this added weight in the front of the body. Ways to minimize the discomfort include maintaining a regular exercise program, lifting objects with the leg muscles and not the back muscles, carrying several smaller objects rather than one large object, and placing a pillow under or between the knees when sleeping. Options for dealing with back pain related to pregnancy include learning exercises to support the muscles of the back and pelvis, using supportive garments, and using spot treatments such as heat and cold. •

OI Issues: Pregnancy Source: Gaithersburg, MD: Osteogenesis Imperfecta Foundation (OIF). 1998. 3 p. Contact: Available from Osteogenesis Imperfecta Foundation. 804 West Diamond Avenue, Suite 210, Gaithersburg, MD 20878. (800) 981-2663 or (301) 947-0083. Fax (301) 947-0456. Website: www.oif.org. PRICE: Single copy free. Summary: This fact sheet intended for health professionals and women with osteogenesis imperfecta (OI) addresses some of the specific problems that have been thought to be associated with OI during pregnancy. Problems that women with OI types I and IV may experience during pregnancy include loose joints, reduced mobility, increased bone pain, and dental problems. Women with more severe, debilitating forms of OI who are short and have curvature of the spine may be at greater risk for heart and lung difficulties. Although various obstetrical complications have been reported in women with OI, there does not appear to be a strong association between OI and these events. Pregnancy has not been associated with an increased risk of fractures, which may, however, result from trauma during pregnancy or delivery. Bleeding disorders are usually not a problem in OI. The fact sheet discusses the risk of a child inheriting OI if either parent has it and the need for genetic counseling in couples at risk. In addition, it addresses obstetric considerations for unaffected women when OI is detected in the fetus, including accuracy of the diagnosis, severity of the disorder, prognosis for survival and development, and mode of delivery.

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Lupus Guide Patient Information Handouts: Pregnancy and Lupus Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1998. 3 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail: [email protected]. Website: www.niams.nih.gov. PRICE: Available only as part of a package of patient information sheets; single copy of package free. Order Number: AR-205. Summary: This fact sheet provides women who have systemic lupus erythematosus and the patient care team with information about pregnancy and lupus. Although most women with lupus can safely become pregnant, the disease should be under control or in remission before conception takes place. The pregnancy should be monitored by an obstetrician experienced at managing high-risk pregnancies, and delivery should be planned at a hospital that can manage a high-risk patient and provide specialized care


for the woman and her baby. Problems that can affect a pregnant woman who has lupus include the development of a lupus flare and pregnancy-induced hypertension. In most cases, babies born to women with lupus have no greater chance of birth defects or mental retardation than babies born to women without lupus. However, about 3 percent of babies born to mothers with lupus will have neonatal lupus. This condition usually disappears by the time the infant is 3 to 6 months old and does not recur. The fact sheet offers tips for planning for a pregnancy and coping with the physical and emotional changes that occur during the postpartum period. Reasons why breastfeeding may not be possible are presented. In addition, the fact sheet offers self-care tips and provides space for making additional notes. •

What Every Pregnant Woman Should Know About HIV and AIDS: What You Can Do to Have a Healthy Baby Contact: Elizabeth Glaser Pediatric AIDS Foundation, 2950 31st St Ste 125, Santa Monica, CA, 90405, (310) 314-1459, http://www.pedaids.org. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This pamphlet emphasizes the importance of human immunodeficiency virus (HIV) antibody testing for pregnant women to prevent perinatal HIV transmission. It explains that many pregnant women do not realize that they have been exposed to HIV and suggests that the HIV antibody test should be performed as part of routine prenatal care. Pregnant women who test positive for HIV can receive early treatment to preserve their health and reduce the risk of perinatal transmission of HIV. The pamphlet recommends that women get the HIV antibody test before conceiving and urges women who do not have HIV to protect themselves. It provides a list of ways HIV is transmitted, reasons why many women do not know that they have been infected with the virus, and information about how and where a woman can get tested.

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Protecting Your Baby From HIV: What Every Pregnant Woman Should Know Contact: GlaxoSmithKline, Oncology/HIV, PO Box 13398, Research Triangle Park, NC, 27709, (919) 248-2100, http://www.imgw.com/forms/GWcoform.html. Summary: This pamphlet explains what a woman can do to prevent her baby from being infected with the human immunodeficiency virus (HIV). The pamphlet suggests that the woman should first be tested to know if she is infected or not and discusses testing sites, in addition to a doctor's office or health clinic, and the issue of confidentiality. The pamphlet explains negative results, repeating the test, positive results, and the effect on the pregnancy. The pamphlet also discusses partner notification, HIV medication, type of delivery, breast-feeding, testing of other children in the family, and other ways of protecting the mother's health and that of the baby.

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Importantes Nouvelles Pour les Femmes Enceintes. [Important News for Pregnant Women] Contact: Canadian Public Health Association, Canadian HIV/AIDS Clearinghouse, 4001565 Carling Ave Ste 400, Ottawa, (613) 725-3434, http://www.cpha.ca. Summary: This brochure provides information for pregnant women concerning the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The brochure explains HIV/AIDS and describes the HIV antibody test. It examines different testing options that allow the readers to keep test results confidential. It

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discusses the options that are available for pregnant women and their newborns who test positive for HIV/AIDS. •

New Information for Pregnant Women Contact: Pennsylvania Department of Health, Bureau of Communicable Diseases, PO Box 90, Harrisburg, PA, 17108-0090, (717) 787-6267, http://www.health.state.pa.us. Summary: This brochure for pregnant women and women thinking about having children provides information about the importance of a human immunodeficiency virus (HIV) antibody test. If a woman knows she has HIV early into her pregnancy or before she becomes pregnant, it is possible to reduce the likelihood of perinatal HIV transmission through the use of medical treatments. The brochure provides a toll-free number women in Pennsylvania (PA) can call to identify a free and confidential HIV test site in their area.

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You Didn't Get Pregnant : You Didn't Get AIDS : So Why Do You Feel Bad? Contact: US Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, Office of Population Affairs Clearinghouse, PO Box 30686, Bethesda, MD, 20824-0686, (301) 654-6190. Summary: This brochure for adolescents and young adults discusses the possible negative emotional effects of having sex and encourages sexual abstinence. Besides the possibilities of an unwanted pregnancy or the contraction of a sexually transmitted disease (STD), having sex also can have emotional consequences. Even if a couple is in love, most teenage relationships do not last. Often it is difficult for teenagers who are having sex to know what they love, the person or the sex. This makes it easy for individuals to end up in relationships, or even marriages, to partners who are wrong for them. Waiting to have sex lets individuals find out if they are in love. Many teenagers have sex to 'keep' their partners. However, often their partners leave anyway. Having sex with someone makes breaking up more hurtful. Teenagers should remember that they can have sex for the rest of their lives, but they can only give away their virginity once.

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If You Are Pregnant or Think You Might Be Pregnant, You Need to Know About HIV. Pregnant? Protect Your Baby From Syphilis Contact: Texas Department of Health Warehouse, Attn: Literature and Forms, 1100 W 49th St, Austin, TX, 78756, (512) 458-7761. Summary: This fact sheet for women who want to become or who are pregnant provides information about the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and syphilis. It recommends that women be tested for HIV and describes the difference between a confidential and an anonymous test. Testing can help the mother because she can begin treatment and can help prevent the transmission of HIV to the baby before, during, and after birth. To avoid HIV infection, persons can practice sexual abstinence, stay in a monogamous relationship, use latex condoms during sex, and avoid drug use and needle sharing. The fact sheet describes syphilis, congenital syphilis, and the health risks associated with the latter. Syphilis can be cured. If the readers think they are exhibiting the symptoms of syphilis or any other sexually transmitted disease (STD) or if they believe they have practiced high-risk behaviors, they should be tested. The readers can prevent syphilis by practicing sexual abstinence, staying in a completely monogamous relationship, using condoms during all sexual activities, seeking prenatal care immediately upon learning they are pregnant, seeking


treatment if they are experiencing symptoms of syphilis, undergoing treatment immediately if they test positive for syphilis, and getting tested early and late in pregnancy for syphilis. •

Important News for Pregnant Women Contact: New York Department of Health, AIDS Institute, Empire State Plz, Corning Tower Rm 1483, Albany, NY, 12237-0684, (518) 473-7238, http://www.health.state.ny.us/nysdoh/aids/hivtesti.htm. Summary: This brochure provides information to women who are pregnant or who are thinking about becoming pregnant about the importance of getting tested for the human immunodeficiency virus (HIV), the virus that causes the acquired immune deficiency syndrome (AIDS). Women who are or who are thinking about becoming pregnant can help to reduce their chances of passing HIV onto their infants by being tested for HIV. If they are HIV-positive they can reduce the chances of perinatal HIV transmission by taking medicines while pregnant and by not breastfeeding their infants because the virus can be transmitted through breastmilk. The sooner women take the HIV-test, the sooner they can start to make decisions about their health and start treatment to protect their baby from HIV. Women can learn more about HIV, pregnancy, and the risk of passing the virus to their infants from their physicians. The brochure provides contact information for services in New York.

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Soundbites: Nutrition and oral health guidelines for pregnant women, infants, and young children. [Video and video guidebook] Source: Boston, MA: Frances Stern Nutrition Center, Tufts University School of Dental Medicine. 2002. 29 pp., 1 videotape (15 minutes, VHS 1/2 inch). Contact: Available from Carole A. Palmer, (617) 636-6808, Fax: (617) 636- 6834, [email protected], Tufts University School of Dental Medicine, Francis Stern Nutrition Center, One Kneeland Street, Boston, MA 02111. Telephone: (617) 636-6828 / fax: (617) 636-6834 / Web site: http://www.tufts.edu/dental. $50.00. Summary: This videotape and guidebook are designed to help promote good nutrition and oral health for pregnant women, infants, children, and are written for parents and caregivers. The videotape discusses common oral health issues such as care of the mouth, nutrition to promote good oral health, and how to prevent the common oral health problems of childhood. The guidebook includes the following sections: pregnancy, birth to 6 months, 6 months to 1 year, 1 year to 2 years, 2 years to 3 years, and children with special health care needs. Additional sections include a review of the goals of the program and suggestions for learning, the importance of nutrition and oral health care during pregnancy and childhood, the narration to the videotape, and an evaluation form.

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Pregnant Women and HIV Counseling and Testing : Recommendations Contact: AIDS Alliance for Children Youth and Families, 918 16th St NW Ste 201, Washington, DC, 20006, (202) 785-3564, http://www.aidspolicycenter.org. Summary: This fact sheet, for health professionals, educators, and policy makers, discusses counseling and testing for the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) for pregnant women. The fact sheet contains the recommendations of the AIDS Alliance for Children, Youth, and Families for public health policy on HIV testing and addresses health care providers,

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those involved in preservice/continuing education, and policymakers/advocates. Recommendations for each of the aforementioned groups are given; specifically, how each group can improve access to testing, improve the education of professionals, and understand the legal issues surrounding informed consent for HIV counseling and testing for pregnant women. •

Key Messages About HIV for Pregnant Women Summary: This information sheet discusses the human immunodeficiency virus (HIV) antibody test during pregnancy. It describes available treatments to prevent the perinatal transmission of HIV/acquired immune deficiency syndrome (AIDS), and New York state law regarding the HIV testing of newborns, and confidentiality. It provides personal anecdotes from pregnant women in support of HIV testing during pregnancy. The National Guideline Clearinghouse™

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

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

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Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2001 July; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2874&nbr=2100&a mp;string=pregnancy

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National High Blood Pressure Education Program: Working Group report on high blood pressure in pregnancy Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 1990 (revised 2000 Jul); 39 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1478&nbr=704&am p;string=pregnancy


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Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1998 January 30 (revised 2003 June 16); 47 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3797&nbr=3023&a mp;string=pregnancy

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Recommendations for the evaluation and management of nausea and vomiting of early pregnancy ( Source: University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution; 2002 May; 19 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3228&nbr=2454&a mp;string=pregnancy

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Revised recommendations for HIV screening of pregnant women Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2001 November 9; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3053&nbr=2279&a mp;string=pregnancies

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SAGES guidelines for laparoscopic surgery during pregnancy Source: Society of American Gastrointestinal Endoscopic Surgeons - Medical Specialty Society; 1996 February (revised 2000 Oct); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3146&nbr=2372&a mp;string=pregnancy

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Screening for bacterial vaginosis in pregnancy: recommendations and rationale Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2001 Apr); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2659&nbr=1885&a mp;string=pregnant

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Use of antithrombotic agents during pregnancy. In: Sixth ACCP Consensus Conference on Antithrombotic Therapy Source: American College of Chest Physicians - Medical Specialty Society; 2001 January; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2723&nbr=1949&a mp;string=pregnancy

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Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

10 Tips for Parents to Help Their Children Avoid Teen Pregnancy Summary: Although these tips are designed for parents, they can be used by adults more generally in their relationships with teenagers. Source: National Campaign to Prevent Teen Pregnancy http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3729

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A National Strategy to Prevent Teen Pregnancy Summary: The U.S. Dept. Source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1070

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Abortion after the First Trimester Summary: This fact sheet discusses abortions that are performed after the first trimester of pregnancy. Source: Planned Parenthood Federation of America http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6031

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American Indian and Alaska Native Maternal and Child Health Page Summary: This page links to many topics relevant to maternal and child health, among them patient education, pregnancy, and breastfeeding. Source: Indian Health Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6851

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American Indian and Alaska Native Maternal Child Health: Pregnancy Summary: This page features links to information on vaccines, delivery, fertilization, and other pregnancy-related topics. Source: Indian Health Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6862


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Are You Pregnant and Thinking About Adoption? Summary: Answers questions and concerns that someone may have who is pregnant and unsure about keeping the baby, and is considering adoption. Source: National Adoption Information Clearinghouse, Administration for Children and Families http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4731

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Ask NOAH About: Pregnancy Source: NOAH: New York Online Access to Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1407

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Aspirin and Pregnancy/Aspirin and Breastfeeding Summary: These electronic guidelines recommend that pregnant and breastfeeding women refrain from taking aspirin. The dangers of aspirin to developing fetuses and infants are described. Source: National Institute of Environmental Health Sciences, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4831

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Awareness of a Group B Strep Infection During Pregnancy Summary: This brochure answers questions about this Group B Strep, a bacterial infection that causes illness in newborn babies, pregnant women, the elderly, and adults with other illnesses. Source: Group B Strep Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3039

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Cerebral Palsy Risks and Pregnancy Summary: This brochure describes the National Institute of Neurological Disorders and Stroke's (NINDS) conduct and support of research aimed at preventing CP. Source: National Institutes of Health, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4851

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Choosing Abortion - Questions and Answers Summary: A decision making guide. Answers questions about abortion and future pregnancies, mental and physical health effects; parental notification, and more. Source: Planned Parenthood Federation of America http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6030

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Diabetes in Pregnancy - Gestational Diabetes Source: New South Wales Multicultural Health Communication Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7476

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Drinking and Your Pregnancy Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3211

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FAQ - About Group B Streptococcal Infections Summary: Answers to consumers' most commonly asked questions about Group B streptococcus (GBS) -- a type of bacterium that causes illness in newborn babies, pregnant women, the elderly, and adults with other Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3038

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Folic Acid Now: Before You Know You’re Pregnant Source: National Center on Birth Defects and Developmental Disabilities http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5429

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Group B Streptococcus (GBS) Disease Home Page - National Center for Infectious Diseases/CDC Summary: Information and resources about Group B streptococcus (GBS) that includes fact sheets, slide set, a video for pregnant women and more. Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3037

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HCG Reference Service Summary: This web site provides information about the hCG (pregnancy) test kits, one of the most common immunoassays run in clinical laboratories. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4541

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healthfinder® just for you: Women Summary: healthfinder®'s just for you: Women section features topics such as breast cancer, osteoporosis, and pregnancy. Source: U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7014


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Healthy Pregnancy Source: National Women's Health Information Center, U.S. Public Health Service's Office on Women's Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5410

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Help for Smokers: Ideas to Help You Quit Summary: Information that can help you kick the smoking habit. Includes information about pregnancy and smoking and discusses the added risks for a smoker facing surgery. Source: Agency for Healthcare Research and Quality http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2462

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Herpes Simplex and Pregnancy Source: International Herpes Alliance http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5944

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HIPAA OnLine Summary: An interactive tool provided by the Federal Government that answers your questions on getting and continuing health coverage during events such as losing or changing jobs, pregnancy, moving, or Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6155

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How Do HIV, STD and Unintended Pregnancy Prevention Work Together? Source: Center for AIDS Prevention Studies http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3490

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How Do I Know If I Have an Infertility Problem? Summary: Answers to the most commonly asked questions from couples who have been trying to get pregnant without success. Source: RESOLVE http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4308

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Information for Pregnant Women Summary: This site links to selected information and resources for pregnant women. Source: Center for Food Safety and Applied Nutrition http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1406

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Listeriosis and Pregnancy: What Is Your Risk? Summary: This fact sheet from the Food Safety and Inspection Service answers questions pregnant women may have about listeriosis and what causes it, and its symptoms, prevention, and treatment. Source: Food Safety and Inspection Service, U.S. Department of Agriculture http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6363

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Maternal HIV Consumer Information Project: What Women and Doctors Need to Know Summary: This page provides links to valuable information on reducing the transmission of HIV to infants and Medicaid coverage for pregnant women. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=759

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Nutrition During Pregnancy and Breastfeeding Summary: An online bibliography of print materials focusing on nutrition during the pregnancy and breast feeding phase. Source: Food and Nutrition Information Center, U.S. Department of Agriculture http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4834

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Parents Resource Guide: On Talking with Kids About Love, Sex, and Relationships Summary: This web site provides a list of easily available resources for parents to help them talk more effectively with their children about important issues like sex and pregnancy. Source: National Campaign to Prevent Teen Pregnancy http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3730

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Pregnancy & Newborn Health Education Center Summary: The Pregnancy & Newborn Health Education Center is an online guide to a healthy pregnancy developed by the March of Dimes, features information on planning a pregnancy and on prenatal and postnatal Source: March of Dimes Birth Defects Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6325


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Pregnancy After Age 35 Summary: Consumer health education information written for women over 35 who are thinking of starting a family. Details the special risks some women who have postponed childbearing may face. Source: March of Dimes Birth Defects Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2602

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Pregnancy Quiz Summary: Take this quiz to find out how much you know about being pregnant. Source: National Women's Health Information Center, U.S. Public Health Service's Office on Women's Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7471

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Preserving Your Fertility: Risk Factors Summary: This fact sheet lists both male and female symptoms and risk factors that may adversely affect your chances of getting pregnant. Source: RESOLVE http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3931

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Preventing Malaria in the Pregnant Woman Summary: Written especially for pregnant women planning a trip abroad, this fact sheet provides information about the drugs your doctor would prescribe to protect you from malaria infection. Source: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6244

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Sexuality Fact Sheets Summary: Online consumer health information fact sheets about sexuality, adolescents and abstinence, homosexuality, teen pregnancy, contraception and more. Source: Sexuality Information and Education Council of the United States http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2666

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STDs and Pregnancy Summary: Pregnancy does not provide women or their babies any protection against STDs. Source: National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2456

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Teen Sex and Pregnancy Summary: Facts and statistics about reproductive health issues in teenagers -- sexual activity, sexually transmitted diseases (STDs), contraceptive use, abortion, pregnancy and other related topics. Source: Alan Guttmacher Institute http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6017

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Ten Tips for a Healthy Pregnancy Summary: Important advice for mothers-to-be on maintaining a healthy pregnancy through sensible food choices, mental health and other healthy behavior choices. Source: Lamaze International http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2223

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Thalidomide: Important Patient Information Summary: Do not take this drug if there is any possibility that you are, or may become, pregnant. Just one dose can cause severe birth defects. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1212 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 pregnancy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

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

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

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

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

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


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

Associations and Pregnancy The following is a list of associations that provide information on and resources relating to pregnancy: •

Abiding Hearts Telephone: (406) 293-4416 Fax: (406) 587-7197 Email: [email protected] Web Site: http://www.LCLINK.com/~hearts Background: Abiding Hearts is a not-for-profit organization dedicated to providing support and information to parents continuing their pregnancies after prenatal testing has revealed the presence of birth defects, some of which may be life-threatening. Established in 1993, Abiding Hearts provides a network of contact parents in a growing number of areas across the United States, enabling the exchange of support, information, and resources between new members and parents who have already experienced similar circumstances. Abiding Hearts also promotes patient advocacy; provides referrals to support groups and other services; and offers a variety of educational and support materials to parents and other affected family members, health care professionals, and the general public through its directory, brochures, reports, and its regular newsletter.

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Antiepileptic Drug Pregnancy Registry Telephone: (617) 726-7739 Toll-free: (888) 233-2334 Fax: (617) 724-1911 Email: [email protected] Web Site: http://www.aedpregnancyregistry.org Background: The Antiepileptic Drug Pregnancy Registry is a national not-for-profit research organization that was established to study the safety of antiepileptic drugs (AEDs) during pregnancy. This organization was established at the Massachusetts General Hospital with funds provided by six manufacturers of antiepileptic drugs. The Registry seeks to determine whether the frequency of birth defects is increased among infants exposed to any AEDs during pregnancy. The Registry works toward this goal through collecting and analyzing data from women in the United States and Canada during pregnancy and post delivery. The Registry hopes to enroll women during pregnancy and before any prenatal testing in order to avoid any selection bias. The Antiepileptic Drug Pregnancy Registry supplies fact sheets, flyers, general information about the potential affects of antiepileptic drugs, and slides for presentations. In addition, the Registry is working to provide assistance to Spanish speaking individuals. Pregnant women with epilepsy and their health care providers may call a toll-free number (888) 233-2334 for enrollment information.

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Arthritis Foundation Telephone: (404) 872-7100 Toll-free: (800) 283-7800

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Fax: (404) 872-0457 Email: [email protected] Web Site: http://www.arthritis.org Background: The Arthritis Foundation is a not-for-profit voluntary health organization dedicated to supporting research into the prevention and cure of arthritis and providing services to improve the quality of life for affected individuals. Arthritis, an inflammatory condition of the joints that may result in swelling and pain, is a joint disease that may be due to a number of different underlying causes. Established in 1948, the Arthritis Foundation disseminates information worldwide on how arthritis is diagnosed, how it is inherited, how it affects pregnancy, its potential symptoms, and treatments. The organization works for all people affected by any of the more than 100 forms of arthritis or related diseases. In nationwide chapters, the Foundation helps support research, offers professional and community education programs, provides referral services, engages in government advocacy, and conducts fund-raising activities. Educational materials include a bimonthly magazine entitled 'Arthritis Today,' regular newsletters, reports, audiovisual aids, and various topical brochures. •

Carter Centers for Brain Research in Holoprosencephaly and RelatedMalformations Telephone: (214) 559-8411 Toll-free: (800) 421-1121 Fax: (214) 559-8383 Email: [email protected] Web Site: http://www.stanford.edu/group/hpe Background: The Carter Centers for Brain Research in Holoprosencephaly represent the most concentrated study of holoprosencephaly in the world. The Centers were created to gather, store, organize, analyze and share information about HPE, but most importantly, to help families find hope. Holoprosencephaly (HPE) is a neurological birth defect in which the fetal brain does not grow and divide as it should during early pregnancy. The effects of this brain malformation can range from mild to severe. Specific chromosomal abnormalities and gene mutations have been identified in some patients and there is evidence that in some families, HPE is inherited. The Carter Centers are a collaborative initiative among sponsored Centers of Excellence in the field of HPE: The Texas Scottish Rite Hospital for Children in Texas; the Kennedy Krieger Institute in Maryland; Stanford University and UCSF in California; and National Institutes of Health in Maryland.

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Crohn's and Colitis Foundation of Canada Telephone: (416) 920-5035 Toll-free: (800) 387-1479 Fax: (416) 929-0364 Email: [email protected] Web Site: http://www.ccfc.ca Background: The Crohn s and Colitis Foundation of Canada (CCFC) is a not-for-profit voluntary health organization dedicated to raising funds for research to determine the cause of and the cure for Crohn s disease and colitis. Crohn s disease and ulcerative colitis, known as inflammatory bowel diseases, are chronic digestive disorders of unknown cause. Crohn s disease may affect any part of the digestive tract and often results in swelling, soreness, and inflammation of layers of the large and/or small


intestinal wall. Ulcerative colitis affects the colon (large intestine), causing inflammation of the inner lining and resulting in diarrhea, often mixed with blood, cramping abdominal pain, and other symptoms. Established in 1974, CCFC s mission is to help find the cure for Crohn s disease and ulcerative colitis. The Foundation provides educational programs for affected individuals, their families, health professionals, and the general public. In addition, the Foundation provides educational and awareness initiatives through approximately 75 local CCFC volunteer groups and CCFC community education events, featuring leading IBD specialists. The Foundation publishes a brochure series in both French and English. Titles include 'Surgery and Inflammatory Bowel Disease,' 'Nutrition, Diet and Inflammatory Bowel Disease,' 'Medication for Inflammatory Bowel Disease,' 'Sexuality, Fertility, Pregnancy and Inflammatory Bowel Disease,' and 'Living with Inflammatory Bowel Disease.' 'The Journal,' a regularly published newsletter, is also available. •

Diabetes UK Telephone: 020 7424 1000 Fax: 020 7424 1001 Email: [email protected] Web Site: http://www.diabetes.org.uk Background: Diabetes UK is a voluntary organization in the United Kingdom that was founded in 1934. Diabetes UK is dedicated to helping and caring for individuals with diabetes and family members, representing and campaigning for their interests, and funding research. There are different forms of diabetes, including diabetes insipidus and diabetes mellitus. Diabetes insipidus is a condition in which deficient production or secretion of antidiuretic hormone results in excessive thirst (polydipsia) and excessive excretion of urine (polyuria). Diabetes mellitus is characterized by impaired fat, protein, and carbohydrate metabolism due to deficient secretion of insulin. Diabetes UK has five regional offices across the United Kingdom and a network of over 450 local groups and branches that are run by people living with diabetes. Diabetes UK offers a confidential service that provides information and support on all aspects of diabetes to affected individuals and family members. The service handles inquiries concerning such issues as employment, pregnancy, insurance, driving, diet, and many other areas. The Youth and Family Services department provides services and support to children and young people affected by diabetes, parents, teachers, career officers, and others. The department provides Youth Packs and School Packs; distributes a quarterly newsletter; offers a wide range of holiday events in the UK for affected children and adolescents from six to 18 years of age; holds regional days and annual family weekends; and conducts the Youth Diabetes Project to provide a strong voice for affected individuals from 18 to 30 years of age. In addition, the Tadpole Club is for all children with diabetes and their siblings and friends. Diabetes UK also typically funds approximately 140 to 160 ongoing research projects to investigate the causes, prevention, and treatment of diabetes; provides educational materials for affected individuals and family members; and maintains a web site on the Internet.

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Gilda Radner Familial Ovarian Cancer Registry Telephone: (716) 845-4503 Toll-free: (800) 682-7426 Fax: (716) 845-8266 Email: [email protected]

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Web Site: www.ovariancancer.com Background: The Gilda Radner Familial Ovarian Cancer Registry, located at the Roswell Park Cancer Institute, is dedicated to enrolling families with two or more close relatives with ovarian cancer, promoting and conducting research into the causes and treatment of familial ovarian cancer, and providing information and support to affected individuals and family members. Comedienne Gilda Radner died in 1989 after a long, courageous battle against ovarian cancer. Neither she nor her husband, Gene Wilder, knew that her family history of ovarian and breast cancer put her at a high risk for developing ovarian cancer. The Registry, which was renamed in her honor, currently has over 1,700 families enrolled. Ovarian cancer refers to a group of diseases that are characterized by uncontrolled growth and division of cells of the ovary. The cells may grow to form a tumor on the ovary and may also break off from the main tumor and spread (metastasize) to other parts of the body. The Gilda Radner Familial Ovarian Cancer Registry conducts research into the causes of familial ovarian cancer in collaboration with investigators at Stanford University of Medicine and Cambridge University. Research goals include identifying new genes associated with familial ovarian cancer and characterizing lifestyle choices (e.g., oral contraceptive use, hormone replacement therapy, number of pregnancies) that may reduce ovarian cancer risk in women who may be more susceptible to the disease. The ultimate goal of the Registry is to acquire information that will lead to better methods of detecting ovarian cancer and prevent the disease in future generations. The Gilda Radner Familial Ovarian Cancer Registry also offers a telephone support service for women who are at risk of developing ovarian cancer. In addition, the Registry maintains a web site on the Internet that provides understandable information on ovarian cancer, an FAQ ('frequently asked questions') area, contact information for the Registry and other helpful resources, the Registry's newsletter, and links to additional sources of information and support. •

Group B Strep Association Telephone: (919) 932-5344 Fax: (919) 932-3657 Web Site: http://www.groupbstrep.org Background: The Group B Strep Association (GBSA) is a voluntary not-for-profit organization dedicated to educating the public about Group B Streptococcus (GBS) bacterial infections during pregnancies. Established in 1990 by parents whose babies were affected by GBS infections, the Group B Strep Association works closely with its Medical Advisory Board of researchers and physicians to help bring about guidelines for testing and treatment of GBS. The organization promotes routine screening of pregnant women for GBS and generates continuing support for vaccine research. The Group B Strep Association promotes patient advocacy, public awareness, and beneficial legislation and provides a variety of educational and support materials to patients, family members, health care professionals, and the general public. These include a biannual newsletter, and brochures.

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Health Resource Center for Women with Disabilities Telephone: (312) 908-7997 Fax: (312) 908-1087 Email: [email protected] Web Site: None


Background: The Health Resource Center for Women with Disabilities (HRCWD) is a national, not-for-profit, general health and service center that provides accessible medical services for women with disabilities, conducts research into health issues concerning disabled women, and offers educational resources for health care professionals and women with disabilities. Established in 1991 and located at the Rehabilitation Institute of Chicago, the HRCWD uses an interdisciplinary team approach that addresses the wide range of physical, psychosocial, and emotional issues that may affect women with disabilities. Its medical services for women with disabilities include consultative pregnancy services, family planning, mammography referrals, preventive health care counseling, parenting support, peer counseling, psychological and psychosocial services, and peer support groups. •

Ileostomy and Internal Pouch Support Group (UK) Telephone: 4724-721601 Toll-free: 0800 018 Fax: 01724-721601 Email: [email protected] Web Site: http://ww.ileostomypouch.demon.co.uk Background: The Ileostomy and Internal Pouch Support Group is a registered charity in the United Kingdom dedicated to helping individuals who have undergone surgical removal of the colon (colectomy) and creation of an ileostomy or an ileo-anal pouch. In individuals who receive an ileostomy, an opening is established between the lower region of the small intestine (ileum) and the abdominal wall and the body's waste material is collected in an externally attached bag. In individuals with an internal pouch, a reservoir is constructed from a section of the ileum. The Ileostomy and Internal Pouch Support Group was founded in 1956 by a group of people who had ileostomies and by some members of the medical profession. The organization currently includes over 60 local groups throughout Great Britain and Ireland. The Group is committed to helping affected individuals return to fully active lives as soon as possible; assisting them with all aspects of their rehabilitation including social activities and relationships with family members, friends, employers, and others; and working in close cooperation with medical authorities as part of a team whose primary aim is the complete rehabilitation of every individual who has received an ileostomy or internal pouch. The Ileostomy and Internal Pouch Support Group is also dedicated to improving knowledge about the management of ileostomies or pouches; encouraging development of new ostomy equipment and skin care preparations; and promoting and coordinating research concerning the diseases that may lead to such surgical procedures and ways to improve the quality of life with an ileostomy or an internal pouch. The Group works to fulfill its mission and objectives by providing hospital and home visits; conducting member meetings throughout the UK; offering advisory services on matters such as employment, housing, insurance, pensions, pregnancy, marriage, financial difficulties, and personal relationships; and conducting lectures and demonstrations for physicians, surgeons, and nurses. The Ileostomy and Internal Pouch Support Group also has a web site on the Internet and publishes the 'ia Journal,' a handbook based on articles published in the Journal, and several books.

•

Immunization Action Coalition/Hepatitis B Coalition Telephone: (651) 647-9009 Fax: (651) 647-9131

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Email: [email protected] Web Site: http://www.immunize.org Background: The Immunization Action Coalition (IAC) is a nonprofit organization that works to prevent disease by creating and distributing educational materials for health professionals and the public that enhance delivery of safe and effective immunization services and increase their use. The Coalition also facilitates communication within the broad immunization community, including parents, concerning issues of safety, efficacy, and the use of vaccines. The Hepatitis B Coalition, a program of IAC, promotes hepatitis B vaccination for all children 0-18 years of age, HBsAg screening for all pregnant women, hepatitis B testing and vaccination for risk groups, and education and treatment for people who are chronically infected with hepatitis B. The IAC's educational materials include 3 print periodicals, NEEDLE TIPS and the Hepatitis B Coalition News, VACCINATE ADULTS!, and VACCINATE WOMEN. IAC also produces a weekly email news service containing current immunization information titled IAC EXPRESS. In addition, IAC creates and distributes print materials and audiovisual aids and maintains 4 websites, www.immunize.org, www.vaccineinformation.org, www.izcoalitions.org, and www.hepprograms.org. •

JDF The Diabetes Research Foundation Telephone: (905) 889-4171 Toll-free: (800) 287-2533 Fax: (905) 889-4209 Email: [email protected] Web Site: http://www.jdfc.ca Background: JDF The Diabetes Research Foundation is an international not-for-profit organization in Canada dedicated to raising funds to support and promote diabetes research. Diabetes is a chronic metabolic disorder that affects the body s ability to properly manufacture or utilize insulin, a hormone necessary for the body to transport food glucose into cells for energy. There are several types of diabetes including InsulinDependent Diabetes Mellitus, IDDM (also known as Juvenile Diabetes); Non-Insulin Dependent (Type II, also known as Adult-Onset Diabetes); and Gestational Diabetes. Established in 1974 and consisting of 14 chapters, JDF supports research advances in therapies to reduce the risk of diabetes-caused blindness, decrease the number of amputations due to diabetes, and control high blood pressure associated with diabetes; disease management practices that help maintain tight control of glucose levels to prevent or delay complications of diabetes; and practices that afford women with diabetes the opportunity for safe pregnancies and healthy children.

•

Lithium Information Center/Obsessive Compulsive Information Center Telephone: (608) 827-2470 Fax: (608) 827-2479 Email: [email protected] Web Site: http://www.miminc.org Background: The Lithium Information Center and Obsessive Compulsive Information Center are affiliated with the Madison Institute of Medicine, a not-for-profit organization committed to conceptualizing, developing, and disseminating innovative approaches to the education of professionals, consumers, and the general public about psychiatric disorders and their treatment. An additional focus of the Institute is clinical


research as a vehicle to advance the frontiers of medicine and improve quality of life. At the core of the Institute's educational efforts are the Lithium Information Center (LIC) and the Obsessive Compulsive Information Center (OCIC). The LIC acquires, catalogs, and disseminates information on the biomedical uses of lithium and other medications for the treatment of bipolar (manic-depressive) disorder, a psychiatric disorder in which affected individuals experience recurrent mood swings including episodes of depression and episodes characterized by overactivity, elation, irritability, and other symptoms (mania). The Center currently has more than 28,000 references on such topic areas as lithium treatment in bipolar disorder or related psychiatric disorders, use of lithium during pregnancy, interactions with other medications, and appropriate monitoring procedures. The Obsessive Compulsive Center obtains, catalogs, and distributes biomedical information concerning obsessive compulsive disorder (OCD) and related disorders. OCD is an anxiety disorder characterized by repetitive actions or rituals (compulsions) performed in response to recurrent obsessive thoughts, according to certain rules. The OCIC currently has more than 12,000 references on file on such topics as OCD, related disorders including trichotillomania and body dysmorphic disorder, diagnosis and classification, behavior therapy, and pharmacologic therapy. The LIC's and OCIC's references include medical journal articles, books, book chapters, government documents, meeting proceedings, pamphlets, magazine articles, and other documents. Reference files may be searched by author, title word, key word (subject), publication name, and year of publication. In response to requests, the Centers provide computer-printed bibliographies and single photocopies of articles (subject to copyright law) on any topic relating to lithium or OCD. The Centers also maintain physician and support group referral lists. The Madison Institute of Medicine also hosts semiannual Continuing Medical Education (CME) conferences concerning mental health and health care issues. Such programs are endorsed and certified by the University of Wisconsin Medical School Continuing Medical Education. •

March of Dimes Birth Defects Foundation Telephone: (914) 428-7100 Toll-free: (888) 663-4637 Fax: (914) 997-4763 Email: [email protected] Web Site: http://www.marchofdimes.com Background: The March of Dimes Birth Defects Foundation is a national not-for-profit organization that was established in 1938. The mission of the Foundation is to improve the health of babies by preventing birth defects and infant mortality. The March of Dimes funds programs of research, community services, education, and advocacy. Educational programs that seek to prevent birth defects are important to the Foundation and to that end it also produces a wide variety of printed informational materials and videos. The Pregnancy and Newborn Health Education Center staffs trained health information specialists who provide researched information on pregnancy issues, complications and risks, newborn care, birth defects, genetic diseases and related topics as well as referrals to relevant organizations and support groups.

•

National Fetal AntiConvulsant Syndrome Association Telephone: 01 461 206 870 Fax: 01 461 206 870 Email: [email protected]

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Web Site: http://www.facsline.org Background: The National Fetal Anticonvulsant Syndrome Association provides advice and support to families and health workers involved with children who have been affected by anticonvulsant drugs prescribed for their mothers during pregnancy. The major problems encountered include spina bifida, cleft palate, congenital heart disease, kidney abnormalities, and limb defects. There is also an increased incidence of minor birth defects, including learning problems and speech delay. The Association works to increase awareness of these various problems, to put families in touch with each other, to encourage families in their quest for a firm diagnosis, to ensure that future mothers are made aware of risks, and to promote and participate in research. •

National Healthy Mothers, Healthy Babies Telephone: (703) 836-6110 Fax: (703) 836-3470 Email: None. Web Site: None Background: National Healthy Mothers, Healthy Babies is a not-for-profit, self-help, service organization dedicated to promoting public awareness and education concerning perinatal health issues, particularly preventive health habits for pregnant women and their families. Established in 1990, this national coalition has over 100 members, representing national voluntary organizations, health professional organizations, and the Federal Government. This service group is organized into several working issue committees: adolescent pregnancy, breast feeding promotion, genetics, immunization, injury/violence prevention, oral health, and substance abuse. National Healthy Mothers, Healthy Babies assists the development of state and local Healthy Mothers, Healthy Babies Coalitions. The organization provides technical assistance and resource materials; develops networks for sharing information among groups concerned about improving the health of mothers and babies; and conducts quarterly membership meetings. It promotes maternal and infant health educational campaigns and conducts biennial national conferences for health care professionals and administrators. Healthy Mothers, Healthy Babies also distributes public and professional educational materials including a quarterly newsletter, brochures, audiovisual aids, posters, and resource lists of additional publications. Relevant area(s) of interest: Pregnancy

•

National Organization on Fetal Alcohol Syndrome Telephone: (202) 785-4585 Toll-free: (800) 666-6327 Fax: (202) 466-6456 Email: [email protected] Web Site: http://www.nofas.org Background: The National Organization on Fetal Alcohol Syndrome is a voluntary notfor-profit service agency dedicated to eliminating birth defects caused by alcohol consumption during pregnancy and improving the quality of life for all those affected by fetal alcohol syndrome. Established in 1990, the organization is committed to increasing public awareness of fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE); assisting in community empowerment and the promotion of preventive education through media campaigns; and training health care professionals, educators,


and community members in addressing the specialized needs of affected children. The organization is also committed to serving as a national clearinghouse for local, regional, and state fetal alcohol syndrome organizations to ensure the effective exchange of information and resources. In addition, it engages in patient advocacy; promotes and supports research; provides appropriate referrals; and offers educational and supportive information through its database, directory, regular newsletter, reports, and brochures. •

Ongwanada Fragile X Resource Centre Telephone: (613) 548-4417 Toll-free: TTY: Fax: (613) 548-1743 Background: The Ongwanada Fragile X Resource Center is a voluntary organization that is dedicated to providing support and information concerning Fragile X Syndrome. Fragile X Syndrome is an inherited defect of the X chromosome that causes mental retardation. Established in 1948, the Center provides information on genetic counseling; genetic testing; parent and family support; networking options for parents; research opportunities; a registry; and educational materials. These materials include a newsletter, Spanish language materials, and pamphlets such as 'Fragile X Syndrome' or 'Alcohol and Pregnancy.' Fragile X Syndrome is also known as Martin-Bell Syndrome, FRAXA, X-linked Mental Retardation and Macroorchidism, and Marker X Syndrome.

•

Organization For Anti-Convulsant Syndrome Telephone: 0161-343-6079 Toll-free: 999-999-9999 Fax: 0161-343-6079 Email: [email protected] Web Site: Http://www.oacs-uk.co.uk Background: The Organization for Anti-Convulsant Syndrome provides help and support to families of children suffering with anti-convulsant syndrome. It provides advice related to special educational needs, assistance in obtaining a diagnosis, and information to increase awareness of risks related to the use of anti-convulsant medication and steps to minimise them. Anti-convulsant syndrome is caused by the use of anti-convulsant medication during pregnancy. The syndrome is known by other names, including anti-epileptic drug syndrome and fetal Valproate syndrome. It may result in learning difficulties or behavioral problems or any of various movement disorders. Established ni 1999, the Organization is based in the United Kingdom.

•

Pregnancy and Infant Loss Center Telephone: (612) 473-9372 Toll-free: TTY: Fax: (612) 473-8978 Background: The Pregnancy and Infant Loss Center, a national not-for-profit service organization, was established in 1983 by parents and professionals to serve the unique needs of bereaved families and their care providers. The Center is dedicated to providing information, referrals, comfort, understanding, and resources to individuals and families who have experienced the death of an infant; encouraging and promoting healthy grieving as affected families work towards healing; helping individuals and families utilize their own support networks to the fullest; and providing information, education, and consultation services to professional caregivers and the general public in

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order to increase sensitivity, understanding, and awareness of miscarriage, stillbirth, and infant death. The Pregnancy and Infant Loss Center provides referrals to appropriate national and local support groups, other bereaved parents, counselors, and nationwide resources; offers educational programs for parents and professional care providers; and has volunteer opportunities that may aid in the healing process. •

SHARE-Pregnancy and Infant Loss Support, Inc Telephone: (314) 947-6164 Toll-free: (800) 821-6819 Fax: (314) 947-7486 Email: [email protected] Web Site: http://www.nationalshareoffice.com Background: SHARE-Pregnancy and Infant Loss Support, Inc. is a not-for-profit, selfhelp organization whose purpose is to serve those who are touched by the death of a baby through miscarriage, stillbirth, or newborn death. Established in 1977, SHARE s primary purpose is to provide support toward the positive resolution of grief experienced at the time of and/or following the death of an infant. The secondary purpose is to provide information, education, and resources on the needs and rights of bereaved parents and siblings. Currently, SHARE has 115 groups with a total of 1,400 members. Educational materials include informational brochures, bereavement resources, and an information packet. The packet includes a video catalog, bibliography, and the organization s self-titled newsletter which is published six times per year, as well as a quartertly newsletter, 'Caring Notes,' for professionals.

•

Triplet Connection Telephone: (209) 474-0885 Fax: (209) 474-9243 Email: [email protected] Web Site: http://www.tripletconnection.org Background: The Triplet Connection is a not-for-profit organization dedicated to providing support and information to families who have or, particularly, who are expecting triplets, quadruplets, or quintuplets. Established in 1983, the organization provides information regarding the prevention of preterm birth in larger multiple gestations, and helps expectant parents know exactly what they can do in order to enhance the best possible outcomes to their pregnancies. Consisting of 25,000 members, the organization produces educational materials including a quarterly self-titled newsletter, a packet of information for expectant parents, and various reports. The organization coordinates support and networking opportunities for families of multiple births; maintains a database of medical information regarding larger multiple pregnancies and their outcomes; has an advisory board comprised of physicians who are in charge of research; and provides resources to help families who have lost one or more of their children. The Triplet Connection is a vital lifeline to expectant parents, a source of encouragement to parents of larger multiple births, and a resource for health care professionals.

•

Twin to Twin Transfusion Syndrome Foundation Telephone: (440) 899-8887


Fax: (440) 899-1184 Email: [email protected] Web Site: http://www.tttsfoundation.com Background: The Twin to Twin Transfusion Syndrome Foundation is a national voluntary not-for-profit organization dedicated to providing educational, emotional, and financial support to families, caregivers, and medical professionals before, during, and after pregnancies diagnosed with twin to twin transfusion syndrome (TTTS). Twin to twin transfusion syndrome is a rare disorder that affects identical twins during pregnancy when blood passes unequally from one fetus to the other through connecting blood vessels in their shared placenta. Established in 1992, the Foundation is dedicated to educating families, health care professionals, and the general public about TTTS and the latest available treatments. It supports medical research on TTTS and related complications, is working to develop a national registry of all TTTS pregnancies, promotes patient and family advocacy; offers financial assistance through corporate sponsors to affected families who require treatment; and provides a referral network.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to pregnancy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with pregnancy. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about pregnancy. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “pregnancy” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received

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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 “pregnancy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “pregnancy” (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 “pregnancy” (or a synonym) into the search box, and click “Submit Query.”

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

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.27

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

27

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

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)28: •

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

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

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

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

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

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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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

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

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

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

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

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

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

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

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

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

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

28

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

Finding Medical Libraries 549

•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

•

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

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•

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

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

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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

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

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

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

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

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

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

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

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

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

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

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

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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 551

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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). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on pregnancy: •

Basic Guidelines for Pregnancy Pregnancy risk factors Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002129.htm Pregnancy test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003432.htm Pregnancy ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003778.htm

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Diagnostics and Tests for Pregnancy HCG - qualitative - serum Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003509.htm HCG - qualitative - urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003619.htm

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HCG - quantitative Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003510.htm Sperm count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003627.htm •

Nutrition for Pregnancy Well-balanced diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002449.htm

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Background Topics for Pregnancy Alcohol consumption Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm

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

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

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

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

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

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PREGNANCY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 1-Naphthylamine: A suspected industrial carcinogen (and listed as such by OSHA). Its Nhydroxy metabolite is strongly carcinogenic and mutagenic. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Abruptio Placentae: Premature separation of the normally implanted placenta. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acne Vulgaris: A chronic disorder of the pilosebaceous apparatus associated with an increase in sebum secretion. It is characterized by open comedones (blackheads), closed comedones (whiteheads), and pustular nodules. The cause is unknown, but heredity and age are predisposing factors. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive T-

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lymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Acute leukemia: A rapidly progressing cancer of the blood-forming tissue (bone marrow). [NIH]

Acute lymphoblastic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphocytic leukemia. [NIH] Acute lymphocytic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphoblastic leukemia. [NIH] Acute myelogenous leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute nonlymphocytic leukemia. [NIH] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH] Acute nonlymphocytic leukemia: A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute myelogenous leukemia. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Monophosphate: Adenylic acid. Adenine nucleotide containing one phosphate group esterified to the sugar moiety in the 2'-, 3'-, or 5'-position. [NIH]

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Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adolescent Behavior: Any observable response or action of an adolescent. [NIH] Adolescent Nutrition: Nutrition of children aged 13-18 years. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and

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stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Air Pressure: The force per unit area that the air exerts on any surface in contact with it. Primarily used for articles pertaining to air pressure within a closed environment. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Albuminuria: More than normal amounts of a protein called albumin in the urine. Albuminuria may be a sign of kidney disease. [NIH] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allantois: An embryonic diverticulum of the hindgut of reptiles, birds, and mammals; in man its blood vessels give rise to those of the umbilical cord. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Allo: A female hormone. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH]

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Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha Cell: A type of cell in the pancreas (in areas called the islets of Langerhans). Alpha cells make and release a hormone called glucagon, which raises the level of glucose (sugar) in the blood. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH]

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Amniocentesis: Percutaneous transabdominal puncture of the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal karyotype determination in order to diagnose abnormal fetal conditions. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anabasine: A botanical insecticide. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] 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,

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C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneuploidy: The chromosomal constitution of cells which deviate from the normal by the addition or subtraction of chromosomes or chromosome pairs. In a normally diploid cell the loss of a chromosome pair is termed nullisomy (symbol: 2N-2), the loss of a single chromosome is monosomy (symbol: 2N-1), the addition of a chromosome pair is tetrasomy (symbol: 2N+2), the addition of a single chromosome is trisomy (symbol: 2N+1). [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anomalies: Birth defects; abnormalities. [NIH] Anophthalmia: Absence of an eye or eyes in the newborn due to failure of development of the optic cup or to disappearance of the eyes after partial development. [NIH]

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Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anthropometric measurements: Measurements of human body height, weight, and size of component parts, including skinfold measurement. Used to study and compare the relative proportions under normal and abnormal conditions. [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibodies, Anticardiolipin: Antiphospholipid antibodies found in association with systemic lupus erythematosus (lupus erythematosus, systemic), antiphospholipid syndrome, and in a variety of other diseases as well as in healthy individuals. The antibodies are detected by solid-phase immunoassay employing the purified phospholipid antigen cardiolipin. [NIH] Antibodies, Antiphospholipid: Autoantibodies directed against phospholipids. These antibodies are characteristically found in patients with systemic lupus erythematosus, antiphospholipid syndrome, related autoimmune diseases, some non-autoimmune diseases, and also in healthy individuals. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antidiuretic: Suppressing the rate of urine formation. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antiepileptic: An agent that combats epilepsy. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with

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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] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiphospholipid Syndrome: The presence of antibodies directed against phospholipids (antibodies, antiphospholipid). The condition is associated with a variety of diseases, notably systemic lupus erythematosus and other connective tissue diseases, thrombopenia, and arterial or venous thromboses. In pregnancy it can cause abortion. Of the phospholipids, the cardiolipins show markedly elevated levels of anticardiolipin antibodies (antibodies, anticardiolipin). Present also are high levels of lupus anticoagulant (lupus coagulation inhibitor). [NIH] Antiserum: The blood serum obtained from an animal after it has been immunized with a particular antigen. It will contain antibodies which are specific for that antigen as well as antibodies specific for any other antigen with which the animal has previously been immunized. [NIH] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Anti-Ulcer Agents: Various agents with different action mechanisms used to treat or ameliorate ulcers or irritation of the gastrointestinal tract. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Antiviral Agents: Agents used in the prophylaxis or therapy of virus diseases. Some of the ways they may act include preventing viral replication by inhibiting viral DNA polymerase; binding to specific cell-surface receptors and inhibiting viral penetration or uncoating; inhibiting viral protein synthesis; or blocking late stages of virus assembly. [NIH] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH]

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Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Rupture: Tearing of aortic tissue. It may be rupture of an aneurysm or it may be due to trauma. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Aortic Valve Insufficiency: Backflow of blood from the aorta into the left ventricle, owing to imperfect functioning of the aortic semilunar valve. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aplastic anemia: A condition in which the bone marrow is unable to produce blood cells. [NIH]

Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Approximate: Approximal [EU] 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] Archaea: One of the three domains of life (the others being bacteria and Eucarya), formerly called Archaebacteria under the taxon Bacteria, but now considered separate and distinct. They are characterized by: 1) the presence of characteristic tRNAs and ribosomal RNAs; 2) the absence of peptidoglycan cell walls; 3) the presence of ether-linked lipids built from branched-chain subunits; and 4) their occurrence in unusual habitats. While archaea resemble bacteria in morphology and genomic organization, they resemble eukarya in their method of genomic replication. The domain contains at least three kingdoms: crenarchaeota, euryarchaeota, and korarchaeota. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arnica: Genus of composite-flowered plants in the family Asteraceae. The dried flower heads of Arnica montana are used externally as a counterirritant and tincture for sprains and bruises. Arnica contains volatile oils, arnicin, arnisterol, flavonoids, tannins, and resin. [NIH]

Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arterial embolization: The blocking of an artery by a clot of foreign material. This can be

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done as treatment to block the flow of blood to a tumor. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Articular: Of or pertaining to a joint. [EU] Ascariasis: Infection by nematodes of the genus Ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspartic: The naturally occurring substance is L-aspartic acid. One of the acidic-amino-acids is obtained by the hydrolysis of proteins. [NIH] Aspartic Acid: One of the non-essential amino acids commonly occurring in the L-form. It is found in animals and plants, especially in sugar cane and sugar beets. It may be a neurotransmitter. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements.

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This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Audiovisual Aids: Auditory and visual instructional materials. [NIH] Aura: A subjective sensation or motor phenomenon that precedes and marks the of a paroxysmal attack, such as an epileptic attack on set. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autologous bone marrow transplantation: A procedure in which bone marrow is removed from a person, stored, and then given back to the person after intensive treatment. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Dysreflexia: That part of the nervous system concerned with the unconscious regulation of the living processes of the body. [NIH] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH]

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Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Baroreflex: A negative feedback system which buffers short-term changes in blood pressure. Increased pressure stretches blood vessels which activates pressoreceptors (baroreceptors) in the vessel walls. The net response of the central nervous system is a reduction of central sympathetic outflow. This reduces blood pressure both by decreasing peripheral vascular resistance and by lowering cardiac output. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure. [NIH]

Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [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

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subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzoyl Peroxide: A peroxide derivative that has been used topically for burns and as a dermatologic agent in the treatment of acne and poison ivy. It is used also as a bleach in the food industry. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Bioassay: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU]

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Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biomolecular: A scientific field at the interface between advanced computing and biotechnology. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Birth Certificates: Official certifications by a physician recording the individual's birth date, place of birth, parentage and other required identifying data which are filed with the local registrar of vital statistics. [NIH] Birth Rate: The number of births in a given population per year or other unit of time. [NIH] Bivalent: Pertaining to a group of 2 homologous or partly homologous chromosomes during the zygotene stage of prophase to the first metaphase in meiosis. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in

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the blood coagulation process. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Body Burden: The total amount of a chemical, metal or radioactive substance present at any time after absorption in the body of man or animal. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone Remodeling: The continuous turnover of bone matrix and mineral that involves first, an increase in resorption (osteoclastic activity) and later, reactive bone formation (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium homeostasis. An imbalance in the regulation of bone remodeling's two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as osteoporosis. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [NIH]

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Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breathing Exercises: Therapeutic exercises aimed to deepen inspiration or expiration or even to alter the rate and rhythm of respiration. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Broad Ligament: A broad fold of peritoneum that extends from the side of the uterus to the wall of the pelvis. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchioles: The tiny branches of air tubes in the lungs. [NIH] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU]

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Budesonide: A glucocorticoid used in the management of asthma, the treatment of various skin disorders, and allergic rhinitis. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Buprenorphine: A derivative of the opioid alkaloid thebaine that is a more potent and longer lasting analgesic than morphine. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use. [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Cadaverine: A foul-smelling diamine formed by bacterial decarboxylation of lysine. [NIH] Cadmium: An element with atomic symbol Cd, atomic number 48, and atomic weight 114. It is a metal and ingestion will lead to cadmium poisoning. [NIH] Cadmium Poisoning: Poisoning occurring after exposure to cadmium compounds or fumes. It may cause gastrointestinal syndromes, anemia, or pneumonitis. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calcitonin Gene-Related Peptide: Calcitonin gene-related peptide. A 37-amino acid peptide derived from the calcitonin gene. It occurs as a result of alternative processing of mRNA from the calcitonin gene. The neuropeptide is widely distributed in neural tissue of the brain, gut, perivascular nerves, and other tissue. The peptide produces multiple biological effects and has both circulatory and neurotransmitter modes of action. In particular, it is a potent endogenous vasodilator. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the

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alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Compounds: Inorganic compounds that contain calcium as an integral part of the molecule. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [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] Carboxy: Cannabinoid. [NIH] Carboxylic Acids: Organic compounds containing the carboxy group (-COOH). This group of compounds includes amino acids and fatty acids. Carboxylic acids can be saturated, unsaturated, or aromatic. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH]

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Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiolipins: Acidic phospholipids composed of two molecules of phosphatidic acid covalently linked to a molecule of glycerol. They occur primarily in mitochondrial inner membranes and in bacterial plasma membranes. They are the main antigenic components of the Wassermann-type antigen that is used in nontreponemal syphilis serodiagnosis. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiotoxicity: Toxicity that affects the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardioversion: Electrical reversion of cardiac arrhythmias to normal sinus rhythm, formerly using alternatic current, but now employing direct current. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Carrier State: The condition of harboring an infective organism without manifesting symptoms of infection. The organism must be readily transmissable to another susceptible host. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catalogs: Ordered compilations of item descriptions and sufficient information to afford access to them. [NIH] Catalyse: To speed up a chemical reaction. [EU]

Dictionary 575

Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the

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brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Aqueduct: Narrow channel in the mesencephalon that connects the third and fourth ventricles. [NIH] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] 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] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Chancroid: Acute, localized autoinoculable infectious disease usually acquired through sexual contact. Caused by Haemophilus ducreyi, it occurs endemically almost worldwide, especially in tropical and subtropical countries and more commonly in seaports and urban areas than in rural areas. [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] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Care: Care of children in the home or institution. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Child Nutrition: Nutrition of children aged 2-12 years. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for

Dictionary 577

the passage of blood vessels and a nerve. [NIH] Chlordiazepoxide: An anxiolytic benzodiazepine derivative with anticonvulsant, sedative, and amnesic properties. It has also been used in the symptomatic treatment of alcohol withdrawl. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Choleretic: A choleretic agent. [EU] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH]

Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chondroitin sulfate: The major glycosaminoglycan (a type of sugar molecule) in cartilage. [NIH]

Chorioamnionitis: An inflammatory process involving the chorion, its fetal blood vessels, the umbilical cord, and the amnion by extension of the inflammation, as the amnion itself has no blood supply. This inflammatory process is potentially fatal to mother and fetus. [NIH]

Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Chorion: The outermost extraembryonic membrane. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Choroid Plexus: A villous structure of tangled masses of blood vessels contained within the third, lateral, and fourth ventricles of the brain. It regulates part of the production and composition of cerebrospinal fluid. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU]

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Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chromosome Abnormalities: Defects in the structure or number of chromosomes resulting in structural aberrations or manifesting as disease. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chronotropic: Affecting the time or rate, as the rate of contraction of the heart. [EU] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P450. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Civil Rights: Legal guarantee protecting the individual from attack on personal liberties, right to fair trial, right to vote, and freedom from discrimination on the basis of race, religion, national origin, age, or gender. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Cleft Lip: Congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. It is thought to be caused by faulty migration of the mesoderm in the head region. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clitoral: Pertaining to the clitoris. [EU]

Dictionary 579

Clomiphene: A stilbene derivative that functions both as a partial estrogen agonist and complete estrogen antagonist depending on the target tissue. It antagonizes the estrogen receptor thereby initiating or augmenting ovulation in anovulatory women. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]

Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Coenzymes: Substances that are necessary for the action or enhancement of action of an enzyme. Many vitamins are coenzymes. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Coitus: Sexual intercourse. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may

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occur in other body regions as well. [NIH] Coliphages: Viruses whose host is Escherichia coli. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Coloboma: Congenital anomaly in which some of the structures of the eye are absent due to incomplete fusion of the fetal intraocular fissure during gestation. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Community Networks: Organizations and individuals cooperating together toward a common goal at the local or grassroots level. [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

Dictionary 581

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] Complement Activation: The sequential activation of serum components C1 through C9, initiated by an erythrocyte-antibody complex or by microbial polysaccharides and properdin, and producing an inflammatory response. [NIH] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compulsions: In psychology, an irresistible urge, sometimes amounting to obsession to perform a particular act which usually is carried out against the performer's will or better judgment. [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] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confounder: A factor of confusion which blurs a specific connection between a disease and a probable causal factor which is being studied. [NIH]

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Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congenita: Displacement, subluxation, or malposition of the crystalline lens. [NIH] Conization: The excision of a cone of tissue, especially of the cervix uteri. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [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] Connective Tissue Diseases: A heterogeneous group of disorders, some hereditary, others acquired, characterized by abnormal structure or function of one or more of the elements of connective tissue, i.e., collagen, elastin, or the mucopolysaccharides. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Dictionary 583

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corpus: The body of the uterus. [NIH] Corpus Callosum: Broad plate of dense myelinated fibers that reciprocally interconnect regions of the cortex in all lobes with corresponding regions of the opposite hemisphere. The corpus callosum is located deep in the longitudinal fissure. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to

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angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Corticotropin-Releasing Hormone: A neuropeptide released by the hypothalamus that stimulates the release of corticotropin by the anterior pituitary gland. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]

fumarate.

Stimulant

proposed

as

Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]

Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclooxygenase Inhibitors: Compounds or agents that combine with cyclooxygenase (prostaglandin-endoperoxide synthase) and thereby prevent its substrate-enzyme combination with arachidonic acid and the formation of eicosanoids, prostaglandins, and thromboxanes. [NIH]

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Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Cyclopia: Elements of the two eyes fused into one median eye in the center of the forehead of a fetal monster. [NIH] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cystathionine beta-Synthase: A multifunctional pyridoxal phosphate enzyme. In the second stage of cysteine biosynthesis it catalyzes the reaction of homocysteine with serine to form cystathionine with the elimination of water. Deficiency of this enzyme leads to hyperhomocysteinemia and homocystinuria. EC 4.2.1.22. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Dalteparin: A drug that helps prevent the formation of blood clots; it belongs to the family of drugs called anticoagulants. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH]

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De novo: In cancer, the first occurrence of cancer in the body. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delavirdine: A potent, non-nucleoside reverse transcriptase inhibitor with activity specific for HIV-1. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]

Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Deoxyribonucleic: A polymer of subunits called deoxyribonucleotides which is the primary genetic material of a cell, the material equivalent to genetic information. [NIH] Deoxyribonucleic acid: A polymer of subunits called deoxyribonucleotides which is the primary genetic material of a cell, the material equivalent to genetic information. [NIH]

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Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermatitis: Any inflammation of the skin. [NIH] Dermatofibrosarcoma protuberans: A type of tumor that begins as a hard nodule and grows slowly. These tumors are usually found in the dermis (the inner layer of the two main layers of tissue that make up the skin) of the limbs or trunk of the body. They can grow into surrounding tissue, but do not spread to other parts of the body. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Developmental Biology: The field of biology which deals with the process of the growth and differentiation of an organism. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH]

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Diamines: Organic chemicals which have two amino groups in an aliphatic chain. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Diathesis: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the person more than usually susceptible to certain diseases. [EU] Didanosine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. Didanosine is a potent inhibitor of HIV replication, acting as a chain-terminator of viral DNA by binding to reverse transcriptase; ddI is then metabolized to dideoxyadenosine triphosphate, its putative active metabolite. [NIH] Dideoxyadenosine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is an inhibitor of HIV replication, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal side effect is nephrotoxicity. In vivo, dideoxyadenosine is rapidly metabolized to didanosine (ddI) by enzymatic deamination; ddI is then converted to dideoxyinosine monophosphate and ultimately to dideoxyadenosine triphosphate, the putative active metabolite. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Dietetics: The study and regulation of the diet. [NIH] Diethylstilbestrol: DES. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Diffusion of Innovation: The broad dissemination of new ideas, procedures, techniques, materials, and devices and the degree to which these are accepted and used. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH]

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Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydroprogesterone: 20 alpha-Hydroxypregn-4-en-3-one. progesterone derivative with progestational activity. [NIH]

A

naturally

occurring

Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilation and curettage: D&C. A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage). [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease Transmission: The transmission of infectious disease or pathogens. When transmission is within the same species, the mode can be horizontal (disease transmission, horizontal) or vertical (disease transmission, vertical). [NIH] Disease Transmission, Vertical: The transmission of infectious disease or pathogens from one generation to another. It includes transmission in utero or intrapartum by exposure to blood and secretions, and postpartum exposure via breastfeeding. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissection: Cutting up of an organism for study. [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

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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] 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] Disulfides: Chemical groups containing the covalent disulfide bonds -S-S-. The sulfur atoms can be bound to inorganic or organic moieties. [NIH] Diuresis: Increased excretion of urine. [EU] Domestic Violence: Deliberate, often repetitive, physical abuse by one family member against another: marital partners, parents, children, siblings, or any other member of a household. [NIH] Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] 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] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Drinking Behavior: Behaviors associated with the ingesting of water and other liquids; includes rhythmic patterns of drinking (time intervals - onset and duration), frequency and satiety. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH]

Dictionary 591

Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Dyskinesias: Abnormal involuntary movements which primarily affect the extremities, trunk, or jaw that occur as a manifestation of an underlying disease process. Conditions which feature recurrent or persistent episodes of dyskinesia as a primary manifestation of disease may be referred to as dyskinesia syndromes (movement disorders). Dyskinesias are also a relatively common manifestation of basal ganglia diseases. [NIH] Dyslexia: Partial alexia in which letters but not words may be read, or in which words may be read but not understood. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eccentricities: Oddness of behavior or conduct without insanity. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

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

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH]

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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] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromagnetic Fields: Fields representing the joint interplay of electric and magnetic forces. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electroplating: Coating with a metal or alloy by electrolysis. [NIH] Electroretinogram: The electrical effect recorded from the surface of the eyeball and originated by a pulse of light. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Embolectomy: Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called thrombectomy. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH]

Dictionary 593

Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsions: Colloids of two immiscible liquids where either phase may be either fatty or aqueous; lipid-in-water emulsions are usually liquid, like milk or lotion and water-in-lipid emulsions tend to be creams. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]

Encephalomyelitis: A general term indicating inflammation of the brain and spinal cord, often used to indicate an infectious process, but also applicable to a variety of autoimmune and toxic-metabolic conditions. There is significant overlap regarding the usage of this term and encephalitis in the literature. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endocytosis: Cellular uptake of extracellular materials within membrane-limited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine

594 Pregnancy

mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endosonography: Ultrasonography of internal organs using an ultrasound transducer sometimes mounted on a fiberoptic endoscope. In endosonography the transducer converts electronic signals into acoustic pulses or continuous waves and acts also as a receiver to detect reflected pulses from within the organ. An audiovisual-electronic interface converts the detected or processed echo signals, which pass through the electronics of the instrument, into a form that the technologist can evaluate. The procedure should not be confused with endoscopy which employs a special instrument called an endoscope. The "endo-" of endosonography refers to the examination of tissue within hollow organs, with reference to the usual ultrasonography procedure which is performed externally or transcutaneously. [NIH]

Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid

Dictionary 595

and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Enteral Nutrition: Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [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]

Environmental tobacco smoke: ETS. Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers (second-hand smoke). Inhaling ETS is called involuntary or passive smoking. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophil: A polymorphonuclear leucocyte with large eosinophilic granules in its cytoplasm, which plays a role in hypersensitivity reactions. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH]

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Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelial ovarian cancer: Cancer that occurs in the cells lining the ovaries. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Erythrina: A genus of leguminous shrubs or trees, mainly tropical, yielding certain alkaloids, lectins, and other useful compounds. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Erythropoiesis: The production of erythrocytes. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Esotropia: A form of ocular misalignment characterized by an excessive convergence of the visual axes, resulting in a "cross-eye" appearance. An example of this condition occurs when

Dictionary 597

paralysis of the lateral rectus muscle causes an abnormal inward deviation of one eye on attempted gaze. [NIH] Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estriol: (16 alpha,17 beta)-Estra-1,3,5(10)-triene-3,16,17-triol. A metabolite of estradiol and usually the predominant estrogenic metabolite in urine. During pregnancy, large amounts of estriol are produced by the placenta. It has also been obtained from plant sources. The 16 beta-isomer has also been isolated from the urine of pregnant women. [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]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excrete: To get rid of waste from the body. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotropia: A form of ocular misalignment where the visual axes diverge inappropriately. For example, medial rectus muscle weakness may produce this condition as the affected eye will deviate laterally upon attempted forward gaze. An exotropia occurs due to the relatively unopposed force exerted on the eye by the lateral rectus muscle, which pulls the eye in an outward direction. [NIH] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extender: Any of several colloidal substances of high molecular weight, used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. [NIH] Extracellular: Outside a cell or cells. [EU]

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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] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Facial: Of or pertaining to the face. [EU] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [NIH] False Positive Reactions: Area that the program rates as suspicious but that the radiologist ultimately decides does not represent a possible malignancy. [NIH] Family Leave: The authorized absence from work of a family member to attend the illness or participate in the care of a parent, a sibling, or other family member. For the care of a parent for a child or for pre- or postnatal leave of a parent, parental leave is available. [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] Fatal Outcome: Death resulting from the presence of a disease in an individual, as shown by a single case report or a limited number of patients. This should be differentiated from death, the physiological cessation of life and from mortality, an epidemiological or statistical concept. [NIH] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH]

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Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH] Fetal Alcohol Syndrome: A disorder occurring in children born to alcoholic women who continue to drink heavily during pregnancy. Common abnormalities are growth deficiency (prenatal and postnatal), altered morphogenesis, mental deficiency, and characteristic facies - small eyes and flattened nasal bridge. Fine motor dysfunction and tremulousness are observed in the newborn. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Death: Death of the young developing in utero. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetal Distress: Adverse or threatening condition of the fetus identified by fetal bradycardia or tachycardia and passage of meconium in vertex presentation. [NIH] Fetal Growth Retardation: The failure of a fetus to attain its expected growth potential at any gestational stage. [NIH] Fetal Macrosomia: A complication of several conditions including diabetes mellitus and prolonged pregnancy. A macrosomic fetus is defined as weighing more than 4000 grams. [NIH]

Fetal Membranes: Thin layers of tissue which surround the embryo or fetus and provide for its nutrition, respiration, excretion and protection; they are the yolk sac, allantois, amnion, and chorion. [NIH] Fetal Monitoring: Physiologic or biochemical monitoring of the fetus. It is usually done during labor and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery. [NIH] Fetal Resorption: Death and resorption of the fetus at any stage after the completion of organogenesis which, in humans, is after the 9th week of gestation. It does not include embryo resorption. [NIH] Fetal Weight: The weight of the fetus in utero, which is usually estimated by various formulas based on measurements made during prenatal ultrasonography. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU]

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Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibroblast Growth Factor: Peptide isolated from the pituitary gland and from the brain. It is a potent mitogen which stimulates growth of a variety of mesodermal cells including chondrocytes, granulosa, and endothelial cells. The peptide may be active in wound healing and animal limb regeneration. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fibrosarcoma: A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place. [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] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fish Products: Food products manufactured from fish (e.g., fish flour, fish meal). [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] 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] Flatus: Gas passed through the rectum. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU]

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Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Foetal: Of or pertaining to a fetus; pertaining to in utero development after the embryonic period. [EU] Foetoplacental: Pertaining to the fetus and placenta. [EU] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Follicles: Shafts through which hair grows. [NIH] Follicular Fluid: A fluid consisting of sex steroid hormones, plasma proteins, mucopolysaccharides, and electrolytes that is present in the vesicular ovarian follicle (Graafian follicle) surrounding the ovum. [NIH] Follicular Phase: The period of the menstrual cycle that begins with menstruation and ends with ovulation. [NIH] Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. [NIH]

Food Handling: Any aspect of the operations in the preparation, transport, storage, packaging, wrapping, exposure for sale, service, or delivery of food. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fornix: A bundle of nerves connected to the hippocampus. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fossil Fuels: Any hydrocarbon deposit that may be used for fuel. Examples are petroleum, coal, and natural gas. [NIH] Fourth Ventricle: An irregularly shaped cavity in the rhombencephalon, between the medulla oblongata, the pons, and the isthmus in front, and the cerebellum behind. It is continuous with the central canal of the cord below and with the cerebral aqueduct above, and through its lateral and median apertures it communicates with the subarachnoid space. [NIH]

Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free

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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] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Fucose: Deoxysugar. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamete Intrafallopian Transfer: A technique that came into use in the mid-1980's for assisted conception in infertile women with normal fallopian tubes. The protocol consists of hormonal stimulation of the ovaries, followed by laparoscopic follicular aspiration of oocytes, and then the transfer of sperm and oocytes by catheterization into the fallopian tubes. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrinoma: A gastrin-secreting tumor of the non-beta islet cells. It is usually located in the pancreas but is also found at other sites, as in the antrum of the stomach, hilus of the spleen, and regional lymph nodes. The presence of gastrinoma is one of three requirements to be met for identification of Zollinger-Ellison syndrome, which sometimes occurs in families with multiple endocrine neoplasia type 1 (MEN-1). Gastrinomas in patients with MEN-1 are

Dictionary 603

usually diffuse in nature. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [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] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gelsolin: A 90-kD protein produced by macrophages that severs actin filaments and forms a cap on the newly exposed filament end. Gelsolin is activated by calcium ions and participates in the assembly and disassembly of actin, thereby increasing the motility of some cells. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Deletion: A genetic rearrangement through loss of segments of DNA or RNA, bringing sequences which are normally separated into close proximity. This deletion may be detected using cytogenetic techniques and can also be inferred from the phenotype, indicating a deletion at one specific locus. [NIH] Gene Dosage: The number of copies of a given gene present in a cell or nucleus. An increase in gene dosage can result in the formation of higher levels of gene product, provided that the gene is not subject to autogenous regulation. [NIH] Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH]

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Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetic Screening: Searching a population or individuals for persons possessing certain genotypes or karyotypes that: (1) are already associated with disease or predispose to disease; (2) may lead to disease in their descendants; or (3) produce other variations not known to be associated with disease. Genetic screening may be directed toward identifying phenotypic expression of genetic traits. It includes prenatal genetic screening. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestation period: The period of development of the young from the time of conception until birth. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gestational trophoblastic disease: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic tumor, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic neoplasia: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic tumor, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic tumor: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH]

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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] Gleason: Numerical value ranging from 1 to 5 used to indicate the degree of differentiation of the prostate cancer cells. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It

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is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycan: A type of long, unbranched polysaccharide molecule. Glycosaminoglycans are major structural components of cartilage and are also found in the cornea of the eye. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadotropic: Stimulating the gonads; applied to hormones of the anterior pituitary which influence the gonads. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [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] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to

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replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Granulocyte: A type of white blood cell that fights bacterial infection. Neutrophils, eosinophils, and basophils are granulocytes. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Granuloma Inguinale: Anogenital ulcers caused by Calymmatobacterium granulomatis as distinguished from lymphogranuloma inguinale (see lymphogranuloma venereum) caused by Chlamydia trachomatis. Diagnosis is made by demonstration of typical intracellular Donovan bodies in crushed-tissue smears. [NIH] Granulosa Cells: Cells of the membrana granulosa lining the vesicular ovarian follicle which become luteal cells after ovulation. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Guinea Pigs: A common name used for the family Caviidae. The most common species is Cavia porcellus which is the domesticated guinea pig used for pets and biomedical research. [NIH]

Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haematemesis: The vomiting of blood. [EU] Haematuria: Blood in the urine. [EU] Haemophilia: A haemorrhagic diathesis occurring in two main forms: 1. Haemophilia A (classic haemophilia, factor VIII deficiency), an X-linked disorder due to deficiency of coagulation factor VIII; 2. Haemophilia B (factor IX deficiency, Christmas disease), also Xlinked, due to deficiency of coagulation factor IX. Both forms are determined by a mutant gene near the telomere of the long arm of the X chromosome (Xq), but a different loci, and are characterized by subcutaneous and intramuscular haemorrhages; bleeding from the

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mouth, gums, lips, and tongue; haematuria; and haemarthroses. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Happiness: Highly pleasant emotion characterized by outward manifestations of gratification; joy. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Harmony: Attribute of a product which gives rise to an overall pleasant sensation. This sensation is produced by the perception of the product components as olfactory, gustatory, tactile and kinaesthetic stimuli because they are present in suitable concentration ratios. [NIH]

Hay Fever: A seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching, regarded as an allergic condition triggered by specific allergens. [NIH]

Hazardous Waste: Waste products which, upon release into the atmosphere, water or soil, cause health risks to humans or animals through skin contact, inhalation or ingestion. Hazardous waste sites which contain hazardous waste substances go here. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH]

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Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematopoiesis: The development and formation of various types of blood cells. [NIH] Hematopoietic Stem Cell Transplantation: The transference of stem cells from one animal or human to another (allogeneic), or within the same individual (autologous). The source for the stem cells may be the bone marrow or peripheral blood. Stem cell transplantation has been used as an alternative to autologous bone marrow transplantation in the treatment of a variety of neoplasms. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal

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failure. [NIH] Hemoperitoneum: Hemorrhage into the peritoneal cavity. [NIH] Hemophilia: Refers to a group of hereditary disorders in which affected individuals fail to make enough of certain proteins needed to form blood clots. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Hepatotoxic: Toxic to liver cells. [EU] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterodimer: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterotropia: One in which the angle of squint remains relatively unaltered on conjugate movement of the eyes. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of

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the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Holoprosencephaly: Anterior midline brain, cranial, and facial malformations resulting from the failure of the embryonic prosencephalon to undergo segmentation and cleavage. Alobar prosencephaly is the most severe form and features anophthalmia; cyclopia; severe mental retardation; cleft lip; cleft palate; seizures; and microcephaly. Semilobar holoprosencepaly is characterized by hypotelorism, microphthalmia, coloboma, nasal malformations, and variable degrees of mental retardation. Lobar holoprosencephaly is associated with mild (or absent) facial malformations and intellectual abilities that range from mild mental retardation to normal. Holoprosencephlay is associated with chromosome abnormalities. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homicide: The killing of one person by another. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homosexuality: Sexual attraction or relationship between members of the same sex. [NIH] Hookworms: A parasitic infection that may affect workers exposed to warm moist soil in which the larvae of the worm lives. [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] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hospital Records: Compilations of data on hospital activities and programs; excludes patient medical records. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein

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hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hybridoma: A hybrid cell resulting from the fusion of a specific antibody-producing spleen cell with a myeloma cell. [NIH] Hydatidiform Mole: A trophoblastic disease characterized by hydrops of the mesenchymal portion of the villus. Its karyotype is paternal and usually homozygotic. The tumor is indistinguishable from chorioadenoma destruens or invasive mole ( = hydatidiform mole, invasive) except by karyotype. There is no apparent relation by karyotype to choriocarcinoma. Hydatidiform refers to the presence of the hydropic state of some or all of the villi (Greek hydatis, a drop of water). [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hydroxysteroids: Steroids in which one or more hydroxy groups have been substituted for hydrogen atoms either within the ring skeleton or on any of the side chains. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperemesis: Excessive vomiting. [EU] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine betasynthase and is a risk factor for coronary vascular disease. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperoxaluria: Excretion of an excessive amount of oxalate in the urine. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypersecretion: Excessive secretion. [EU]

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Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hyperstimulation: Excessive stimulation. [EU] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertension, Renal: Hypertension due to renal diseases, especially chronic parenchymal disease. Hypertension as a result of compression or obstruction of the renal artery or its branches is hypertension, renovascular. [NIH] Hypertension, Renovascular: Hypertension due to compression or obstruction of the renal artery or its branches. [NIH] Hypertensive Encephalopathy: Brain dysfunction or damage resulting from malignant hypertension, usually associated with a diastolic blood pressure in excess of 125 mmHg. Clinical manifestations include headache, nausea, emesis, seizures, altered mental status (in some cases progressing to coma), papilledema, and retinal hemorrhage. Focal neurologic signs may develop. Pathologically, this condition may be associated with the formation of ischemic lesions in the brain (brain ischemia). [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophic cardiomyopathy: Heart muscle disease that leads to thickening of the heart walls, interfering with the heart's ability to fill with and pump blood. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypogonadism: Condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [NIH] Hypophyseal: Hypophysial. [EU] Hypophysis: A remnant of the entodermal pouch of Rathke beneath the mucous membrane of the pharynx, which shows pituitary tissue. [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypoplastic Left Heart Syndrome: A condition characterized by underdevelopment of the left cardiac chambers, atresia or stenosis of the aorta or mitral valve or both, and hypoplasia of the aorta. These anomalies are a common cause of heart failure in early infancy. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH]

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Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypovitaminosis: A condition due to a deficiency of one or more essential vitamins. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysteroscopy: Endoscopic examination, therapy or surgery of the interior of the uterus. [NIH]

Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [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]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immune Tolerance: The specific failure of a normally responsive individual to make an immune response to a known antigen. It results from previous contact with the antigen by an immunologically immature individual (fetus or neonate) or by an adult exposed to extreme high-dose or low-dose antigen, or by exposure to radiation, antimetabolites, antilymphocytic serum, etc. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH]

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Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunodiffusion: Technique involving the diffusion of antigen or antibody through a semisolid medium, usually agar or agarose gel, with the result being a precipitin reaction. [NIH]

Immunodominant Epitopes: Subunits of the antigenic determinant that are most easily recognized by the immune system and thus most influence the specificity of the induced antibody. [NIH] Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive Agents: Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of suppressor T-cell populations or by inhibiting the activation of helper cells. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of interleukins and other cytokines are emerging. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Impregnation: 1. The act of fecundation or of rendering pregnant. 2. The process or act of saturation; a saturated condition. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU]

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In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral bioavailability. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant Behavior: Any observable response or action of a neonate or infant up through the age of 23 months. [NIH] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [NIH] Infectious Mononucleosis: A common, acute infection usually caused by the Epstein-Barr virus (Human herpesvirus 4). There is an increase in mononuclear white blood cells and other atypical lymphocytes, generalized lymphadenopathy, splenomegaly, and occasionally hepatomegaly with hepatitis. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH]

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Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Inhibin: Glyceroprotein hormone produced in the seminiferous tubules by the Sertoli cells in the male and by the granulosa cells in the female follicles. The hormone inhibits FSH and LH synthesis and secretion by the pituitary cells thereby affecting sexual maturation and fertility. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Initiator: A chemically reactive substance which may cause cell changes if ingested, inhaled or absorbed into the body; the substance may thus initiate a carcinogenic process. [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] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inositol 1,4,5-Trisphosphate: Intracellular messenger formed by the action of phospholipase C on phosphatidylinositol 4,5-bisphosphate, which is one of the phospholipids that make up the cell membrane. Inositol 1,4,5-trisphosphate is released into the cytoplasm where it releases calcium ions from internal stores within the cell's endoplasmic reticulum. These calcium ions stimulate the activity of B kinase or calmodulin. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insect Repellents: Substances causing insects to turn away from them or reject them as food. [NIH]

Insecticides: Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own

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psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Instillation: . [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-13: T-lymphocyte-derived cytokine that produces proliferation, immunoglobulin isotype switching, and immunoglobulin production by immature Blymphocytes. It appears to play a role in regulating inflammatory and immune responses. [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] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU]

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Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intrahepatic: Within the liver. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraspecific: Occurring among members of a single species. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Involution: 1. A rolling or turning inward. 2. One of the movements involved in the gastrulation of many animals. 3. A retrograde change of the entire body or in a particular organ, as the retrograde changes in the female genital organs that result in normal size after delivery. 4. The progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Transport: The movement of ions across energy-transducing cell membranes. Transport can be active or passive. Passive ion transport (facilitated diffusion) derives its energy from the concentration gradient of the ion itself and allows the transport of a single solute in one direction (uniport). Active ion transport is usually coupled to an energy-yielding chemical or photochemical reaction such as ATP hydrolysis. This form of primary active transport is called an ion pump. Secondary active transport utilizes the voltage and ion gradients

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produced by the primary transport to drive the cotransport of other ions or molecules. These may be transported in the same (symport) or opposite (antiport) direction. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Islet: Cell producing insulin in pancreas. [NIH] Isoelectric: Separation of amphoteric substances, dissolved in water, based on their isoelectric behavior. The amphoteric substances are a mixture of proteins to be separated and of auxiliary "carrier ampholytes". [NIH] Isoelectric Focusing: Electrophoresis in which a pH gradient is established in a gel medium and proteins migrate until they reach the site (or focus) at which the pH is equal to their isoelectric point. [NIH] Isoelectric Point: The pH in solutions of proteins and related compounds at which the dipolar ions are at a maximum. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [NIH] Karyotype: The characteristic chromosome complement of an individual, race, or species as defined by their number, size, shape, etc. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU]

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Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Killer Cells: Lymphocyte-like effector cells which mediate antibody-dependent cell cytotoxicity. They kill antibody-coated target cells which they bind with their Fc receptors. [NIH]

Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lacrimal: Pertaining to the tears. [EU] Lacrimal gland: The small almond-shaped structure that produces tears; located just above the outer corner of the eye. [NIH] Lactation: The period of the secretion of milk. [EU] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large

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intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lateral Ventricles: Cavity in each of the cerebral hemispheres derived from the cavity of the embryonic neural tube. They are separated from each other by the septum pellucidum, and each communicates with the third ventricle by the foramen of Monro, through which also the choroid plexuses of the lateral ventricles become continuous with that of the third ventricle. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lead Poisoning: Disease caused by the gradual accumulation of a significant body burden of lead. [NIH] Learning Disorders: Conditions characterized by a significant discrepancy between an individual's perceived level of intellect and their ability to acquire new language and other cognitive skills. These disorders may result from organic or psychological conditions. Relatively common subtypes include dyslexia, dyscalculia, and dysgraphia. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lenticular: 1. Pertaining to or shaped like a lens. 2. Pertaining to the crystalline lens. 3. Pertaining to the lenticular nucleus. [EU] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukaemia: An acute or chronic disease of unknown cause in man and other warm-blooded animals that involves the blood-forming organs, is characterized by an abnormal increase in the number of leucocytes in the tissues of the body with or without a corresponding increase of those in the circulating blood, and is classified according of the type leucocyte most prominently involved. [EU]

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Leukemia: Cancer of blood-forming tissue. [NIH] Leukocyte Count: A count of the number of white blood cells per unit volume in venous blood. A differential leukocyte count measures the relative numbers of the different types of white cells. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukoencephalopathy: A condition with spongy holes in the brain's white matter. [NIH] Leukopenia: A condition in which the number of leukocytes (white blood cells) in the blood is reduced. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligase: An enzyme that repairs single stranded discontinuities in double-stranded DNA molecules in the cell. Purified DNA ligase is used in gene cloning to join DNA molecules together. [NIH] Ligase Chain Reaction: A DNA amplification technique based upon the ligation of oligonucleotide probes. The probes are designed to exactly match two adjacent sequences of a specific target DNA. The chain reaction is repeated in three steps in the presence of excess probe: (1) heat denaturation of double-stranded DNA, (2) annealing of probes to target DNA, and (3) joining of the probes by thermostable DNA ligase. After the reaction is repeated for 20-30 cycles the production of ligated probe is measured. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival

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behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipolysis: The hydrolysis of lipids. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoprotein(a): A family of lipoprotein particles varying in density and size depending on the protein-lipid ratio and the protein composition. These particles consist of apolipoprotein B-100 covalently linked to apolipoprotein-a by one or two disulfide bonds. There is a correlation between high plasma levels of this lipoprotein and increased risk for atherosclerotic cardiovascular disease. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Litter: Appliance consisting of an oblong frame over which is stretched a canvas or other material, used for carrying an injured or disabled person. [NIH] Litter Size: The number of offspring produced at one birth by an animal. [NIH]

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Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Loratadine: A second-generation histamine H1 receptor antagonist used in the treatment of allergic rhinitis and urticaria. Unlike most classical antihistamines it lacks central nervous system depressing effects such as drowsiness. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back, saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

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Lubricants: Oily or slippery substances. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lupus Nephritis: Glomerulonephritis associated with systemic lupus erythematosus. It is classified into four histologic types: mesangial, focal, diffuse, and membranous. [NIH] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Luteolytic Agents: Chemical compounds causing corpus luteum regression or degeneration. [NIH]

Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [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]

Lymphadenopathy: Disease or swelling of the lymph nodes. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphoblastic: One of the most aggressive types of non-Hodgkin lymphoma. [NIH] Lymphoblasts: Interferon produced predominantly by leucocyte cells. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphogranuloma Venereum: Subacute inflammation of the inguinal lymph glands caused by certain immunotypes of Chlamydia trachomatis. It is a sexually transmitted disease in the U.S. but is more widespread in developing countries. It is distinguished from granuloma venereum (granuloma inguinale), which is caused by Calymmatobacterium granulomatis. [NIH]

Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH]

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Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lysophospholipase: An enzyme that catalyzes the hydrolysis of a single fatty acid ester bond in lysoglycerophosphatidates with the formation of glyceryl phosphatidates and a fatty acid. EC 3.1.1.5. [NIH] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [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] Macrophage Activation: The process of altering the morphology and functional activity of macrophages so that they become avidly phagocytic. It is initiated by lymphokines, such as the macrophage activation factor (MAF) and the macrophage migration-inhibitory factor (MMIF), immune complexes, C3b, and various peptides, polysaccharides, and immunologic adjuvants. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU]

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Mammography: Radiographic examination of the breast. [NIH] Mandatory Testing: Testing or screening required by federal, state, or local law or other agencies for the diagnosis of specified conditions. It is usually limited to specific populations such as categories of health care providers, members of the military, and prisoners or to specific situations such as premarital examinations or donor screening. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Marital Status: A demographic parameter indicating a person's status with respect to marriage, divorce, widowhood, singleness, etc. [NIH] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Maternal Mortality: Maternal deaths resulting from complications of pregnancy and childbirth in a given population. [NIH] 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] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Meat Products: Articles of food which are derived by a process of manufacture from any portion of carcasses of any animal used for food (e.g., head cheese, sausage, scrapple). [NIH] Mebendazole: A nematocide in humans and animals. It acts by interfering with the carbohydrate metabolism and associated energy production of the parasite. [NIH] Meconium: The thick green-to-black mucilaginous material found in the intestines of a fullterm fetus. It consists of secretions of the intestinal glands, bile pigments, fatty acids, amniotic fluid, and intrauterine debris. It constitutes the first stools passed by a newborn. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen

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with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Assistance: Financing of medical care provided to public assistance recipients. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH] Membrane Lipids: Lipids, predominantly phospholipids, cholesterol and small amounts of glycolipids found in membranes including cellular and intracellular membranes. These lipids may be arranged in bilayers in the membranes with integral proteins between the layers and peripheral proteins attached to the outside. Membrane lipids are required for active transport, several enzymatic activities and membrane formation. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Menarche: The establishment or beginning of the menstrual function. [EU] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental deficiency: A condition of arrested or incomplete development of mind from inherent causes or induced by disease or injury. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the

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adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mercaptopurine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesenteric Arteries: Arteries which arise from the abdominal aorta and distribute to most of the intestines. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metaphase: The second phase of cell division, in which the chromosomes line up across the equatorial plane of the spindle prior to separation. [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] Metastasize: To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH]

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Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Methyltransferase: A drug-metabolizing enzyme. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [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] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Midwifery: The practice of assisting women in childbirth. [NIH] Mifepristone: A progestational and glucocorticoid hormone antagonist. Its inhibition of progesterone induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. As a glucocorticoid receptor antagonist, the drug has been used to treat hypercortisolism in patients with nonpituitary

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Cushing syndrome. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Mineralocorticoid: 1. Any of the group of C21 corticosteroids, principally aldosterone, predominantly involved in the regulation of electrolyte and water balance through their effect on ion transport in epithelial cells of the renal tubules, resulting in retention of sodium and loss of potassium; some also possess varying degrees of glucocorticoid activity. Their secretion is regulated principally by plasma volume, serum potassium concentration and angiotensin II, and to a lesser extent by anterior pituitary ACTH. 2. Of, pertaining to, having the properties of, or resembling a mineralocorticoid. [EU] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Miscible: Susceptible of being mixed. [EU] Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molar pregnancy: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or choriocarcinoma. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other

Dictionary 633

procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocyte: A type of white blood cell. [NIH] Monogenic: A human disease caused by a mutation in a single gene. [NIH] Mononuclear: A cell with one nucleus. [NIH] Mononucleosis: The presence of an abnormally large number of mononuclear leucocytes (monocytes) in the blood. The term is often used alone to refer to infectious mononucleosis. [EU]

Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Monosomy: The condition in which one chromosome of a pair is missing. In a normally diploid cell it is represented symbolically as 2N-1. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Morula: The early embryo at the developmental stage in which the blastomeres, resulting from repeated mitotic divisions of the fertilized ovum, form a compact mass. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motivations: The most compelling inner determinants of human behavior; also called drives, urges, impulses, needs, wants, tensions, and willful cravings. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Motor Skills: Performance of complex motor acts. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucilaginous: Pertaining to or secreting mucus. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or

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glycoprotein, the chief constituent of mucus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multidose: Occurring in, or using multiple doses. [EU] Multidrug resistance: Adaptation of tumor cells to anticancer drugs in ways that make the drugs less effective. [NIH] Multiparous: 1. Having had two or more pregnancies which resulted in viable fetuses. 2. Producing several ova or offspring at one time. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mutagen: Any agent, such as X-rays, gamma rays, mustard gas, TCDD, that can cause abnormal mutation in living cells; having the power to cause mutations. [NIH] Mutagenic: Inducing genetic mutation. [EU] Myalgia: Pain in a muscle or muscles. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myeloma: Cancer that arises in plasma cells, a type of white blood cell. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myograph: A recording instrument by which tracings are made of muscular contractions. [NIH]

Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the

Dictionary 635

organ. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Nadir: The lowest point; point of greatest adversity or despair. [EU] Naive: Used to describe an individual who has never taken a certain drug or class of drugs (e. g., AZT-naive, antiretroviral-naive), or to refer to an undifferentiated immune system cell. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Natural Childbirth: Psychophysical relaxation techniques that are used to facilitate childbirth. [NIH] Natural killer cells: NK cells. A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called large granular lymphocytes (LGL). [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] 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] Needle Sharing: Usage of a single needle among two or more people for injecting drugs. Needle sharing is a high-risk behavior for contracting infectious disease. [NIH] Needlestick Injuries: Penetrating stab wounds caused by needles. They are of special concern to health care workers since such injuries put them at risk for developing infectious disease. [NIH] Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed. [NIH] Nelfinavir: A potent HIV protease inhibitor. It is used in combination with other antiviral drugs in the treatment of HIV in both adults and children. [NIH] Nematocide: A chemical used to kill nematodes. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process

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which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nephrotic Syndrome: Clinical association of heavy proteinuria, hypoalbuminemia, and generalized edema. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurogenic Inflammation: Inflammation caused by an injurious stimulus of peripheral neurons and resulting in release of neuropeptides which affect vascular permeability and help initiate proinflammatory and immune reactions at the site of injury. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH]

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Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Neutrophil Activation: The process in which the neutrophil is stimulated by diverse substances, resulting in degranulation and/or generation of reactive oxygen products, and culminating in the destruction of invading pathogens. The stimulatory substances, including opsonized particles, immune complexes, and chemotactic factors, bind to specific cellsurface receptors on the neutrophil. [NIH] Nevirapine: A potent, non-nucleoside reverse transcriptase inhibitor used in combination with nucleoside analogues for treatment of HIV infection and AIDS. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nidation: Implantation of the conceptus in the endometrium. [EU] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

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] Non-nucleoside: A member of a class of compounds, including delavirdine, loviride and nevirapine, that acts to directly combine with and block the action of HIV's reverse transcriptase. [NIH] Nonoxynol: Nonionic surfactant mixtures varying in the number of repeating ethoxy (oxy1,2-ethanediyl) groups. They are used as detergents, emulsifiers, wetting agents, defoaming

638 Pregnancy

agents, etc. Nonoxynol-9, the compound with 9 repeating ethoxy groups, is a spermatocide, formulated primarily as a component of vaginal foams and creams. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Proteins: Proteins found in the nucleus of a cell. Do not confuse with nucleoproteins which are proteins conjugated with nucleic acids, that are not necessarily present in the nucleus. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleoproteins: Proteins conjugated with nucleic acids. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Research: Research carried out by nurses, generally in clinical settings, in the areas of clinical practice, evaluation, nursing education, nursing administration, and methodology. [NIH] Nutrition Assessment: Evaluation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual. Nutrition surveys may be used in making the assessment. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH]

Dictionary 639

Obsession: A recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions involve thoughts of violence, contamination, and selfdoubt. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occupational Groups: Members of the various professions (e.g., physicians) or occupations (e.g., police). [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Oestradiol: Growth hormone. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oligohydramnios: Presence of less than 300 ml of amniotic fluid at term. Principal causes include malformations of fetal urinary tracts, intra-uterine growth retardation, high maternal blood pressure, nicotine poisoning, and prolonged pregnancy. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Oligonucleotide Probes: Synthetic or natural oligonucleotides used in hybridization studies in order to identify and study specific nucleic acid fragments, e.g., DNA segments near or within a specific gene locus or gene. The probe hybridizes with a specific mRNA, if present. Conventional techniques used for testing for the hybridization product include dot blot assays, Southern blot assays, and DNA:RNA hybrid-specific antibody tests. Conventional labels for the probe include the radioisotope labels 32P and 125I and the chemical label biotin. [NIH]

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Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Opacity: Degree of density (area most dense taken for reading). [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] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Organogenesis: Clonal propagation which involves culturing explants from roots, leaves, or stems to form undifferentiated callus tissue; after the cells form shoots, they are separated and rooted. Alternatively, if the callus is put in liquid culture, somatic embryos form. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH]

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Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Ornithosis: Infection with Chlamydophila psittaci (formerly Chlamydia psittaci), transmitted to man by inhalation of dust-borne contaminated nasal secretions or excreta of infected birds. This infection results in a febrile illness characterized by pneumonitis and systemic manifestations. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] 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] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU]

Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Ovalbumin: An albumin obtained from the white of eggs. It is a member of the serpin superfamily. [NIH] Ovarian Cysts: General term for cysts and cystic diseases of the ovary. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovarian Hyperstimulation Syndrome: Syndrome composed of a combination of ovarian

642 Pregnancy

enlargement and an acute fluid shift out of the intravascular space. The enlargement is caused by ovarian cyst formation and the fluid shift may result in ascites, hydrothorax, or generalized edema. The syndrome is most usually seen as a complication of ovulation induction, a treatment for infertility. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovulation Induction: Techniques for the artifical induction of ovulation. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Ovum Implantation: Endometrial implantation of the blastocyst. [NIH] Oxalate: A chemical that combines with calcium in urine to form the most common type of kidney stone (calcium oxalate stone). [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [NIH]

Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxytocic: 1. Pertaining to, characterized by, or promoting oxytocia (= rapid labor). 2. An agent that hastens evacuation of the uterus by stimulating contractions of the myometrium. [EU]

Dictionary 643

Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [NIH]

Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] 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] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Panniculitis: General term for inflammation of adipose tissue, usually of the skin, characterized by reddened subcutaneous nodules. [NIH] Papilledema: Swelling around the optic disk. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct exposure. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH]

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Parathyroidectomy: Excision of one or both of the parathyroid glands. [NIH] Parental Leave: The authorized absence from work of either parent prior to and after the birth of their child. It includes also absence because of the illness of a child or at the time of the adoption of a child. It does not include leave for care of siblings, parents, or other family members: for this family leave is available. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Partial response: A decrease in the size of a tumor, or in the extent of cancer in the body, in response to treatment. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Patch-Clamp Techniques: An electrophysiologic technique for studying cells, cell membranes, and occasionally isolated organelles. All patch-clamp methods rely on a very high-resistance seal between a micropipette and a membrane; the seal is usually attained by gentle suction. The four most common variants include on-cell patch, inside-out patch, outside-out patch, and whole-cell clamp. Patch-clamp methods are commonly used to voltage clamp, that is control the voltage across the membrane and measure current flow, but current-clamp methods, in which the current is controlled and the voltage is measured, are also used. [NIH] Patella: The flat, triangular bone situated at the anterior part of the knee. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH]

Dictionary 645

Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Peer Group: Group composed of associates of same species, approximately the same age, and usually of similar rank or social status. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pensions: Fixed sums paid regularly to individuals. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Chain Elongation: The process whereby an amino acid is joined through a substituted amide linkage to a chain of peptides. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perennial: Lasting through the year of for several years. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU]

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Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Periaqueductal Gray: Central gray matter surrounding the cerebral aqueduct in the mesencephalon. Physiologically it is probably involved in rage reactions, the lordosis reflex, feeding responses, bladder tonus, and pain. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineum: The area between the anus and the sex organs. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Perioral: Situated or occurring around the mouth. [EU] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Perivascular: Situated around a vessel. [EU] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pesticides: Chemicals used to destroy pests of any sort. The concept includes fungicides (industrial fungicides), insecticides, rodenticides, etc. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH]

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PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phorbol: Class of chemicals that promotes the development of tumors. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for

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the body's cells.) [NIH] Phosphorylate: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Phosphotyrosine: An amino acid that occurs in endogenous proteins. Tyrosine phosphorylation and dephosphorylation plays a role in cellular signal transduction and possibly in cell growth control and carcinogenesis. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical 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]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placebos: Any dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Placental tissue: The tissue intervening between fetal blood and maternal blood in the placenta; it acts as a selective membrane regulating the passage of substances from the maternal to the fetal blood. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plaque Assay: Method for measuring viral infectivity and multiplication in cultured cells.

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Clear lysed areas or plaques develop as the viral particles are released from the infected cells during incubation. With some viruses, the cells are killed by a cytopathic effect; with others, the infected cells are not killed but can be detected by their hemadsorptive ability. Sometimes the plaque cells contain viral antigens which can be measured by immunofluorescence. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelet Count: A count of the number of platelets per unit volume in a sample of venous blood. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Pneumonitis: A disease caused by inhaling a wide variety of substances such as dusts and

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molds. Also called "farmer's disease". [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Ovary Syndrome: Clinical symptom complex characterized by oligomenorrhea or amenorrhea, anovulation, and regularly associated with bilateral polycystic ovaries. [NIH] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polyhydramnios: Excess of amniotic fluid greater than 2,000 ml. It is a common obstetrical complication whose major causes include maternal diabetes, chromosomal disorders, isoimmunological disease, congenital abnormalities, and multiple gestations. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polyradiculopathy: Disease or injury involving multiple spinal nerve roots. Polyradiculitis refers to inflammation of multiple spinal nerve roots. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency,

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commonly seen in diabetes. [NIH] Polyvalent: Having more than one valence. [EU] Population Control: Includes mechanisms or programs which control the numbers of individuals in a population of humans or animals. [NIH] Population Growth: Increase, over a specific period of time, in the number of individuals living in a country or region. [NIH] Porokeratosis: A rare, chronic, progressive autosomal dominant disorder seen most often in males and usually appearing in early childhood. It is characterized by the formation of slightly atrophic patches surrounded by an elevated, keratotic border. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Post partum: After childbirth, or after delivery. [EU] 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] Postmenopause: The physiological period following the menopause, the permanent cessation of the menstrual life. Since in the United States the age of the menopause ranges between 48 and 55 years, generally conceived as middle age, the postmenopause often refers to women considerably older. [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postnatal Care: The care provided a woman following the birth of a child. [NIH] Postoperative: After surgery. [NIH] Postoperative Nausea and Vomiting: Emesis and queasiness occurring after anesthesia. [NIH]

Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Channels: Cell membrane glycoproteins selective for potassium ions. [NIH] Potassium Chloride: Potassium chloride. A white crystal or crystalline powder used as an electrolyte replenisher, in the treatment of hypokalemia, in buffer solutions, and in fertilizers and explosives. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and

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costs. [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] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Preconception Care: An organized and comprehensive program of health care that identifies and reduces a woman's reproductive risks before conception through risk assessment, health promotion, and interventions. Preconception care programs may be designed to include the male partner in providing counseling and educational information in preparation for fatherhood, such as genetic counseling and testing, financial and family planning, etc. This concept is different from prenatal care, which occurs during pregnancy. [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] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Pre-Eclampsia: Development of hypertension with proteinuria, edema, or both, due to pregnancy or the influence of a recent pregnancy. It occurs after the 20th week of gestation, but it may develop before this time in the presence of trophoblastic disease. [NIH] Pre-eclamptic: A syndrome characterized by hypertension, albuminuria, and generalized oedema, occurring only in pregnancy. [NIH] Pregnancy Complications: The co-occurrence of pregnancy and a disease. The disease may precede or follow conception and it may or may not have a deleterious effect on the pregnant woman or fetus. [NIH] Pregnancy Maintenance: Physiological mechanisms that sustain the state of pregnancy. [NIH]

Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Pregnancy Toxemias: Pregnancy-induced hypertensive states, including EPH gestosis when edema and proteinuria accompany hypertension. Other hypertensive disorders that develop during pregnancy or the puerperium are pre-eclampsia and eclampsia, either of which may be superimposed upon chronic hypertensive vascular or renal disease. [NIH]

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Pregnancy, High-Risk: Pregnancy in which the mother and/or fetus are at greater than normal risk of morbidity or mortality. Causes include lack of adequate prenatal care, previous obstetrical history, pre-existing maternal disease or pregnancy-induced disease, and multiple gestation, as well as advanced maternal age. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. [NIH] Presumptive: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and cirrhosis in later stages of the disease. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Primary tumor: The original tumor. [NIH] Prion: Small proteinaceous infectious particles that resist inactivation by procedures modifying nucleic acids and contain an abnormal isoform of a cellular protein which is a major and necessary component. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progeny: The offspring produced in any generation. [NIH]

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Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Program Development: The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development). [NIH]

Program Evaluation: Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proliferative Retinopathy: A disease of the small blood vessels of the retina of the eye. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prosencephalon: The part of the brain developed from the most rostral of the three primary vesicles of the embryonic neural tube and consisting of the diencephalon and telencephalon. [NIH]

Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH]

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Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandin-Endoperoxide Synthase: An enzyme complex that catalyzes the formation of prostaglandins from the appropriate unsaturated fatty acid, molecular oxygen, and a reduced acceptor. EC 1.14.99.1. [NIH] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [NIH] Prostaglandins F: (9 alpha,11 alpha,13E,15S)-9,11,15-Trihydroxyprost-13-en-1-oic acid (PGF(1 alpha)); (5Z,9 alpha,11,alpha,13E,15S)-9,11,15-trihydroxyprosta-5,13-dien-1-oic acid (PGF(2 alpha)); (5Z,9 alpha,11 alpha,13E,15S,17Z)-9,11,15-trihydroxyprosta-5,13,17-trien-1oic acid (PGF(3 alpha)). A family of prostaglandins that includes three of the six naturally occurring prostaglandins. All naturally occurring PGF have an alpha configuration at the 9carbon position. They stimulate uterine and bronchial smooth muscle and are often used as oxytocics. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [NIH] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH]

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Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [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] Protein Subunits: Single chains of amino acids that are the units of a multimeric protein. They can be identical or non-identical subunits. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] 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] Proteome: The protein complement of an organism coded for by its genome. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Protozoan Infections: Infections with unicellular organisms of the subkingdom Protozoa. [NIH]

Proximal: Nearest; closer to any point of reference; opposed to distal. [EU]

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Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pseudocysts: A collection of enzyme-rich pancreatic fluid and tissue debris arising within areas of necrosis or an obstructed smaller duct. [NIH] Pseudopregnancy: Any abdominal condition resembling pregnancy. [NIH] Psittaci: Causal agent of ornithosis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotomimetic: Psychosis miming. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Emphysema: Condition of the lungs characterized by increase beyond normal in the size of air spaces distal to the terminal bronchioles, either from dilatation of the alveoli or from destruction of their walls. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

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Pupil: The aperture in the iris through which light passes. [NIH] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Putrescine: A toxic diamine formed by putrefaction from the decarboxylation of arginine and ornithine. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Pyramidal Cells: Projection neurons in the cerebral cortex and the hippocampus. Pyramidal cells have a pyramid-shaped soma with the apex and an apical dendrite pointed toward the pial surface and other dendrites and an axon emerging from the base. The axons may have local collaterals but also project outside their cortical region. [NIH] Pyridoxal: 3-Hydroxy-5-(hydroxymethyl)-2-methyl-4- pyridinecarboxaldehyde. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quiescent: Marked by a state of inactivity or repose. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioactive iodine: A radioactive form of the chemical element iodine, often used for

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imaging tests or as a treatment for cancer. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Rage: Fury; violent, intense anger. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Ranitidine: A non-imidazole blocker of those histamine receptors that mediate gastric secretion (H2 receptors). It is used to treat gastrointestinal ulcers. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure,

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produce, etc., other substances. [EU] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptivity: The condition of the reproductive organs of a female flower that permits effective pollination. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Reconstitution: 1. A type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. The restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regional lymph node: In oncology, a lymph node that drains lymph from the region around a tumor. [NIH]

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Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Relaxin: Hormone produced by the ovaries during pregnancy that loosens ligaments that hold the hip bones together. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [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] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal Circulation: The circulation of the blood through the vessels of the kidney. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Reproductive History: An important aggregate factor in epidemiological studies of

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women's health. The concept usually includes the number and timing of pregnancies and their outcomes, the incidence of breast feeding, and may include age of menarche and menopause, regularity of menstruation, fertility, gynecological or obstetric problems, or contraceptive usage. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]

Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Reticulata: Part of substantia nigra. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Hemorrhage: Bleeding from the vessels of the retina. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH]

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Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Reverse Transcriptase Inhibitors: Inhibitors of reverse transcriptase (RNA-directed DNA polymerase), an enzyme that synthesizes DNA on an RNA template. [NIH] Reversion: A return to the original condition, e. g. the reappearance of the normal or wild type in previously mutated cells, tissues, or organisms. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [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] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rhythm Method: A contraceptive method whereby abstinence is practiced a few days before and after the estimated day of ovulation. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Ribonuclease: RNA-digesting enzyme. [NIH] Ribonucleic acid: RNA. One of the two nucleic acids found in all cells. The other is deoxyribonucleic acid (DNA). Ribonucleic acid transfers genetic information from DNA to proteins produced by the cell. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of

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person he/she is. [EU] Risk-Taking: Undertaking a task involving a challenge for achievement or a desirable goal in which there is a lack of certainty or a fear of failure. It may also include the exhibiting of certain behaviors whose outcomes may present a risk to the individual or to those associated with him or her. [NIH] Ritonavir: An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rodenticides: Substances used to destroy or inhibit the action of rats, mice, or other rodents. [NIH]

Role Playing: The adopting or performing the role of another significant individual in order to gain insight into the behavior of that person. [NIH] Role-play: In this method, a conflict is artificially constructed, and the trainee is given a strategic position in it. [NIH] Roseolovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, whose viruses have been isolated from lymphocytes. Human herpesvirus 6 is the type species. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Ruminants: A suborder of the order Artiodactyla whose members have the distinguishing feature of a four-chambered stomach. Horns or antlers are usually present, at least in males. [NIH]

Sacroiliac Joint: The immovable joint formed by the lateral surfaces of the sacrum and ilium. [NIH] Salicylic: A tuberculosis drug. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salpingectomy: Excision if a uterine tube. [NIH] Salpingostomy: Formation of an artificial opening in a fallopian tube. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid

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or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Saquinavir: An HIV protease inhibitor which acts as an analog of an HIV protease cleavage site. It is a highly specific inhibitor of HIV-1 and HIV-2 proteases. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Scrapie: A fatal disease of the nervous system in sheep and goats, characterized by pruritus, debility, and locomotor incoordination. It is caused by proteinaceous infectious particles called prions. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Seafood: Marine fish and shellfish used as food or suitable for food. (Webster, 3d ed) shellfish and fish products are more specific types of seafood. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast

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cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Secular trends: A relatively long-term trend in a community or country. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [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] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming;

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immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septate: An organ or structure that is divided into compartments. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Behavior: Sexual activities of humans. [NIH] Sex Behavior, Animal: Sexual activities of animals. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to

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reproduction. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH] Sex Education: Education which increases the knowledge of the functional, structural, and behavioral aspects of human reproduction. [NIH] Sexual Abstinence: Refraining from sexual intercourse. [NIH] Sexual Harassment: A form of discrimination in the workplace which violates the Civil Rights Act of 1964. Sexual harassment takes two forms: quid pro quo, where the employee must submit to sexual advances in exchange for job benefits or be penalized for refusing; or a hostile environment, where the atmosphere of the workplace is offensive and affects the employee's well-being. Offensive sexual conduct may include unwelcome advances, comments, touching, questions about marital status and sex practices, etc. Both men and women may be aggressors or victims. (Slee and Slee, Health Care Terms, 2d ed, p.404). While civil rights legislation deals with sexual harassment in the workplace, the behavior is not restricted to this; it may take place outside the work environment: in schools and colleges, athletics, and other social milieus and activities. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Sickle Cell Trait: The condition of being heterozygous for hemoglobin S. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH]

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Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin test: A test for an immune response to a compound by placing it on or under the skin. [NIH]

Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Sludge: A clump of agglutinated red blood cells. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Smooth Muscle Tumor: A tumor composed of smooth muscle tissue, as opposed to leiomyoma, a tumor derived from smooth muscle. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Medicine: A branch of medicine concerned with the role of socio-environmental factors in the occurrence, prevention and treatment of disease. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [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

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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] Soft tissue sarcoma: A sarcoma that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sperm Count: A count of sperm in the ejaculum, expressed as number per milliliter. [NIH] Spermicide: An agent that is destructive to spermatozoa. [EU] Spermidine: A polyamine formed from putrescine. It is found in almost all tissues in association with nucleic acids. It is found as a cation at all pH values, and is thought to help stabilize some membranes and nucleic acid structures. It is a precursor of spermine. [NIH] Spermine: A biogenic polyamine formed from spermidine. It is found in a wide variety of organisms and tissues and is an essential growth factor in some bacteria. It is found as a polycation at all pH values. Spermine is associated with nucleic acids, particularly in

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viruses, and is thought to stabilize the helical structure. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sporotrichosis: The commonest and least serious of the deep mycoses, characterized by nodular lesions of the cutaneous and subcutaneous tissues. It is caused by inhalation of contaminated dust or by infection of a wound. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Sprayer: A device for converting a medicated liquid into a vapor for inhalation; an instrument for applying a spray which is a jet of fine medicated vapor used either as an application to a diseased part or to charge the air of a room with a disinfectant. [NIH] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover

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internal and external surfaces of the body. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

State Government: The level of governmental organization and function below that of the national or country-wide government. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steady state: Dynamic equilibrium. [EU] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem cell transplantation: A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Sterilization Reversal: Reversal of sexual sterilization. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH]

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Strabismus: Deviation of the eye which the patient cannot overcome. The visual axes assume a position relative to each other different from that required by the physiological conditions. The various forms of strabismus are spoken of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia. Called also cast, heterotropia, manifest deviation, and squint. [EU] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [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] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Sublingual: Located beneath the tongue. [EU] Submucous: Occurring beneath the mucosa or a mucous membrane. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and

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peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acid-binding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sulfonic Acids: Inorganic or organic oxy acids of sulfur which contain the RSO2(OH) radical. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulfuric acid: A strong acid that, when concentrated is extemely corrosive to the skin and mucous membranes. It is used in making fertilizers, dyes, electroplating, and industrial explosives. [NIH] Sumatriptan: A serotonin agonist that acts selectively at 5HT1 receptors. It is used in the treatment of migraines. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] 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] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Suppuration: A pathologic process consisting in the formation of pus. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH]

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Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synchrony: The normal physiologic sequencing of atrial and ventricular activation and contraction. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Syphilis, Congenital: Syphilis acquired in utero and manifested by any of several characteristic tooth (Hutchinson's teeth) or bone malformations and by active mucocutaneous syphilis at birth or shortly thereafter. Ocular and neurologic changes may also occur. [NIH] Systemic: Affecting the entire body. [NIH]

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Systemic disease: Disease that affects the whole body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Technology Transfer: Spread and adoption of inventions and techniques from one geographic area to another, from one discipline to another, or from one sector of the economy to another. For example, improvements in medical equipment may be transferred from industrial countries to developing countries, advances arising from aerospace engineering may be applied to equipment for persons with disabilities, and innovations in science arising from government research are made available to private enterprise. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Telomere: A terminal section of a chromosome which has a specialized structure and which is involved in chromosomal replication and stability. Its length is believed to be a few hundred base pairs. [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] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [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] Teratogen: A substance which, through immediate, prolonged or repeated contact with the skin may involve a risk of subsequent non-hereditable birth defects in offspring. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Teratogenicity: The power to cause abnormal development. [NIH] Terbutaline: A selective beta-2 adrenergic agonist used as a bronchodilator and tocolytic. [NIH]

Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH]

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Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetani: Causal agent of tetanus. [NIH] Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Theca Cells: The connective tissue cells of the ovarian follicle. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood

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vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombopenia: Reduction in the number of platelets in the blood. [NIH] Thrombophilia: A disorder of hemostasis in which there is a tendency for the occurrence of thrombosis. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [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] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] 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] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH]

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Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tissue Distribution: Accumulation of a drug or chemical substance in various organs (including those not relevant to its pharmacologic or therapeutic action). This distribution depends on the blood flow or perfusion rate of the organ, the ability of the drug to penetrate organ membranes, tissue specificity, protein binding. The distribution is usually expressed as tissue to plasma ratios. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tome: A zone produced by a number of irregular spaces contained in the outermost layer of denture of the root of a tooth. [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] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxemia: A generalized intoxication produced by toxins and other substances elaborated by an infectious agent. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Toxoplasma: A genus of protozoa parasitic to birds and mammals. T. gondii is one of the most common infectious pathogenic animal parasites of man. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

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Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU]

Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

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Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triad: Trivalent. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Trichinosis: A disease due to infection with Trichinella spiralis. It is caused by eating undercooked meat, usually pork. [NIH] Trichloroethylene: A highly volatile inhalation anesthetic used mainly in short surgical procedures where light anesthesia with good analgesia is required. It is also used as an industrial solvent. Prolonged exposure to high concentrations of the vapor can lead to cardiotoxicity and neurological impairment. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Trichotillomania: Compulsion to pull out one's hair. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH]

Trophoblast: The outer layer of cells of the blastocyst which works its way into the endometrium during ovum implantation and grows rapidly, later combining with mesoderm. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tuberculosis, Renal: Infection of the kidney with species of Mycobacterium. [NIH] Tuberculostatic: Inhibiting the growth of Mycobacterium tuberculosis. [EU] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [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] Tumorigenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH]

Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A

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new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ubiquitin: A highly conserved 76 amino acid-protein found in all eukaryotic cells. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Arteries: Either of a pair of arteries originating from the internal iliac artery and passing through the umbilical cord to carry blood from the fetus to the placenta. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Umbilical cord blood: Blood from the placenta (afterbirth) that contains high concentrations of stem cells needed to produce new blood cells. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Universal Precautions: Prudent standard preventive measures to be taken by professional and other health personnel in contact with persons afflicted with a communicable disease, to avoid contracting the disease by contagion or infection. Precautions are especially applicable in the diagnosis and care of AIDS patients. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH]

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Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterine Monitoring: Measurement or recording of contraction activity of the uterine muscle. It is used to determine progress of labor and assess status of pregnancy. It is also used in conjunction with fetal monitoring to determine fetal response to stress of maternal uterine contractions. [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] Uvea: The middle coat of the eyeball, consisting of the choroid in the back of the eye and the ciliary body and iris in the front of the eye. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagal: Pertaining to the vagus nerve. [EU]

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Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Smears: Collection of pooled secretions of the posterior vaginal fornix for cytologic examination. [NIH] Vagotomy: The interruption or removal of any part of the vagus (10th cranial) nerve. Vagotomy may be performed for research or for therapeutic purposes. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH]

Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]

Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide

Dictionary 685

back for gas exchange. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Venter: Belly. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vesicovaginal Fistula: An abnormal communication between the bladder and the vagina. [NIH]

Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinarians: Individuals with a degree in veterinary medicine that provides them with training and qualifications to treat diseases and injuries of animals. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vial: A small bottle. [EU] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villous: Of a surface, covered with villi. [NIH] Villus: Cell found in the lining of the small intestine. [NIH] Vimentin: An intermediate filament protein found in most differentiating cells, in cells grown in tissue culture, and in certain fully differentiated cells. Its insolubility suggests that it serves a structural function in the cytoplasm. MW 52,000. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Viremia: The presence of viruses in the blood. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH]

686 Pregnancy

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] Virus Diseases: A general term for diseases produced by viruses. [NIH] Virus Shedding: The expelling of virus particles from the body. Important routes include the respiratory tract, genital tract, and intestinal tract. Virus shedding is an important means of vertical transmission (disease transmission, vertical). [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitamin U: A vitamin found in green vegetables. It is used in the treatment of peptic ulcers, colitis, and gastritis and has an effect on secretory, acid-forming, and enzymatic functions of the intestinal tract. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vocational Education: Education for specific trades or occupations. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Vomica: The profuse and sudden expectoration of pus and putrescent matter. An abnormal cavity in an organ especially in the lung, caused by suppuration and the breaking down of tissue. [NIH] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Wetting Agents: A surfactant that renders a surface wettable by water or enhances the spreading of water over the surface; used in foods and cosmetics; important in contrast media; also with contact lenses, dentures, and some prostheses. Synonyms: humectants; hydrating agents. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others.

Dictionary 687

[NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenobiotics: Chemical substances that are foreign to the biological system. They include naturally occurring compounds, drugs, environmental agents, carcinogens, insecticides, etc. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yolk Sac: An embryonic membrane formed from endoderm and mesoderm. In reptiles and birds it incorporates the yolk into the digestive tract for nourishing the embryo. In placental mammals its nutritional function is vestigial; however, it is the source of most of the intestinal mucosa and the site of formation of the germ cells. It is sometimes called the vitelline sac, which should not be confused with the vitelline membrane of the egg. [NIH] Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chainterminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH] Zidovudine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by an azido group. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication, acting as a chain-terminator of viral DNA during reverse transcription. It improves immunologic function, partially reverses the HIVinduced neurological dysfunction, and improves certain other clinical abnormalities associated with AIDS. Its principal toxic effect is dose-dependent suppression of bone marrow, resulting in anemia and leukopenia. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

689

INDEX 1 1-Naphthylamine, 395, 555 A Abdominal Pain, 537, 555, 646, 682 Aberrant, 555 Ablate, 555, 592 Abruptio Placentae, 555 Abscess, 555, 667 Acceptor, 555, 624, 642, 655, 680 Acetylcholine, 555, 577, 637 Acetylcysteine, 555 Acidosis, 555, 620 Acne, 5, 316, 349, 555, 568, 620, 662 Acne Vulgaris, 555, 620 Acoustic, 555, 594 Acquired Immunodeficiency Syndrome, 389, 494, 516, 555 Acrylonitrile, 556, 664 Actin, 556, 603, 635 Action Potentials, 556 Acute leukemia, 556 Acute lymphoblastic leukemia, 556 Acute lymphocytic leukemia, 556 Acute myelogenous leukemia, 556 Acute myeloid leukemia, 556 Acute nonlymphocytic leukemia, 556 Acute renal, 448, 449, 450, 556, 609 Acyclovir, 139, 556 Adaptability, 272, 556, 575 Adaptation, 232, 291, 408, 452, 556, 634, 649 Adenine, 556, 658 Adenocarcinoma, 556, 610 Adenoma, 556 Adenosine, 412, 556, 572, 647, 677 Adenosine Monophosphate, 412, 556 Adhesions, 15, 403, 557 Adipocytes, 557, 582, 622 Adipose Tissue, 557, 643 Adjustment, 270, 300, 305, 308, 310, 351, 383, 556, 557 Adjuvant, 557, 603 Adolescence, 284, 295, 301, 423, 424, 451, 557, 576, 645 Adolescent Behavior, 557 Adolescent Nutrition, 557 Adrenal Cortex, 363, 557, 558, 583, 584, 597, 639, 654, 661

Adrenal Medulla, 557, 595, 596, 638 Adrenergic, 557, 590, 596, 675, 676 Adverse Effect, 12, 366, 459, 461, 557, 620, 647, 668 Aerosol, 557, 568, 675 Afferent, 557, 622, 671 Affinity, 130, 557, 565, 669 Agar, 135, 377, 557, 584, 615, 648 Age of Onset, 557, 682 Agonist, 557, 571, 572, 579, 590, 637, 674, 676 Agoraphobia, 558, 647 Air Pressure, 343, 558 Airway, 365, 558, 571, 669 Albumin, 558, 641, 649 Albuminuria, 441, 558, 652 Aldosterone, 329, 558, 632 Alertness, 558, 572 Algorithms, 558, 569 Alimentary, 11, 558, 595, 644, 645 Alkaline, 362, 388, 415, 416, 419, 555, 558, 559, 573, 677 Alkaline Phosphatase, 362, 558 Alkaloid, 558, 571, 572, 579, 633, 637, 677 Allantois, 558, 599 Alleles, 558 Allergen, 400, 558, 667 Allergic Rhinitis, 400, 558, 572, 608, 625 Allo, 558 Allogeneic, 558, 607, 609 Allograft, 379, 450, 558 Allylamine, 558, 559 Alopecia, 559, 585 Alpha Cell, 559 Alpha Particles, 559, 658 Alpha-fetoprotein, 559, 599 Alternative medicine, 472, 559 Aluminum, 348, 559, 674 Alveolar Process, 559, 662 Alveoli, 559, 657, 685 Amebiasis, 445, 559, 631 Ameliorating, 400, 559 Amenorrhea, 375, 376, 559, 571, 650 Amine, 380, 422, 559, 611 Amino Acid Sequence, 380, 415, 559, 562, 603 Ammonia, 559, 605, 675, 682 Amnestic, 559, 631

690 Pregnancy

Amniocentesis, 346, 435, 560 Amnion, 380, 388, 419, 560, 577, 599 Amoxicillin, 560 Amphetamine, 560, 587 Ampicillin, 560 Amplification, 560, 623 Ampulla, 560, 577, 594 Amygdala, 560, 567, 624, 677 Anabasine, 560 Anabolic, 560, 589 Anaemia, 427, 560, 629 Anaerobic, 137, 560 Anaesthesia, 560, 616 Anaesthetic, 560 Anal, 14, 16, 445, 539, 560, 595, 598, 600, 625 Anal Fissure, 16, 560 Analgesic, 363, 560, 572, 633, 640 Analog, 338, 347, 556, 560, 578, 621, 632, 665 Analogous, 560, 680 Anaphylatoxins, 560, 581 Anaphylaxis, 400, 561 Anastomosis, 445, 561 Anatomical, 372, 403, 561, 566, 570, 576, 582, 589, 615, 624, 631, 665 Androgens, 557, 561, 584 Anesthesia, 17, 558, 561, 584, 631, 651, 653, 681 Anesthetics, 19, 561, 596 Aneuploidy, 384, 561 Aneurysm, 561, 564, 684 Angiogenesis, 561, 628 Angiotensinogen, 321, 561, 661 Animal model, 561 Anionic, 561 Anions, 558, 561, 620, 667 Ankle, 561, 684 Annealing, 561, 623, 650 Anomalies, 21, 353, 394, 446, 561, 613, 676 Anophthalmia, 561, 611 Anorectal, 14, 562 Anorexia, 562, 641, 682 Anovulation, 562, 650 Antagonism, 562, 572, 677 Anthropometric measurements, 562 Anthropometry, 562 Antibacterial, 562, 578, 620, 670 Antibiotic, 16, 560, 562, 571, 578, 596, 624, 645, 670, 677 Antibodies, Anticardiolipin, 562, 563 Antibodies, Antiphospholipid, 562, 563

Anticoagulant, 475, 562, 563, 656 Anticonvulsant, 542, 562, 573, 577, 647 Antidepressant, 413, 562, 572, 584, 601 Antidiuretic, 537, 562 Antiemetic, 242, 562 Antiepileptic, 131, 307, 535, 562 Antifungal, 5, 562 Antigen-Antibody Complex, 563, 580 Antigen-presenting cell, 563, 586 Antihypertensive, 328, 563 Anti-infective, 563, 577, 612, 619 Anti-inflammatory, 19, 136, 141, 475, 563, 565, 568, 584, 605, 643, 652 Anti-Inflammatory Agents, 19, 563, 565, 584 Antimetabolite, 556, 563, 631, 663 Antimicrobial, 137, 563, 587 Antineoplastic, 563, 584, 585, 631 Antioxidant, 232, 371, 563, 642 Antiphospholipid Syndrome, 474, 562, 563 Antiserum, 375, 376, 379, 397, 563 Antithrombotic, 527, 563, 655 Anti-Ulcer Agents, 19, 563 Antiviral, 138, 323, 331, 386, 555, 556, 563, 618, 635, 663 Antiviral Agents, 386, 563 Anuria, 563, 621 Anus, 16, 560, 562, 563, 566, 571, 580, 610, 619, 646, 660 Anxiolytic, 564, 577, 631 Aorta, 342, 343, 564, 613, 630, 653, 661, 685 Aortic Rupture, 468, 564 Aortic Valve, 564 Aortic Valve Insufficiency, 564 Aperture, 374, 386, 564, 658 Aplastic anemia, 564 Apnea, 564 Apolipoproteins, 564, 624 Apoptosis, 564, 574 Appendicitis, 16, 131, 564 Approximate, 319, 564 Aqueous, 354, 361, 564, 567, 585, 593, 612, 622, 624 Arachidonic Acid, 135, 417, 564, 584, 592, 623, 655 Archaea, 564, 631 Arginine, 338, 350, 560, 564, 637, 641, 658 Arnica, 239, 564 Aromatic, 386, 564, 573, 647, 673 Arterial embolization, 564 Arteriolar, 565, 571, 661

Index 691

Arterioles, 565, 570, 573, 684 Arteriosclerosis, 565, 613 Arteriovenous, 565 Arthroplasty, 565 Articular, 565, 641 Ascariasis, 445, 565 Aseptic, 565, 640, 672 Aspartic, 137, 142, 565, 594 Aspartic Acid, 565 Asphyxia, 565 Aspirate, 565 Aspiration, 17, 380, 565, 599, 602 Aspirin, 475, 529, 565 Astringents, 565, 630 Astrocytes, 565, 631, 633 Ataxia, 504, 505, 565, 677 Atresia, 566, 613 Atrial, 566, 583, 675, 681 Atrial Fibrillation, 566 Atrioventricular, 566, 583 Atrium, 566, 583, 632, 681, 685 Atrophy, 504, 505, 566 Attenuation, 566 Audiovisual Aids, 536, 540, 542, 566 Aura, 566 Autoantibodies, 6, 562, 566 Autoantigens, 566 Autodigestion, 566, 643 Autoimmune disease, 394, 562, 566, 634 Autoimmune Hepatitis, 15, 566 Autoimmunity, 566 Autologous, 249, 566, 609 Autologous bone marrow transplantation, 566, 609 Autonomic, 555, 566, 638, 646, 671, 675 Autonomic Dysreflexia, 566 Autonomic Nervous System, 566, 646, 675 Axillary, 567, 571 Axillary Artery, 567, 571 Axons, 567, 586, 640, 658, 671 B Back Pain, 244, 288, 386, 387, 521, 522, 567 Bacterial Infections, 394, 538, 567 Bacterial Physiology, 556, 567 Bactericidal, 567, 597 Bacteriophage, 567, 648, 680 Bacteriostatic, 567, 596 Bacterium, 530, 567, 609 Bacteriuria, 131, 448, 449, 567, 683 Baroreflex, 567 Basal Ganglia, 566, 567, 591, 624 Basal Ganglia Diseases, 566, 567, 591

Base, 340, 359, 421, 556, 567, 585, 586, 603, 620, 621, 658, 676, 682 Basement Membrane, 567, 598 Basophils, 400, 568, 607, 623 Beclomethasone, 328, 568 Bed Rest, 388, 419, 438, 568 Behavior Therapy, 541, 568 Benign, 15, 18, 556, 568, 600, 608, 622, 635, 664, 665 Benzene, 568, 620 Benzoyl Peroxide, 5, 568 Bereavement, 544, 568 Bifida, 568 Bilateral, 449, 568, 650 Bile, 12, 568, 577, 602, 603, 611, 620, 625, 628, 653, 666, 672, 674 Bile Acids, 568, 603, 672 Bile Acids and Salts, 568 Bile duct, 568, 577, 602, 653 Bile Pigments, 568, 620, 628 Biliary, 16, 18, 443, 444, 568, 573, 577, 643 Biliary Tract, 16, 18, 443, 444, 568, 573, 643 Bilirubin, 9, 558, 568, 602, 612 Binding Sites, 568 Bioassay, 568 Bioavailability, 322, 371, 568, 616 Biological Markers, 367, 410, 569 Biological response modifier, 569, 618 Biological therapy, 569, 607 Biomarkers, 569 Biomolecular, 569 Biopsy, 384, 569 Biotechnology, 130, 441, 472, 491, 503, 504, 505, 506, 569 Bipolar Disorder, 541, 569 Birth Certificates, 569 Birth Rate, 230, 350, 424, 510, 569 Bivalent, 360, 361, 569 Blastocyst, 403, 569, 581, 592, 642, 648, 681 Blood Cell Count, 569, 609 Blood Coagulation, 344, 569, 570, 573, 678 Blood Coagulation Factors, 569 Blood Glucose, 315, 446, 447, 570, 609, 613, 618 Blood Platelets, 344, 570, 667, 678 Blood transfusion, 570 Blood Volume, 570 Blot, 570, 639 Body Burden, 570, 622 Body Composition, 305, 570 Body Fluids, 336, 339, 354, 361, 415, 569, 570, 591, 670, 681

692 Pregnancy

Body Image, 297, 570 Body Mass Index, 399, 570, 642 Body Regions, 570, 580 Bolus, 323, 570 Bolus infusion, 570 Bone Density, 322, 570 Bone Remodeling, 570 Bone Resorption, 240, 570 Bone scan, 571, 665 Bowel Movement, 571, 588, 672 Brachial, 571, 628 Brachial Artery, 571 Brachial Plexus, 571, 628 Bradycardia, 571, 599 Bradykinin, 571, 620, 637, 649 Brain Ischemia, 571, 613 Brain Stem, 571, 576 Branch, 308, 359, 551, 571, 603, 626, 644, 657, 661, 669, 670, 675, 677 Breakdown, 571, 588, 602 Breathing Exercises, 355, 571 Breeding, 140, 401, 403, 571 Broad Ligament, 571, 598 Broad-spectrum, 560, 571 Bromocriptine, 571 Bronchi, 571, 596, 677, 680 Bronchial, 571, 611, 655, 677 Bronchioles, 559, 571, 657 Bronchodilator, 571, 676 Buccal, 571, 626 Budesonide, 471, 572 Buffers, 567, 572 Bulimia, 572 Bupivacaine, 572, 623 Buprenorphine, 572 Bupropion, 572 Burns, 238, 397, 568, 572 Burns, Electric, 572 C Cadaverine, 572 Cadmium, 233, 572 Cadmium Poisoning, 572 Caesarean section, 572 Caffeine, 299, 307, 572, 658 Calcitonin, 572 Calcitonin Gene-Related Peptide, 572 Calcium Compounds, 371, 573 Calculi, 449, 573, 606 Callus, 573, 593, 640 Calmodulin, 391, 392, 394, 395, 396, 397, 573, 617

Capillary, 315, 342, 357, 571, 573, 605, 684, 685 Capillary Permeability, 571, 573 Capsules, 257, 480, 573, 603, 605 Carbamazepine, 573 Carbohydrate, 369, 377, 380, 412, 452, 537, 573, 584, 605, 606, 628, 650, 667 Carbon Dioxide, 573, 586, 600, 602, 648, 662, 684 Carboxy, 573 Carboxylic Acids, 573 Carcinogen, 555, 573, 631 Carcinogenesis, 139, 141, 573, 648 Carcinogenic, 555, 568, 573, 617, 654, 672, 681 Carcinoma, 8, 16, 466, 573 Cardiac Output, 567, 574 Cardiolipins, 563, 574 Cardiomyopathy, 233, 574 Cardiorespiratory, 574, 631 Cardiotoxicity, 574, 681 Cardiovascular disease, 574, 624 Cardioversion, 574 Carotene, 134, 574, 662 Carrier Proteins, 574, 649, 659 Carrier State, 559, 574 Case series, 12, 574, 578 Case-Control Studies, 132, 574, 595 Caspase, 574 Catabolism, 574 Catalogs, 541, 574 Catalyse, 574, 680 Catheter, 314, 575 Catheterization, 575, 602 Cauda Equina, 575, 665 Caudal, 575, 588, 613, 651 Causal, 575, 581, 595, 609, 657, 663, 667, 677 Cause of Death, 575 Cecum, 575, 621 Celiac Disease, 13, 14, 277, 575 Cell Adhesion, 132, 142, 575 Cell Death, 564, 575 Cell Differentiation, 575, 668 Cell Division, 504, 567, 575, 607, 629, 630, 632, 648, 654, 666 Cell membrane, 247, 574, 575, 587, 617, 619, 644, 647, 651 Cell proliferation, 565, 575, 618, 668 Cell Respiration, 575, 642, 662 Cell Survival, 575, 607 Cell Transplantation, 575

Index 693

Centrifugation, 575, 609, 631 Cerebellar, 566, 575, 660 Cerebellum, 575, 601, 660 Cerebral Aqueduct, 576, 601, 646, 677 Cerebral Arteries, 576 Cerebral Cortex, 566, 576, 597, 600, 658 Cerebral Palsy, 349, 529, 576, 670 Cerebrospinal, 576, 577, 668 Cerebrospinal fluid, 576, 577, 668 Cerebrovascular, 567, 574, 576, 677 Cerebrum, 576, 681 Cervix, 132, 355, 367, 555, 576, 582, 589, 600, 662 Cesarean Section, 10, 19, 461, 512, 576 Chancroid, 398, 576 Character, 576, 586, 606 Chemoprevention, 576 Chemotactic Factors, 576, 581, 637 Chemotherapeutic agent, 576 Chemotherapy, 238, 239, 248, 470, 576 Child Care, 436, 465, 576 Child Development, 576 Child Nutrition, 416, 576 Chin, 576, 629 Chlordiazepoxide, 577 Chlorhexidine, 577 Chloroquine, 577 Cholecystitis, 18, 577 Choledocholithiasis, 577 Cholelithiasis, 9, 18, 577 Cholera, 577, 667 Choleretic, 577 Cholestasis, 9, 12, 15, 18, 234, 237, 443, 452, 503, 577 Cholesterol, 568, 577, 578, 583, 591, 602, 612, 624, 625, 629, 672 Cholesterol Esters, 577, 624 Cholinergic, 577, 637 Chondrocytes, 380, 577, 600 Chondroitin sulfate, 577 Chorioamnionitis, 577 Choriocarcinoma, 577, 604, 612, 632 Chorion, 388, 419, 577, 599 Choroid, 577, 622, 662, 683 Choroid Plexus, 577, 622 Chromatin, 564, 577 Chromosomal, 353, 394, 536, 560, 561, 577, 650, 676 Chromosome Abnormalities, 578, 611 Chronic Disease, 424, 578, 622 Chronic renal, 448, 578, 650, 682 Chronotropic, 396, 578

Chylomicrons, 578, 624 Cimetidine, 10, 578 Cirrhosis, 8, 9, 578, 609, 653 Civil Rights, 578, 668 Clamp, 578, 644 Clarithromycin, 578 Clear cell carcinoma, 578, 588 Cleft Lip, 330, 578, 611 Cleft Palate, 330, 542, 578, 611 Climacteric, 360, 441, 578 Clindamycin, 5, 478, 578 Clinical Medicine, 578, 652 Clinical study, 441, 578, 582 Clinical trial, 313, 332, 491, 494, 495, 578, 582, 585, 590, 634, 648, 656, 659 Clitoral, 346, 578 Clomiphene, 479, 579 Clone, 579 Cloning, 569, 579, 623 Coagulation, 563, 570, 579, 607, 610, 649, 678 Coal, 568, 579, 601 Coca, 579 Cocaine, 462, 579 Coenzymes, 579, 637 Cofactor, 579, 656, 678 Cognition, 579 Cognitive behavior therapy, 579 Cohort Studies, 8, 579, 595 Coitus, 579 Colectomy, 539, 579 Colic, 18, 286, 579 Coliphages, 567, 580 Colitis, 13, 18, 473, 475, 536, 580, 686 Collapse, 561, 571, 580, 669 Colloidal, 558, 580, 597, 667, 675 Coloboma, 580, 611 Colon, 16, 252, 504, 537, 539, 579, 580, 591, 617, 622, 682 Colorectal, 16, 580 Colostomy, 580 Combination Therapy, 520, 580 Communicable disease, 580, 682 Communis, 580 Community Networks, 454, 580 Complement, 372, 560, 580, 581, 604, 620, 627, 649, 667 Complement Activation, 560, 581 Complementary and alternative medicine, 237, 239, 240, 268, 581 Complementary medicine, 240, 581 Complete remission, 581, 661

694 Pregnancy

Compliance, 242, 400, 497, 581 Compulsions, 541, 581 Computational Biology, 491, 503, 581 Computed tomography, 570, 581, 665 Concomitant, 581 Concretion, 573, 581 Condoms, 287, 386, 389, 400, 464, 511, 512, 513, 516, 521, 524, 581 Cone, 389, 581, 582, 674 Confidence Intervals, 581 Confounder, 581 Confounding, 138, 582 Congenita, 582 Conization, 582 Conjugated, 360, 363, 416, 568, 582, 585, 638 Conjunctiva, 581, 582, 617 Conjunctivitis, 581, 582, 608 Connective Tissue Cells, 582, 677 Connective Tissue Diseases, 563, 582 Consciousness, 560, 582, 586, 590, 657 Constipation, 16, 241, 582, 646 Constitutional, 582 Constriction, 582, 620, 684 Constriction, Pathologic, 582, 684 Consultation, 133, 326, 543, 582 Contamination, 582, 610, 639 Continuous infusion, 324, 582 Contractility, 582 Contraindications, ii, 238, 582 Control group, 4, 582, 648, 653 Controlled clinical trial, 495, 582, 659 Controlled study, 582 Convulsions, 393, 562, 583, 591, 652 Coordination, 495, 576, 583, 634 Cor, 143, 583, 584 Cornea, 583, 606, 665, 673, 683 Coronary, 574, 583, 612, 631 Coronary Circulation, 583 Coronary heart disease, 574, 583 Coronary Thrombosis, 583, 631 Coronary Vessels, 583 Corpus Callosum, 583, 667, 677 Cortex, 263, 583, 595, 660 Cortical, 448, 449, 583, 597, 658, 666, 677 Corticosteroid, 297, 583, 652 Corticotropin-Releasing Hormone, 143, 584 Cortisol, 558, 584 Cortisone, 584, 652 Cotinine, 584 Cranial, 575, 584, 608, 611, 646, 684

Creatinine, 584, 621, 682 Credentialing, 239, 584 Cues, 584 Culture Media, 557, 584 Cultured cells, 584, 648 Curare, 584, 634 Curative, 11, 584, 637, 677 Curettage, 584, 589 Curette, 584, 589 Cutaneous, 584, 626, 671 Cyclic, 412, 572, 573, 584, 607, 637, 655, 677 Cyclooxygenase Inhibitors, 584 Cyclophosphamide, 475, 585 Cyclopia, 585, 611 Cyclosporine, 9, 444, 475, 585 Cyst, 136, 565, 585, 642 Cystathionine beta-Synthase, 585, 612 Cystitis, 497, 585 Cytochrome, 279, 578, 585 Cytokine, 329, 380, 409, 585, 618 Cytomegalovirus, 7, 136, 398, 585 Cytoplasm, 564, 568, 575, 585, 595, 617, 663, 685 Cytosine, 585, 658 Cytotoxic, 585, 615, 668 Cytotoxic chemotherapy, 585 D Dairy Products, 372, 585 Dalteparin, 585 Data Collection, 237, 450, 585, 601 De novo, 586 Deamination, 586, 588, 682 Decarboxylation, 572, 586, 611, 658 Decidua, 132, 138, 586, 631, 648 Decision Making, 284, 300, 529, 586 Decompensation, 558, 586 Degenerative, 586, 610, 633, 641, 663 Delavirdine, 586, 637 Deletion, 564, 586, 603 Dementia, 465, 556, 586 Demography, 230, 586 Denaturation, 586, 623, 650 Dendrites, 586, 636, 658 Dendritic, 586, 629 Dendritic cell, 586 Dental Care, 451, 586 Dentate Gyrus, 586, 611 Dentists, 586 Deoxyribonucleic, 586, 663 Deoxyribonucleic acid, 586, 663 Depolarization, 587, 668

Index 695

Depressive Disorder, 587, 624 Deprivation, 300, 587 Dermatitis, 5, 587 Dermatofibrosarcoma protuberans, 587 Dermis, 587, 675 Detergents, 389, 587, 637 Developed Countries, 8, 400, 587 Developing Countries, 383, 399, 587, 626, 676 Developmental Biology, 587 Dextroamphetamine, 560, 587 Diabetes Insipidus, 537, 587, 650 Diabetic Retinopathy, 587, 648 Diagnostic procedure, 335, 441, 472, 587 Dialyzer, 587, 609 Diamines, 588 Diaphragm, 400, 588 Diarrhea, 16, 241, 500, 537, 559, 565, 588 Diastole, 588 Diastolic, 588, 613 Diastolic blood pressure, 588, 613 Diastolic pressure, 588, 613 Diathesis, 588, 607 Didanosine, 317, 588 Dideoxyadenosine, 588 Diencephalon, 588, 613, 654, 677 Dietary Fats, 231, 588 Dietetics, 460, 588 Diethylstilbestrol, 588 Dietitian, 588 Diffusion of Innovation, 588 Digestion, 232, 330, 366, 558, 568, 571, 588, 619, 625, 645, 672, 683 Digestive system, 332, 588, 603 Digestive tract, 536, 589, 669, 671, 687 Dihydroprogesterone, 589 Dihydrotestosterone, 589, 660 Dilatation, 555, 561, 589, 653, 657, 684 Dilatation, Pathologic, 589, 684 Dilated cardiomyopathy, 589 Dilation, 326, 355, 571, 589, 684 Dilation and curettage, 589 Dimethyl, 422, 589 Diploid, 561, 589, 633, 648, 681 Discrete, 570, 589, 625, 676 Discrimination, 284, 292, 295, 307, 308, 578, 589, 668 Disease Progression, 494, 589, 685 Disease Transmission, 589, 686 Disease Transmission, Vertical, 589, 686 Disinfectant, 577, 589, 597, 671 Dislocation, 390, 589, 671

Disparity, 589 Disposition, 394, 589 Dissection, 589 Dissociation, 557, 589 Distal, 590, 603, 656, 657 Disulfides, 590 Diuresis, 572, 590, 677 Domestic Violence, 511, 590 Domesticated, 590, 607 Dopamine, 280, 560, 571, 572, 579, 587, 590, 633, 637, 647 Dorsal, 408, 590, 651, 671 Dose-dependent, 590, 687 Double-blind, 590 Double-blinded, 590 Douching, 590 Drinking Behavior, 590 Drug Interactions, 483, 484, 590 Drug Tolerance, 590, 679 Duct, 560, 575, 591, 597, 641, 657, 664, 672, 675 Duodenal Ulcer, 591 Duodenum, 568, 591, 594, 643, 666, 672 Dyes, 568, 591, 674 Dysentery, 559, 591 Dyskinesias, 567, 591, 633 Dyslexia, 591, 622 Dyslipidemia, 591 Dysmenorrhea, 591 Dysphoric, 587, 591 Dysplasia, 505, 591 Dyspnea, 586, 591 Dystrophy, 504, 591 E Eccentricities, 591 Echocardiography, 591 Eclampsia, 9, 15, 18, 233, 321, 326, 327, 328, 329, 341, 393, 448, 449, 591, 652 Edema, 250, 341, 393, 402, 453, 586, 587, 591, 636, 639, 642, 652, 682 Effector, 555, 580, 591, 621 Effector cell, 591, 621 Efferent, 591, 633, 671 Eicosanoids, 584, 592 Ejaculation, 592, 666 Elastic, 354, 372, 390, 592, 606, 670, 674 Elasticity, 408, 565, 592 Elastin, 366, 580, 582, 592, 598 Elective, 18, 248, 458, 498, 592 Electrocoagulation, 579, 592 Electrolyte, 481, 558, 584, 592, 609, 621, 632, 651, 670, 682

696 Pregnancy

Electromagnetic Fields, 592 Electromyography, 15, 592 Electroplating, 592, 674 Electroretinogram, 248, 592 Emaciation, 556, 592 Embolectomy, 592, 678 Emboli, 592 Embolization, 592 Embolus, 592, 616 Embryo Transfer, 346, 350, 364, 403, 417, 418, 592, 652 Embryogenesis, 593 Embryology, 346, 350, 593 Emesis, 16, 593, 613, 651 Empiric, 16, 593 Empirical, 285, 593 Emulsions, 557, 593 Encephalitis, 593 Encephalitis, Viral, 593 Encephalocele, 593, 636 Encephalomyelitis, 593 Endemic, 445, 577, 593, 627, 671 Endocrine System, 593, 636 Endocytosis, 593 Endometrial, 139, 402, 405, 441, 593, 594, 642 Endometriosis, 238, 593 Endometrium, 292, 350, 382, 403, 586, 593, 594, 629, 631, 637, 681 Endopeptidases, 594, 655 Endorphins, 594, 637 Endoscope, 594 Endoscopic, 10, 11, 17, 527, 594, 614, 631 Endoscopy, 16, 17, 426, 594 Endosonography, 15, 594 Endothelial cell, 341, 409, 594, 600, 678 Endothelium, 594, 637, 649 Endothelium, Lymphatic, 594 Endothelium, Vascular, 594 Endothelium-derived, 594, 637 Endotoxic, 594, 624 Endotoxin, 594, 681 End-stage renal, 448, 578, 594, 650 Energy balance, 595, 622 Energy Intake, 131, 595 Enhancer, 595, 662 Enkephalins, 595, 637 Enteral Nutrition, 595 Entorhinal Cortex, 595, 611 Environmental Exposure, 569, 595, 640 Environmental Health, 322, 490, 492, 529, 595

Environmental tobacco smoke, 595 Enzymatic, 559, 573, 574, 580, 588, 595, 600, 611, 629, 650, 662, 686 Enzyme Inhibitors, 595, 649 Eosinophil, 595 Eosinophilic, 595 Epidemic, 595, 671 Epidemiologic Studies, 569, 595 Epidermis, 587, 595, 658 Epidermoid carcinoma, 595, 671 Epigastric, 596, 643 Epinephrine, 557, 590, 596, 637, 638, 682 Episiotomy, 9, 10, 14, 596 Epithelial, 390, 556, 586, 596, 632 Epithelial Cells, 390, 596, 632 Epithelial ovarian cancer, 596 Epithelium, 290, 390, 567, 577, 594, 596, 602 Epitope, 324, 325, 596 Erectile, 596, 645 Erection, 446, 596 Ergot, 571, 596 Erythrina, 596 Erythrocyte Volume, 570, 596 Erythrocytes, 136, 382, 560, 561, 569, 570, 596, 609, 660, 667 Erythromycin, 5, 578, 596 Erythropoiesis, 352, 596 Erythropoietin, 596 Esophageal, 17, 596 Esophagitis, 596, 674 Esophagus, 566, 588, 589, 596, 603, 609, 625, 647, 660, 672 Esotropia, 596, 673 Essential Tremor, 504, 597 Estradiol, 281, 365, 480, 597 Estriol, 363, 597 Estrogen receptor, 579, 597 Ethanol, 281, 307, 597 Ethnic Groups, 12, 230, 597 Eukaryotic Cells, 597, 616, 640, 682 Evacuation, 582, 597, 622, 642 Evoke, 597, 672 Excitation, 597, 637 Excitatory, 597, 605 Excrete, 563, 597, 621 Exhaustion, 562, 597, 627 Exocrine, 597, 643 Exogenous, 593, 597, 655, 682 Exotropia, 597, 673 Expander, 597 Expiration, 407, 571, 597, 662

Index 697

Expiratory, 364, 597 Extender, 597 Extracellular, 565, 582, 593, 597, 598, 600, 628, 641, 670, 677 Extracellular Matrix, 582, 598, 600, 628, 641 Extracellular Matrix Proteins, 598, 628 Extracellular Space, 598 Extraction, 360, 416, 576, 598 Extravasation, 409, 598, 609 Extremity, 7, 571, 598, 628 Eye Infections, 598 F Facial, 5, 316, 330, 598, 611 Fallopian tube, 598, 602, 662, 664, 681 False Positive Reactions, 344, 598 Family Leave, 598, 644 Family Planning, 14, 286, 383, 429, 463, 491, 539, 598, 652 Fatal Outcome, 20, 598 Fathers, 270, 289, 355, 440, 458, 598 Fatigue, 598, 608 Fatty acids, 243, 244, 361, 416, 417, 558, 573, 592, 598, 606, 624, 628, 655 Fatty Liver, 9, 15, 18, 142, 443, 448, 449, 452, 598 Fecal Incontinence, 14, 598, 616 Feces, 565, 582, 598, 599, 672 Femur, 599, 678 Ferritin, 232, 248, 287, 352, 599 Fertilization in Vitro, 599, 652 Fertilizers, 599, 651, 674 Fetal Alcohol Syndrome, 284, 461, 542, 599 Fetal Blood, 234, 577, 599, 648 Fetal Death, 363, 469, 599 Fetal Distress, 12, 342, 599 Fetal Growth Retardation, 21, 349, 599 Fetal Macrosomia, 599 Fetal Membranes, 599 Fetal Monitoring, 446, 461, 599, 683 Fetal Resorption, 599 Fetal Weight, 599 Fetoprotein, 599 Fibrillation, 599 Fibrin, 367, 569, 600, 646, 649, 678 Fibrinogen, 600, 649, 678 Fibrinolysis, 600 Fibroblast Growth Factor, 600 Fibroblasts, 142, 582, 600 Fibroid, 403, 600, 622 Fibrosarcoma, 600

Fibrosis, 330, 505, 558, 600, 665 Fibula, 600, 678 Filtration, 600, 621 Fish Products, 600, 665 Fissure, 578, 580, 583, 586, 600 Fistula, 600 Fixation, 600, 667 Flatus, 598, 600, 602 Flexion, 6, 600 Fluorescence, 601 Fluoxetine, 601 Focus Groups, 601 Foetal, 601 Foetoplacental, 601, 639 Folate, 601 Fold, 291, 571, 600, 601, 630 Folic Acid, 247, 248, 371, 372, 447, 479, 530, 601 Follicles, 369, 601, 617 Follicular Fluid, 601 Follicular Phase, 365, 601 Follow-Up Studies, 601 Food Handling, 500, 601 Foramen, 576, 580, 601, 622, 646 Forearm, 570, 601, 628 Fornix, 601, 667, 684 Fossa, 575, 601 Fossil Fuels, 601 Fourth Ventricle, 576, 577, 601, 677 Fractionation, 377, 601 Free Radicals, 563, 589, 601 Fructose, 371, 479, 602, 619 Fucose, 377, 602 Fundus, 600, 602, 640 Fungi, 562, 598, 602, 607, 631, 687 G Gallbladder, 555, 568, 577, 588, 602, 603 Gallstones, 9, 15, 16, 19, 568, 577, 602 Gamete Intrafallopian Transfer, 602 Ganglia, 555, 567, 602, 636, 646, 671, 675 Gangrene, 442, 602 Gangrenous, 602, 667 Gas, 559, 573, 600, 601, 602, 612, 634, 637, 674, 675, 684, 685 Gas exchange, 602, 685 Gastric, 11, 560, 566, 578, 602, 603, 609, 611, 632, 640, 645, 659 Gastric Juices, 602, 645 Gastric Mucosa, 602, 645 Gastrin, 578, 602, 611 Gastrinoma, 11, 602 Gastritis, 603, 674, 686

698 Pregnancy

Gastroenterologist, 443, 603 Gastroesophageal Reflux, 8, 10, 17, 603 Gastrointestinal tract, 563, 597, 600, 603, 622, 623, 667, 672, 681 Gastrostomy, 595, 603 Gelatin, 584, 603, 606, 674, 677 Gels, 386, 603 Gelsolin, 603 Gene Deletion, 603 Gene Dosage, 603 Gene Expression, 505, 603 General practitioner, 131, 603 Generator, 603 Genetic Code, 603, 638 Genetic Counseling, 331, 346, 522, 543, 604, 652 Genetic Engineering, 569, 579, 604 Genetic Markers, 421, 604 Genetic Screening, 137, 604 Genetic testing, 543, 604, 650 Genetics, 140, 232, 347, 444, 542, 604 Genital, 130, 135, 445, 578, 604, 607, 619, 683, 686 Genotype, 604, 647 Germ Cells, 604, 629, 640, 642, 670, 676, 687 Gestation period, 446, 604 Gestational Age, 346, 374, 411, 604 Gestational trophoblastic disease, 246, 604, 632 Gestational trophoblastic neoplasia, 604, 632 Gestational trophoblastic tumor, 248, 604, 632 Giardiasis, 445, 604, 631 Gingivitis, 451, 604 Ginseng, 468, 604 Gleason, 276, 605 Glomerular, 605, 619, 621, 661 Glomerular Filtration Rate, 605, 621 Glomeruli, 605, 658 Glomerulonephritis, 448, 449, 605, 626 Glomerulus, 605, 636 Glucocorticoid, 336, 568, 572, 605, 631, 632, 652 Gluconeogenesis, 605 Glucose Intolerance, 314, 587, 605 Glucose tolerance, 19, 131, 330, 605 Glucose Tolerance Test, 605 Glucuronic Acid, 605, 610 Glutamic Acid, 601, 605, 637, 654 Glutamine, 605

Glutathione Peroxidase, 606, 666 Gluten, 14, 575, 606 Glycerol, 574, 606, 647 Glycerophospholipids, 606, 647 Glycine, 559, 568, 606, 637, 667 Glycosaminoglycan, 577, 606 Glycosylation, 606 Goats, 346, 585, 606, 665 Gonad, 606 Gonadal, 377, 606, 672 Gonadotropic, 354, 361, 369, 382, 606 Gonorrhea, 398, 424, 606 Gout, 443, 606 Governing Board, 606, 652 Government Agencies, 498, 499, 606, 652 Grade, 4, 292, 457, 606 Graft, 352, 379, 381, 606, 607, 611 Graft Rejection, 352, 607 Grafting, 607, 615 Gram-positive, 607, 673 Granule, 586, 607, 663 Granulocyte, 365, 366, 607 Granuloma, 607, 626 Granuloma Inguinale, 607, 626 Granulosa Cells, 607, 617, 626 Grasses, 601, 607 Gravidity, 136, 607, 644 Growth factors, 607, 631 Guanylate Cyclase, 143, 607, 637 Guinea Pigs, 607 H Habitual, 375, 376, 394, 402, 576, 607 Haematemesis, 593, 607 Haematuria, 607, 608 Haemophilia, 607 Haemorrhage, 555, 608 Hair follicles, 587, 608, 686 Half-Life, 608 Happiness, 608 Haptens, 557, 608, 659 Harmony, 608 Hay Fever, 400, 558, 608 Hazardous Waste, 608 Headache, 572, 608, 613, 617, 653 Health Behavior, 233, 285, 492, 608 Health Education, 233, 272, 290, 296, 500, 532, 533, 541, 542, 608 Health Policy, 525, 608 Health Promotion, 424, 450, 514, 608, 652 Health Services, iv, 230, 287, 359, 455, 459, 501, 502, 518, 608 Health Status, 7, 17, 608

Index 699

Heart attack, 574, 608 Heart failure, 608, 613, 639 Heart Transplantation, 609 Heartburn, 10, 17, 609 Hematocrit, 569, 609 Hematoma, 609 Hematopoiesis, 609 Hematopoietic Stem Cell Transplantation, 609 Heme, 568, 585, 609 Hemochromatosis, 15, 609 Hemodiafiltration, 609, 682 Hemodialysis, 449, 587, 609, 621, 682 Hemodynamics, 609 Hemofiltration, 609, 682 Hemoglobin, 561, 569, 596, 609, 622, 668 Hemoglobinuria, 504, 609 Hemolysis, 9, 18, 326, 449, 452, 609 Hemolytic, 448, 449, 609 Hemoperitoneum, 610 Hemophilia, 497, 505, 610 Hemorrhage, 413, 443, 592, 608, 610, 658, 673, 686 Hemorrhoid, 610, 678 Hemostasis, 610, 667, 678 Heparin, 475, 610 Hepatic, 9, 17, 18, 19, 20, 281, 330, 443, 452, 558, 605, 610 Hepatitis, 8, 9, 12, 13, 20, 21, 130, 140, 398, 452, 479, 539, 540, 610, 616, 685 Hepatitis A, 8, 20, 610 Hepatocellular, 8, 18, 610 Hepatocellular carcinoma, 8, 610 Hepatocyte, 577, 610 Hepatotoxic, 443, 610 Hepatotoxicity, 19, 610 Hepatovirus, 610 Hereditary, 582, 606, 610, 633, 662 Heredity, 555, 603, 604, 610 Herpes, 8, 9, 386, 398, 531, 556, 610 Herpes Zoster, 610 Heterodimer, 412, 610 Heterogeneity, 352, 557, 610 Heterotropia, 610, 673 Hippocampus, 586, 601, 610, 624, 658, 673 Histamine, 400, 441, 560, 578, 611, 625, 659 Histidine, 134, 611 Histocompatibility, 381, 611 Histology, 611, 643 Holoprosencephaly, 330, 536, 611 Homeostasis, 396, 452, 570, 611 Homicide, 611

Homologous, 558, 569, 611, 666, 667, 675 Homosexuality, 424, 533, 611 Hookworms, 611 Hormone Replacement Therapy, 360, 442, 538, 611 Hospital Records, 611 Humoral, 325, 607, 611 Humour, 611 Hybrid, 579, 611, 612, 639 Hybridization, 134, 415, 611, 639 Hybridoma, 612 Hydatidiform Mole, 138, 577, 612 Hydrogen Peroxide, 606, 612, 624 Hydrolysis, 565, 612, 619, 624, 627, 647, 656 Hydrophilic, 587, 612 Hydrophobic, 587, 606, 612, 624 Hydroxylation, 396, 612 Hydroxylysine, 580, 612 Hydroxyproline, 559, 580, 612 Hydroxysteroids, 287, 612 Hygienic, 590, 612 Hyperbilirubinemia, 12, 612, 620 Hypercholesterolemia, 591, 612 Hyperemesis, 9, 15, 16, 18, 426, 443, 452, 612 Hyperglycaemia, 612 Hyperglycemia, 612 Hyperhomocysteinemia, 585, 612 Hyperlipidemia, 591, 612 Hyperoxaluria, 612 Hyperreflexia, 612, 677 Hypersecretion, 11, 612 Hypersensitivity, 400, 558, 561, 595, 613, 623, 663, 667 Hyperstimulation, 613 Hypertension, Renal, 453, 613 Hypertension, Renovascular, 613 Hypertensive Encephalopathy, 613 Hyperthyroidism, 613 Hypertriglyceridemia, 591, 613 Hypertrophic cardiomyopathy, 469, 613 Hypertrophy, 137, 583, 613, 681 Hyperuricemia, 606, 613 Hypnotic, 613, 631 Hypoglycemia, 445, 446, 447, 613 Hypoglycemic, 19, 613 Hypoglycemic Agents, 19, 613 Hypogonadism, 613 Hypophyseal, 382, 613 Hypophysis, 382, 613, 666 Hypoplasia, 613

700 Pregnancy

Hypoplastic Left Heart Syndrome, 613 Hypotension, 583, 613 Hypothalamic, 338, 613 Hypothalamus, 370, 566, 584, 588, 613, 624, 648, 677 Hypothyroidism, 250, 614 Hypovitaminosis, 614 Hypoxia, 305, 571, 614, 677 Hypoxic, 614, 631 Hysterectomy, 614 Hysteroscopy, 614 Hysterotomy, 576, 614 I Id, 235, 251, 508, 526, 527, 534, 550, 552, 614 Idiopathic, 384, 394, 614 Ileal, 445, 497, 614 Ileostomy, 445, 539, 614 Ileum, 539, 575, 614 Imidazole, 611, 614, 659 Immersion, 250, 614 Immune function, 326, 614, 615 Immune Sera, 614 Immune system, 381, 392, 409, 513, 515, 563, 566, 569, 591, 614, 615, 623, 626, 627, 634, 635, 647, 683, 686 Immune Tolerance, 614 Immunity, 325, 389, 400, 421, 445, 555, 614, 615, 626, 640, 680 Immunization, 232, 324, 325, 352, 539, 540, 542, 614, 653, 667 Immunoassay, 133, 140, 336, 339, 341, 352, 365, 366, 381, 562, 615 Immunodeficiency syndrome, 426, 494, 500, 615 Immunodiffusion, 557, 615 Immunodominant Epitopes, 615 Immunoelectrophoresis, 557, 615 Immunofluorescence, 615, 649 Immunogenic, 615, 624, 659 Immunoglobulin, 131, 133, 134, 138, 143, 323, 400, 562, 615, 618, 633 Immunohistochemistry, 615 Immunologic, 323, 379, 576, 604, 614, 615, 627, 687 Immunology, 244, 383, 557, 615 Immunosuppressant, 615, 631 Immunosuppressive, 10, 14, 21, 392, 585, 605, 615 Immunosuppressive Agents, 14, 615 Immunosuppressive therapy, 10, 21, 615

Impairment, 14, 367, 383, 474, 565, 577, 598, 615, 619, 630, 681 Impotence, 442, 596, 615 Impregnation, 345, 615 In situ, 615 In Situ Hybridization, 616 In vivo, 354, 357, 362, 369, 409, 588, 610, 616, 642, 678 Incision, 572, 579, 596, 614, 616, 619, 621 Incompetence, 603, 616 Incontinence, 14, 238, 447, 616, 673 Incubated, 616 Incubation, 616, 649 Indicative, 337, 345, 352, 426, 616, 644, 684 Indinavir, 320, 616 Induction, 324, 336, 397, 561, 616, 642, 654 Infancy, 239, 270, 278, 294, 307, 451, 613, 616 Infant Behavior, 616 Infant Mortality, 280, 286, 374, 541, 616 Infarction, 9, 571, 583, 616, 631 Infection Control, 493, 616 Infectious Mononucleosis, 616, 633 Infiltration, 605, 617, 653 Influenza, 617 Informed Consent, 20, 500, 526, 617 Infusion, 617, 680 Ingestion, 452, 565, 572, 605, 608, 617, 630, 650, 677 Inguinal, 617, 626 Inhalation, 557, 608, 617, 641, 650, 671, 681 Inhibin, 617 Initiation, 279, 409, 517, 617, 654, 680 Initiator, 361, 617 Innervation, 571, 617, 628 Inorganic, 573, 590, 617, 634, 674 Inositol, 617 Inositol 1,4,5-Trisphosphate, 617 Inotropic, 396, 590, 617 Insect Repellents, 133, 617 Insecticides, 617, 646, 687 Insight, 348, 617, 664 Insomnia, 618, 653 Instillation, 618 Insulator, 618, 634 Insulin-dependent diabetes mellitus, 618 Insulin-like, 142, 415, 452, 618 Intensive Care, 446, 618 Interferon, 618, 626 Interferon-alpha, 618 Interleukin-1, 138, 244, 421, 618 Interleukin-13, 244, 618

Index 701

Interleukin-2, 618 Interleukins, 615, 618 Intermittent, 6, 441, 618, 646 Internal Medicine, 9, 232, 593, 603, 618, 636 Interstitial, 449, 497, 598, 618, 636, 661 Intervertebral, 408, 618, 619, 625, 665 Intervertebral Disk Displacement, 619, 625, 665 Intestinal, 15, 135, 396, 537, 574, 575, 605, 619, 627, 628, 686, 687 Intestinal Mucosa, 575, 619, 687 Intestinal Obstruction, 15, 619 Intestine, 568, 571, 619, 621, 673, 686 Intoxication, 619, 679, 687 Intrahepatic, 9, 12, 18, 234, 452, 503, 619 Intramuscular, 336, 607, 619, 644 Intraspecific, 619 Intravascular, 619, 642 Intravenous, 138, 139, 317, 323, 324, 331, 425, 617, 619, 644 Intrinsic, 557, 567, 619 Intussusception, 15, 619 Inulin, 605, 619 Involuntary, 567, 591, 595, 597, 598, 599, 619, 634, 660, 669, 673 Involution, 140, 619 Iodine, 362, 371, 619, 658 Ion Channels, 565, 619, 647, 675 Ion Transport, 619, 632 Ionizing, 559, 595, 620 Ions, 567, 572, 573, 589, 592, 603, 612, 617, 619, 620, 651 Ischemia, 465, 566, 571, 620 Islet, 602, 620 Isoelectric, 352, 620 Isoelectric Focusing, 352, 620 Isoelectric Point, 352, 620 Isoenzyme, 620 Isoflavones, 620 Isoniazid, 515, 620 Isotretinoin, 5, 480, 620 J Jaundice, 8, 18, 19, 441, 443, 612, 620 Jejunostomy, 595, 620 K Kallidin, 571, 620 Karyotype, 346, 560, 612, 620 Kb, 490, 620 Keto, 341, 620, 680 Ketoacidosis, 620, 621 Ketone Bodies, 620, 621

Ketosis, 620, 621 Kidney Disease, 332, 362, 448, 449, 450, 474, 490, 505, 558, 621 Kidney Failure, 450, 594, 621 Kidney Failure, Acute, 621 Kidney Failure, Chronic, 621 Killer Cells, 278, 621 Kinetic, 620, 621 L Labile, 580, 621 Laceration, 621, 677 Lacrimal, 621 Lacrimal gland, 621 Lag, 621 Lamivudine, 320, 321, 322, 327, 621 Laparoscopy, 621 Laparotomy, 621 Large Intestine, 537, 575, 588, 589, 619, 621, 660, 669, 686 Latent, 511, 515, 622, 652 Lateral Ventricles, 622, 667, 677 Lavage, 365, 622 Laxative, 557, 622 Lead Poisoning, 248, 322, 622 Learning Disorders, 349, 622 Least-Squares Analysis, 622, 661 Lectin, 356, 622 Leiomyoma, 600, 622, 669 Lens, 582, 622, 662 Lenticular, 353, 622 Leptin, 277, 281, 622 Lethal, 308, 384, 567, 622 Lethargy, 614, 622 Leucine, 135, 338, 622, 645 Leucocyte, 595, 622, 626 Leukaemia, 137, 345, 622 Leukemia, 240, 345, 504, 623 Leukocyte Count, 360, 623 Leukocytes, 384, 394, 568, 569, 570, 576, 618, 623, 681 Leukoencephalopathy, 465, 623 Leukopenia, 623, 687 Leukotrienes, 400, 564, 592, 623 Libido, 383, 561, 623 Library Services, 550, 623 Lidocaine, 623 Life Expectancy, 623 Ligament, 238, 288, 294, 623, 655, 671 Ligands, 623 Ligase, 143, 623 Ligase Chain Reaction, 143, 623 Ligation, 623

702 Pregnancy

Likelihood Functions, 623, 661 Limbic, 560, 623 Limbic System, 560, 623 Lincomycin, 578, 624 Linear Models, 624, 661 Linkage, 138, 296, 604, 624, 645 Lip, 578, 624 Lipid A, 624 Lipid Peroxidation, 234, 624, 642 Lipolysis, 624 Lipopolysaccharides, 624 Lipoprotein, 591, 624, 625 Lipoprotein(a), 624 Lipoxygenase, 623, 624 Liquor, 624, 658 Lithium, 540, 624 Litter, 624 Litter Size, 624 Liver cancer, 8, 559, 625 Liver scan, 625, 665 Liver Transplantation, 15, 625 Localization, 138, 339, 615, 625 Localized, 339, 571, 576, 600, 609, 616, 625, 639, 648, 665, 677, 678, 682, 683 Locomotor, 625, 665 Logistic Models, 625, 661 Longitudinal study, 625 Loop, 369, 614, 625 Loratadine, 625 Lordosis, 408, 625, 646 Low Back Pain, 5, 240, 250, 625 Low-density lipoprotein, 591, 624, 625 Lower Esophageal Sphincter, 17, 603, 625 Lubricants, 511, 626, 646 Lumbar, 6, 408, 567, 575, 619, 625, 626 Lumen, 594, 626 Lupus, 6, 448, 474, 475, 476, 522, 562, 563, 626, 676 Lupus Nephritis, 448, 474, 626 Luteal Phase, 403, 409, 626, 631 Lutein Cells, 364, 417, 626, 654 Luteolytic Agents, 338, 626 Luxation, 589, 626 Lymph, 567, 576, 594, 611, 616, 626, 660, 664 Lymph node, 567, 576, 626, 660, 664 Lymphadenopathy, 616, 626 Lymphatic, 594, 616, 626, 630, 639, 649, 664, 670, 671, 678 Lymphatic system, 626, 664, 670, 671, 678 Lymphoblastic, 626 Lymphoblasts, 556, 626

Lymphocyte, 324, 325, 392, 409, 498, 556, 563, 618, 621, 626, 627, 629 Lymphocyte Count, 324, 325, 498, 556, 626 Lymphocytic, 626 Lymphogranuloma Venereum, 398, 607, 626 Lymphoid, 409, 562, 622, 626 Lymphokines, 626, 627 Lymphoma, 137, 249, 504, 626 Lysine, 572, 612, 627 Lysophospholipase, 243, 627 M Macrolides, 5, 627 Macrophage, 380, 618, 627 Macrophage Activation, 627 Magnetic Resonance Imaging, 627, 665 Major Histocompatibility Complex, 627 Malabsorption, 445, 504, 575, 627 Malaria, Falciparum, 627 Malaria, Vivax, 627 Malformation, 271, 536, 627 Malignancy, 368, 405, 410, 598, 627 Malignant, 352, 504, 556, 563, 577, 613, 625, 627, 635, 665 Malnutrition, 10, 230, 558, 566, 627, 634 Mammary, 132, 133, 139, 141, 627, 628 Mammography, 539, 628 Mandatory Testing, 498, 500, 628 Mandible, 559, 576, 628, 662 Mania, 541, 628 Manic, 541, 569, 624, 628 Manifest, 270, 280, 303, 628, 673 Manometry, 15, 628 Marital Status, 331, 628, 668 Mastitis, 628, 667 Maternal Mortality, 308, 628 Matrix metalloproteinase, 628 Maxillary, 578, 628 Meat, 588, 628, 681 Meat Products, 588, 628 Mebendazole, 628 Meconium, 599, 628 Medial, 565, 578, 597, 628, 640, 678 Median Nerve, 470, 628 Mediate, 590, 621, 628, 659 Mediator, 139, 366, 400, 618, 628, 667 Medical Assistance, 454, 629 Medical Records, 611, 629, 663 Medical Staff, 355, 590, 629 Medicament, 230, 349, 629, 674 MEDLINE, 12, 491, 503, 505, 629 Medullary, 629

Index 703

Megaloblastic, 601, 629 Meiosis, 569, 629, 675 Melanin, 629, 647, 682 Melanocytes, 629 Melanoma, 504, 629 Membrane Glycoproteins, 629 Membrane Lipids, 629, 647 Memory, 370, 372, 373, 374, 417, 562, 586, 629 Menarche, 629, 662 Meninges, 575, 629 Menopause, 238, 239, 360, 382, 416, 629, 639, 651, 653, 662 Menstrual Cycle, 382, 408, 409, 413, 601, 626, 629, 639, 653, 654 Menstruation, 360, 361, 441, 521, 559, 586, 591, 601, 626, 629, 639, 653, 662 Mental deficiency, 599, 629 Mental Disorders, 333, 629, 653, 657 Mental Retardation, 7, 506, 523, 543, 611, 630 Mentors, 630 Mercaptopurine, 475, 630 Mercury, 471, 630 Mesenchymal, 612, 630 Mesenteric, 630, 651 Mesenteric Arteries, 630 Mesentery, 630, 646, 671 Mesoderm, 578, 630, 681, 687 Meta-Analysis, 7, 8, 132, 630 Metabolic disorder, 517, 540, 587, 606, 630 Metabolite, 337, 555, 588, 589, 597, 630 Metaphase, 569, 630 Metastasis, 628, 630 Metastasize, 538, 630, 665 Metastatic, 630, 665 Methanol, 630 Methionine, 237, 589, 631, 674 Methotrexate, 9, 21, 444, 475, 476, 631 Methyltransferase, 631 Metronidazole, 5, 21, 445, 468, 631 MI, 353, 379, 384, 388, 397, 418, 419, 475, 554, 631 Microbe, 631, 679 Microbiological, 631 Microbiology, 414, 556, 567, 631 Microglia, 565, 631, 633 Micronutrients, 631 Microorganism, 579, 631, 686 Microscopy, 567, 631 Microsomal, 631 Midazolam, 631

Midwifery, 4, 239, 245, 254, 378, 631 Mifepristone, 135, 480, 631 Migration, 278, 377, 578, 627, 632 Milliliter, 570, 632, 670 Mineralization, 632, 641 Mineralocorticoid, 632 Miscible, 416, 632 Misoprostol, 135, 271, 632 Mitosis, 564, 632 Mitral Valve, 613, 632 Mobility, 522, 632 Mobilization, 322, 500, 632 Modeling, 632 Modification, 5, 6, 493, 559, 588, 604, 632, 658, 687 Modulator, 632 Molar pregnancy, 604, 632 Monitor, 11, 314, 387, 412, 418, 419, 451, 584, 632, 638 Monoamine, 560, 587, 633 Monoclonal, 140, 352, 369, 381, 400, 415, 633, 658 Monoclonal antibodies, 369, 400, 415, 633 Monocyte, 633 Monogenic, 633 Mononuclear, 324, 380, 607, 616, 633, 681 Mononucleosis, 633 Monophosphate, 588, 633 Monosomy, 561, 633 Morphine, 572, 633, 640 Morphogenesis, 599, 633 Morphological, 405, 444, 592, 629, 633 Morphology, 289, 403, 564, 627, 633 Morula, 569, 633 Motility, 16, 365, 426, 444, 603, 633, 667 Motion Sickness, 633, 635 Motivations, 633 Motor Activity, 583, 633 Motor nerve, 633, 634 Motor Skills, 417, 462, 633 Movement Disorders, 543, 591, 633, 677 Mucilaginous, 416, 628, 633 Mucins, 633, 664 Mucocutaneous, 633, 675 Mucolytic, 555, 633 Mucosa, 451, 602, 626, 634, 654, 673, 674 Mucus, 359, 365, 390, 591, 633, 634, 682 Multicenter study, 634 Multidose, 634 Multidrug resistance, 634 Multiparous, 634 Multiple sclerosis, 634

704 Pregnancy

Muscle Fibers, 634, 635 Muscle relaxant, 634, 647 Muscle Spindles, 634, 647 Muscle tension, 634 Muscular Atrophy, 504, 634 Muscular Dystrophies, 591, 634 Mutagen, 634 Mutagenic, 555, 634 Myalgia, 617, 634 Mydriatic, 589, 634 Myelin, 634 Myeloma, 612, 634 Myocardium, 631, 634 Myograph, 634 Myometrium, 634, 642 Myosin, 635 Myotonic Dystrophy, 504, 635 N Nadir, 635 Naive, 635 Nasal Mucosa, 617, 635 Nasogastric, 595, 635 Natural Childbirth, 355, 435, 635 Natural killer cells, 138, 635 NCI, 1, 332, 489, 635 Need, 3, 6, 10, 11, 16, 316, 319, 346, 351, 352, 357, 373, 380, 383, 389, 394, 413, 421, 422, 423, 425, 428, 430, 432, 438, 440, 442, 447, 451, 453, 457, 463, 469, 472, 474, 476, 484, 492, 495, 497, 509, 512, 513, 516, 520, 522, 524, 532, 546, 578, 628, 635, 679, 681 Needle Sharing, 524, 635 Needlestick Injuries, 493, 635 Needs Assessment, 274, 450, 635 Nelfinavir, 287, 313, 320, 635 Nematocide, 628, 635 Neonatal period, 635 Neoplasia, 11, 504, 602, 635 Neoplasm, 635, 682 Neoplastic, 626, 635 Nephritis, 449, 474, 635 Nephrology, 448, 636 Nephropathy, 448, 449, 621, 636 Nephrosis, 636 Nephrotic, 449, 636 Nephrotic Syndrome, 449, 636 Nervous System, 381, 504, 555, 557, 560, 566, 567, 568, 572, 575, 579, 587, 591, 602, 605, 608, 623, 625, 628, 631, 633, 634, 636, 646, 665, 667, 675, 677 Networks, 310, 542, 543, 636

Neural, 231, 557, 572, 593, 599, 611, 622, 631, 636, 654 Neural tube defects, 231, 599, 636 Neuroendocrine, 288, 636 Neurogenic, 636 Neurogenic Inflammation, 636 Neurologic, 6, 593, 613, 636, 675 Neurologist, 636 Neuroma, 636 Neuronal, 636 Neurons, 280, 579, 586, 597, 602, 634, 636, 637, 658, 671, 675 Neuropathy, 636, 665, 687 Neuropeptide, 572, 584, 636 Neurosis, 636, 647 Neurosurgery, 637 Neurotoxic, 637 Neurotransmitter, 555, 556, 559, 565, 571, 572, 590, 605, 606, 611, 619, 637, 638, 668, 673, 675 Neutralization, 349, 637 Neutrons, 559, 637, 658 Neutrophil, 637 Neutrophil Activation, 637 Nevirapine, 318, 319, 322, 513, 637 Niacin, 372, 481, 637, 681 Nicotine, 315, 462, 481, 637, 639 Nidation, 592, 637 Nitrogen, 558, 559, 561, 585, 598, 600, 606, 621, 637, 681 Non-nucleoside, 499, 586, 637 Nonoxynol, 386, 389, 400, 637 Nonverbal Communication, 638, 657 Norepinephrine, 557, 590, 637, 638 Normotensive, 290, 638 Nuclear, 567, 597, 624, 638 Nuclear Proteins, 638 Nuclei, 559, 560, 604, 624, 627, 632, 637, 638, 656, 664 Nucleic acid, 411, 415, 585, 588, 603, 611, 616, 637, 638, 639, 653, 658, 663, 670, 687 Nucleic Acid Hybridization, 611, 638 Nucleoproteins, 638 Nulliparous, 7, 638 Nursing Care, 638, 645 Nursing Research, 490, 638 Nutrition Assessment, 519, 638 Nutritional Status, 310, 638 O Observational study, 131, 135, 141, 328, 638 Obsession, 581, 639

Index 705

Occult, 368, 406, 411, 639 Occupational Groups, 639 Odds Ratio, 639, 661 Odour, 564, 639, 682 Oedema, 639, 652 Oestradiol, 639 Oestrogen, 639 Ointments, 639, 643 Oligohydramnios, 639 Oligomenorrhea, 639, 650 Oligonucleotide Probes, 623, 639 Oliguria, 621, 640 Omega-3 fatty acid, 245, 416, 640 Omeprazole, 10, 640 Oncogene, 504, 640 On-line, 553, 640 Oocytes, 602, 640 Opacity, 586, 640 Ophthalmology, 248, 600, 640 Opiate, 292, 633, 640 Opium, 633, 640 Opportunistic Infections, 324, 556, 640 Optic Chiasm, 613, 640 Optic Disk, 587, 640, 643 Oral Health, 451, 459, 525, 542, 640 Oral Hygiene, 459, 640 Orbital, 580, 640 Organ Culture, 640, 679 Organelles, 575, 585, 629, 640, 644 Organogenesis, 599, 640 Orgasm, 446, 592, 640 Ornithine, 641, 658 Ornithosis, 641, 657 Osmolality, 641 Osmoles, 641 Osmosis, 641 Osmotic, 558, 641, 667 Ossification, 641 Osteoarthritis, 237, 641 Osteoblasts, 380, 641 Osteoclasts, 396, 572, 641 Osteogenesis, 295, 522, 641 Osteomalacia, 641 Osteoporosis, 530, 570, 639, 641 Ostomy, 539, 641 Ovalbumin, 641 Ovarian Cysts, 641 Ovarian Follicle, 583, 601, 607, 641, 677 Ovarian Hyperstimulation Syndrome, 641 Ovariectomy, 642 Ovaries, 336, 339, 354, 362, 369, 596, 602, 642, 650, 661, 662, 667, 681

Ovary, 249, 354, 361, 407, 412, 538, 583, 597, 606, 639, 641, 642, 673 Overweight, 234, 642 Ovulation Induction, 365, 642 Ovum, 342, 357, 375, 376, 380, 583, 586, 601, 604, 633, 641, 642, 654, 681, 687 Ovum Implantation, 642, 681 Oxalate, 612, 642 Oxidants, 642 Oxidation, 555, 563, 585, 606, 624, 642 Oxidation-Reduction, 642 Oxidative metabolism, 623, 642 Oxidative Stress, 243, 642 Oxygen Consumption, 442, 642, 662 Oxytocic, 632, 642 Oxytocin, 481, 643 P Pain Threshold, 643 Palate, 578, 643, 669, 683 Palliative, 6, 639, 643, 677 Palpation, 6, 403, 643 Pancreas, 555, 559, 569, 588, 602, 603, 609, 618, 620, 643, 666, 671, 681 Pancreatic, 11, 18, 504, 603, 643, 657 Pancreatic cancer, 504, 643 Pancreatic Juice, 603, 643 Pancreatitis, 18, 643 Panniculitis, 249, 643 Papilledema, 613, 643 Paraffin, 391, 392, 394, 395, 396, 643 Paralysis, 584, 597, 643, 670 Parasite, 400, 628, 643, 681 Parasitic, 445, 591, 611, 643, 679 Parasitic Diseases, 445, 643 Parathyroid, 396, 643, 644, 677 Parathyroid Glands, 643, 644 Parathyroid hormone, 396, 643 Parathyroidectomy, 11, 644 Parental Leave, 598, 644 Parenteral, 426, 445, 595, 644 Parenteral Nutrition, 426, 445, 644 Parietal, 11, 640, 644, 646 Parietal Lobe, 644 Parity, 644 Paroxysmal, 504, 566, 644 Partial remission, 644, 661 Partial response, 644 Patch, 644 Patch-Clamp Techniques, 644 Patella, 644 Pathogenesis, 7, 12, 17, 230, 364, 452, 493, 498, 644

706 Pregnancy

Pathologic, 249, 400, 555, 564, 569, 583, 612, 613, 644, 662, 674 Pathologic Processes, 564, 644 Pathologies, 415, 644 Pathophysiology, 10, 15, 17, 444, 449, 452, 644 Patient Advocacy, 535, 538, 543, 644 Patient Care Management, 10, 452, 645 Patient Care Team, 522, 645 Patient Education, 14, 446, 459, 460, 510, 512, 528, 548, 550, 554, 645 Pedigree, 645 Peer Group, 645 Pelvic inflammatory disease, 399, 645 Pelvis, 383, 385, 408, 522, 555, 571, 626, 642, 645, 658, 683 Penicillamine, 9, 19, 475, 645 Penicillin, 400, 560, 562, 645, 684 Penis, 389, 581, 592, 645, 662 Pensions, 539, 645 Pepsin, 578, 632, 645, 666 Pepsin A, 578, 645 Peptic, 17, 645, 674, 686 Peptic Ulcer, 17, 645, 686 Peptide, 338, 369, 406, 411, 559, 572, 578, 594, 600, 622, 645, 655, 656, 678 Peptide Chain Elongation, 578, 645 Perception, 307, 309, 581, 608, 645, 665 Perennial, 247, 645, 681 Perforation, 564, 601, 645, 686 Perfusion, 614, 646, 679 Periaqueductal Gray, 646 Pericardium, 646, 676 Perineum, 646 Periodontal disease, 646 Periodontitis, 604, 646 Perioral, 5, 646 Peripheral blood, 324, 609, 618, 646 Peripheral Nervous System, 595, 637, 646, 665, 674 Peritoneal, 405, 449, 610, 639, 646 Peritoneal Cavity, 610, 639, 646 Peritoneal Dialysis, 449, 646 Peritoneum, 571, 630, 646 Peritonitis, 646, 686 Perivascular, 572, 631, 646 Peroxide, 361, 568, 646 Pesticides, 617, 646 Petroleum, 601, 643, 646 PH, 136, 570, 647 Phagocyte, 642, 647

Pharmaceutical Preparations, 338, 597, 603, 647 Pharmacokinetic, 314, 319, 323, 647 Pharmacologic, 231, 400, 475, 494, 541, 561, 608, 647, 679 Pharynx, 603, 613, 617, 647, 684 Phenotype, 569, 603, 647 Phenyl, 395, 647 Phenylalanine, 329, 330, 645, 647, 682 Phenytoin, 573, 647 Phobia, 238, 647 Phobic Disorders, 647 Phorbol, 647 Phospholipases, 647, 668 Phospholipids, 562, 563, 574, 598, 617, 624, 629, 647 Phosphorus, 371, 573, 643, 647, 648 Phosphorylate, 648 Phosphorylation, 648 Phosphotyrosine, 648 Photocoagulation, 579, 648 Physical Examination, 6, 604, 648 Physical Therapy, 5, 238, 648 Pigmentation, 451, 648 Pigments, 568, 574, 648, 662 Pilot study, 20, 314, 648 Pituitary Gland, 354, 361, 370, 583, 584, 600, 648 Placebos, 648 Placental tissue, 648 Plants, 558, 564, 565, 571, 573, 579, 604, 605, 619, 622, 633, 638, 648, 650, 664, 679, 681 Plaque, 577, 648 Plaque Assay, 648 Plasma cells, 562, 634, 649 Plasmin, 649 Plasminogen, 649 Plasminogen Activators, 649 Plasticity, 141, 649 Platelet Activation, 234, 344, 649, 668 Platelet Aggregation, 560, 637, 649, 678 Platelet Count, 9, 449, 649 Platelets, 18, 279, 366, 452, 637, 649, 678 Platinum, 625, 649 Plexus, 571, 649 Pneumonia, 582, 649 Pneumonitis, 139, 565, 572, 641, 649 Poisoning, 441, 572, 596, 619, 630, 635, 639, 650 Policy Making, 606, 650 Polycystic, 316, 449, 505, 650

Index 707

Polycystic Ovary Syndrome, 316, 650 Polydipsia, 537, 650 Polyethylene, 650 Polyhydramnios, 650 Polymerase, 563, 650, 654, 663 Polymerase Chain Reaction, 650 Polymers, 352, 386, 650, 656, 673 Polymorphic, 133, 577, 586, 650 Polymorphism, 138, 650 Polyposis, 650 Polyradiculopathy, 465, 650 Polysaccharide, 232, 563, 606, 650, 656 Polyunsaturated fat, 650, 678 Polyuria, 537, 650 Polyvalent, 394, 651 Population Control, 383, 651 Population Growth, 399, 651 Porokeratosis, 651 Portal Vein, 651 Post partum, 651 Posterior, 387, 560, 566, 567, 575, 577, 590, 596, 643, 651, 665, 683, 684 Postmenopausal, 641, 651 Postmenopause, 441, 651 Postnatal, 458, 474, 532, 598, 599, 651, 672 Postnatal Care, 474, 651 Postoperative, 239, 651 Postoperative Nausea and Vomiting, 239, 651 Postprandial, 651 Postsynaptic, 651, 668, 675 Post-translational, 651 Post-traumatic, 633, 651 Potassium, 481, 558, 632, 651 Potassium Channels, 651 Potassium Chloride, 651 Potentiates, 618, 651 Potentiation, 651, 668 Practicability, 651, 680 Practice Guidelines, 501, 526, 652 Precancerous, 652, 653 Preconception Care, 652 Precursor, 561, 564, 585, 590, 591, 594, 595, 638, 647, 649, 652, 670, 681, 682, 684 Predisposition, 12, 652 Prednisolone, 21, 652 Prednisone, 9, 10, 475, 652 Pre-eclamptic, 234, 591, 652 Pregnancy Maintenance, 652 Pregnancy Tests, 347, 375, 376, 379, 414, 604, 652

Pregnancy Toxemias, 326, 328, 329, 402, 443, 652 Pregnancy, High-Risk, 653 Premalignant, 652, 653 Premenopausal, 305, 329, 653 Premenstrual, 238, 413, 653 Premenstrual Syndrome, 238, 653 Pressoreceptors, 567, 653 Presumptive, 653 Presynaptic, 637, 653, 675 Primary Biliary Cirrhosis, 15, 653 Primary endpoint, 653 Primary Prevention, 290, 297, 653 Primary tumor, 653 Prion, 140, 653 Probe, 623, 639, 653 Procaine, 623, 653 Progeny, 653 Prognostic factor, 654, 674 Program Development, 654 Program Evaluation, 292, 298, 424, 654 Projection, 374, 638, 654, 658, 660 Prolapse, 654 Proliferative Retinopathy, 654 Proline, 338, 580, 612, 654 Promoter, 421, 654 Promotor, 654, 662 Prone, 342, 343, 350, 378, 382, 386, 421, 654 Prone Position, 342, 343, 378, 386, 654 Prophase, 569, 640, 654, 675 Prophylaxis, 8, 9, 360, 389, 394, 563, 654, 662, 683 Proportional, 641, 654 Prosencephalon, 588, 611, 654 Prostaglandin, 272, 336, 584, 632, 655, 678 Prostaglandin-Endoperoxide Synthase, 584, 655 Prostaglandins A, 655 Prostaglandins D, 241, 655 Prostaglandins F, 336, 631, 655 Prostate, 447, 504, 569, 605, 639, 655, 662, 681 Prosthesis, 655 Protease, 142, 315, 321, 327, 415, 499, 580, 616, 635, 655, 664, 665 Protease Inhibitors, 315, 321, 499, 655 Protein Binding, 354, 361, 655, 679 Protein C, 380, 411, 412, 558, 559, 564, 567, 599, 624, 656, 682 Protein Conformation, 559, 656 Protein Kinases, 656

708 Pregnancy

Protein S, 441, 505, 563, 569, 578, 596, 603, 656, 663, 677 Protein Subunits, 656 Proteinuria, 341, 393, 448, 453, 636, 652, 656 Proteoglycan, 136, 366, 656 Proteolytic, 247, 580, 600, 649, 656 Proteome, 656 Protocol, 358, 494, 498, 602, 648, 656 Proton Pump, 7, 640, 656 Protons, 559, 612, 620, 656, 658 Protozoa, 390, 591, 631, 656, 679 Protozoal, 656 Protozoan, 445, 604, 627, 656, 681 Protozoan Infections, 445, 656 Proximal, 590, 653, 656, 667 Pruritus, 12, 657, 665, 682 Pseudocysts, 657 Pseudopregnancy, 290, 657 Psittaci, 139, 140, 641, 657 Psychiatric, 540, 569, 629, 657 Psychic, 578, 623, 629, 636, 657, 666 Psychoactive, 396, 657, 687 Psychology, 581, 589, 657 Psychomotor, 573, 593, 657 Psychotherapy, 579, 657, 660 Psychotomimetic, 560, 587, 657 Psyllium, 657 Puberty, 657 Public Assistance, 629, 657 Public Policy, 296, 298, 306, 491, 498, 657 Puerperium, 639, 652, 657 Pulmonary Artery, 570, 657, 685 Pulmonary Edema, 621, 657 Pulmonary Emphysema, 365, 657 Pulmonary hypertension, 583, 657 Pulse, 592, 632, 657 Pupil, 583, 589, 634, 658 Purifying, 587, 658 Purines, 658, 667 Purpura, 449, 608, 658 Purulent, 555, 658 Putrefaction, 602, 658 Putrescine, 658, 670 Pyelonephritis, 134, 362, 497, 658 Pyogenic, 658, 667 Pyramidal Cells, 586, 658 Pyridoxal, 585, 658, 680 Pyrimidines, 658, 667 Q Quality of Life, 10, 444, 536, 539, 541, 542, 658

Quiescent, 658 R Race, 283, 296, 308, 424, 492, 497, 578, 620, 632, 658 Radiation, 595, 601, 602, 614, 620, 631, 658, 659, 665, 687 Radiation therapy, 601, 658 Radioactive, 362, 570, 571, 608, 612, 615, 625, 633, 638, 658, 659, 665, 681 Radioactive iodine, 362, 658 Radiography, 604, 659 Radioimmunoassay, 345, 347, 357, 362, 659 Radioisotope, 596, 639, 659, 680 Radiological, 11, 659 Radiologist, 598, 659 Radiology, 659 Radiopharmaceutical, 603, 659 Rage, 646, 659 Randomized clinical trial, 317, 328, 659 Randomized Controlled Trials, 245, 659 Ranitidine, 10, 11, 659 Rape, 392, 395, 397, 659 Reactivation, 659 Reactive Oxygen Species, 659 Reagent, 338, 342, 343, 344, 345, 347, 357, 377, 382, 659 Reassurance, 11, 460, 660 Receptivity, 660 Receptors, Serotonin, 660, 667 Recombinant, 132, 323, 325, 415, 479, 660, 684 Recombination, 604, 660 Reconstitution, 660 Rectal, 135, 407, 660 Rectum, 16, 132, 562, 563, 571, 580, 588, 589, 600, 602, 610, 616, 617, 621, 655, 660, 674 Recur, 6, 326, 400, 523, 660 Recurrence, 7, 141, 384, 569, 576, 660 Red blood cells, 357, 379, 596, 609, 660, 665, 669 Red Nucleus, 566, 660 Reductase, 249, 631, 660 Refer, 1, 381, 571, 580, 594, 600, 602, 610, 625, 633, 635, 637, 660, 667, 679 Reflex, 253, 634, 646, 660 Reflux, 10, 448, 603, 660, 674 Refraction, 660, 670 Refractory, 16, 497, 592, 660 Regeneration, 600, 660

Index 709

Regimen, 319, 320, 321, 327, 380, 492, 495, 498, 511, 515, 592, 660 Regional lymph node, 602, 660 Regression Analysis, 661 Regurgitation, 603, 609, 661 Relapse, 13, 315, 661 Relative risk, 8, 14, 661 Relaxant, 647, 661 Relaxation Techniques, 253, 635, 661 Relaxin, 364, 417, 661 Reliability, 661 Remission, 13, 444, 475, 522, 569, 660, 661 Renal Artery, 613, 661 Renal Circulation, 661 Renal failure, 449, 450, 661 Renin, 327, 329, 561, 661 Renin-Angiotensin System, 327, 661 Renovascular, 661 Reproduction Techniques, 652, 661 Reproductive History, 661 Reproductive system, 662 Research Design, 4, 662 Research Support, 238, 662 Resection, 11, 662 Resolving, 295, 662 Resorption, 570, 599, 641, 662 Respiration, 363, 564, 571, 573, 584, 599, 632, 642, 662 Respiratory Physiology, 662, 685 Response Elements, 662 Restoration, 648, 659, 660, 662, 664, 687 Reticulata, 662 Retina, 577, 587, 622, 640, 654, 662, 663, 664, 683 Retinal, 581, 587, 589, 613, 640, 662, 686 Retinal Hemorrhage, 613, 662 Retinoblastoma, 504, 662 Retinoids, 662, 686 Retinopathy, 587, 663 Retrograde, 619, 663 Retrospective, 13, 132, 138, 141, 142, 288, 305, 373, 374, 663 Retrospective Studies, 663 Retrospective study, 13, 132, 663 Reverse Transcriptase Inhibitors, 499, 663 Reversion, 574, 663 Rheumatic Diseases, 443, 475, 663 Rheumatism, 663 Rheumatoid, 329, 443, 577, 642, 663 Rheumatoid arthritis, 329, 443, 577, 663 Rhinitis, 663, 667 Rhythm Method, 663

Ribavirin, 663 Riboflavin, 232, 663 Ribonuclease, 663 Ribonucleic acid, 663 Ribose, 556, 663 Ribosome, 663, 680 Risk patient, 388, 419, 522, 663 Risk-Taking, 424, 664 Ritonavir, 313, 322, 327, 664 Rod, 567, 578, 664 Rodenticides, 646, 664 Role Playing, 424, 461, 664 Role-play, 664 Roseolovirus, 664 Rubber, 343, 556, 664 Rubella, 526, 664 Ruminants, 606, 664 S Sacroiliac Joint, 408, 664 Salicylic, 5, 664 Saliva, 414, 664 Salivary, 585, 588, 643, 664 Salivary glands, 585, 588, 664 Salpingectomy, 664 Salpingostomy, 664 Sanitary, 351, 664 Sanitation, 565, 664 Saponins, 664, 672 Saquinavir, 327, 665 Scans, 347, 665 Schizoid, 665, 687 Schizophrenia, 665, 687 Schizotypal Personality Disorder, 665, 687 Schwannoma, 665 Sciatica, 386, 387, 665 Sclera, 577, 582, 665, 683 Scleroderma, 448, 665 Sclerosis, 432, 442, 443, 504, 565, 634, 665 Scrapie, 140, 665 Seafood, 138, 665 Sebaceous, 587, 665, 686 Secondary tumor, 630, 665 Secretin, 11, 666 Secretory, 359, 640, 666, 675, 686 Secular trends, 19, 666 Sedative, 577, 631, 666 Sedentary, 666 Sediment, 666, 683 Sedimentation, 357, 377, 416, 575, 666 Segmental, 666, 671 Segmentation, 611, 666 Segregation, 567, 660, 666

710 Pregnancy

Seizures, 462, 573, 611, 613, 644, 647, 666 Selection Bias, 535, 666 Selenium, 12, 248, 482, 666 Sella, 648, 666 Semen, 397, 420, 592, 655, 666 Seminiferous tubule, 617, 666 Semisynthetic, 560, 571, 578, 666 Senile, 641, 666 Senna, 480, 666 Sensitization, 666 Sepsis, 667 Septal, 624, 667 Septate, 403, 667 Septic, 565, 667 Septicaemia, 667 Septum, 136, 622, 667 Septum Pellucidum, 622, 667 Sequence Analysis, 667 Sequencing, 650, 667, 675 Serine, 338, 585, 594, 667 Seroconversion, 667 Serologic, 615, 667 Serology, 667 Serotonin, 400, 601, 637, 660, 667, 674, 681 Serotypes, 667 Serous, 594, 667 Serum Albumin, 659, 667 Sex Behavior, 625, 667 Sex Behavior, Animal, 625, 667 Sex Characteristics, 557, 561, 639, 657, 667, 677 Sex Determination, 346, 414, 505, 668 Sex Education, 302, 305, 307, 458, 494, 521, 668 Sexual Abstinence, 424, 516, 519, 524, 668 Sexual Harassment, 668 Sexual Partners, 497, 668 Sharpness, 668, 686 Shedding, 668, 686 Shock, 561, 668, 680 Shunt, 668 Sickle Cell Trait, 449, 668 Signal Transduction, 412, 617, 648, 668 Signs and Symptoms, 7, 362, 661, 668, 682 Skeletal, 246, 390, 561, 578, 584, 634, 669 Skeleton, 556, 570, 599, 612, 620, 655, 669, 678 Skin test, 515, 669 Skull, 593, 636, 669, 676 Sleep apnea, 386, 387, 669 Sludge, 669

Small intestine, 539, 575, 578, 591, 604, 611, 614, 619, 635, 669, 685 Smooth Muscle Tumor, 600, 669 Sneezing, 668, 669, 673 Snoring, 386, 387, 669 Social Class, 669 Social Environment, 658, 669 Social Isolation, 665, 669 Social Medicine, 669 Social Security, 659, 669 Social Support, 290, 301, 304, 305, 309, 310, 669 Social Work, 273, 274, 279, 285, 286, 294, 296, 300, 301, 306, 425, 458, 669 Sodium, 360, 468, 482, 484, 558, 606, 632, 669, 675 Soft tissue, 570, 600, 669, 670 Soft tissue sarcoma, 600, 670 Solid tumor, 561, 670 Solvent, 416, 568, 597, 606, 630, 641, 670, 681 Soma, 658, 670 Somatic, 557, 578, 593, 611, 623, 629, 632, 640, 646, 670, 684 Sound wave, 347, 659, 670 Soybean Oil, 650, 670 Spastic, 465, 670 Spasticity, 670 Specialist, 545, 589, 670 Specificity, 369, 557, 594, 615, 670, 679 Spectrum, 352, 631, 670 Sperm Count, 470, 471, 670 Spermicide, 386, 670 Spermidine, 670 Spermine, 380, 670 Sphincter, 14, 671, 673 Spina bifida, 231, 542, 636, 671 Spinal Nerve Roots, 650, 665, 671 Spirochete, 671, 675 Spleen, 352, 585, 602, 612, 626, 671 Splenic Vein, 651, 671 Spondylitis, 443, 671 Spontaneous Abortion, 10, 13, 337, 353, 365, 369, 380, 384, 394, 402, 406, 412, 418, 446, 447, 652, 671 Sporadic, 662, 671 Sporotrichosis, 671 Sprains and Strains, 625, 671 Sprayer, 397, 420, 671 Sputum, 365, 671 Squamous, 595, 671 Squamous cell carcinoma, 595, 671

Index 711

Squamous cells, 671 Stabilization, 647, 672 Staging, 665, 672 State Government, 455, 672 Statistically significant, 672 Steady state, 672 Steatosis, 598, 672 Steel, 578, 672 Stem cell transplantation, 249, 609, 672 Stem Cells, 596, 609, 672, 682 Stenosis, 613, 672, 673 Stent, 641, 672 Sterile, 565, 643, 672 Sterilization, 366, 672 Sterilization Reversal, 672 Stillbirth, 138, 140, 141, 349, 429, 434, 439, 469, 544, 652, 672 Stimulant, 560, 572, 584, 587, 611, 620, 672, 684 Stimulus, 582, 590, 591, 597, 617, 619, 621, 636, 647, 660, 672, 677 Stoma, 641, 672 Stool, 580, 616, 621, 672 Strabismus, 673 Strand, 650, 673 Streptococci, 132, 135, 673 Streptococcus, 131, 135, 530, 538, 673 Stress, 14, 15, 16, 17, 238, 270, 287, 288, 297, 304, 305, 307, 308, 310, 358, 372, 374, 383, 408, 447, 449, 464, 476, 566, 584, 635, 642, 652, 663, 664, 673, 683 Stress incontinence, 447, 673 Stress urinary, 673 Stricture, 672, 673 Stroke, 137, 333, 490, 529, 574, 673 Stroma, 673 Stromal, 594, 673 Stromal Cells, 673 Styrene, 664, 673 Subacute, 616, 626, 673 Subclinical, 616, 666, 673 Subcutaneous, 249, 314, 402, 517, 557, 591, 602, 607, 622, 639, 643, 644, 671, 673 Subiculum, 611, 673 Sublingual, 673 Submucous, 403, 673 Subspecies, 670, 673 Substance P, 570, 596, 630, 660, 666, 673 Substrate Specificity, 366, 674 Sucralfate, 10, 674 Suction, 600, 644, 674 Sulfonic Acids, 386, 674

Sulfur, 360, 361, 590, 598, 621, 631, 674 Sulfuric acid, 360, 674 Sumatriptan, 674 Superoxide, 674 Support group, 462, 535, 539, 541, 544, 674 Suppositories, 389, 603, 674 Suppression, 326, 584, 674, 687 Suppressive, 674 Suppuration, 674, 686 Surfactant, 637, 674, 686 Survival Analysis, 674 Survival Rate, 674 Suspensions, 343, 409, 675 Sweat, 402, 587, 675 Sweat Glands, 587, 675 Sympathetic Nervous System, 566, 637, 675 Sympathomimetic, 560, 587, 590, 596, 638, 675 Symphysis, 408, 576, 655, 675 Symptomatic, 241, 324, 444, 445, 449, 577, 643, 675 Symptomatic treatment, 577, 675 Symptomatology, 309, 413, 675 Synapse, 557, 653, 675, 680 Synaptic, 637, 668, 675 Synaptic Transmission, 637, 675 Synchrony, 675 Synergistic, 654, 675 Syphilis, 142, 398, 524, 574, 675 Syphilis, Congenital, 524, 675 Systemic disease, 448, 676 Systemic lupus erythematosus, 6, 443, 448, 449, 475, 522, 562, 563, 577, 626, 676 Systemic therapy, 577, 676 Systolic, 613, 676 Systolic blood pressure, 676 T Tachycardia, 599, 676 Talus, 676, 678 Technology Transfer, 676 Telangiectasia, 505, 676 Telomere, 607, 676 Temporal, 560, 611, 676 Temporal Lobe, 560, 676 Tendon, 580, 670, 676 Teratogen, 676 Teratogenic, 8, 20, 375, 376, 620, 676 Teratogenicity, 21, 676 Terbutaline, 676 Terminator, 588, 676, 687 Testicles, 676, 684

712 Pregnancy

Testicular, 676 Testis, 577, 597, 639, 676 Testosterone, 291, 660, 677 Tetani, 677 Tetanic, 677 Tetanus, 140, 677 Tetany, 643, 677 Tetracycline, 400, 677 Thalamic, 566, 677 Thalamic Diseases, 566, 677 Theca Cells, 626, 677 Theophylline, 328, 658, 677 Therapeutics, 11, 484, 677 Thermal, 589, 637, 650, 677 Third Ventricle, 613, 622, 677 Thoracic, 567, 571, 588, 628, 677, 687 Thorax, 555, 626, 677, 684 Threonine, 667, 677 Threshold, 337, 613, 677 Thrombectomy, 140, 592, 677 Thrombin, 600, 649, 656, 678 Thrombocytes, 649, 678 Thrombocytopenia, 326, 427, 678 Thromboembolism, 678 Thrombolytic, 649, 678 Thrombomodulin, 656, 678 Thrombopenia, 563, 678 Thrombophilia, 678 Thrombosed, 678 Thromboses, 563, 678 Thrombosis, 442, 656, 673, 678 Thromboxanes, 564, 584, 592, 678 Thrombus, 583, 616, 649, 678, 685 Thymus, 140, 614, 626, 678 Thyroid, 394, 403, 442, 572, 613, 614, 619, 643, 678, 682 Thyroid Gland, 613, 643, 678 Thyrotropin, 614, 678 Thyroxine, 250, 558, 647, 678 Tibia, 402, 600, 678 Tissue Culture, 679, 685 Tissue Distribution, 679 Tome, 679 Tomography, 581, 665, 679 Tone, 638, 640, 670, 679 Tonicity, 609, 679 Tonus, 646, 679 Tooth Preparation, 556, 679 Topical, 5, 389, 480, 536, 565, 577, 597, 612, 620, 643, 679 Torsion, 616, 679 Toxaemia, 652, 679

Toxemia, 18, 289, 342, 366, 393, 402, 443, 466, 679 Toxicity, 21, 307, 317, 352, 574, 590, 630, 674, 679 Toxicology, 233, 248, 492, 679 Toxin, 135, 594, 677, 679 Toxoplasma, 132, 134, 137, 141, 143, 679 Toxoplasmosis, 133, 138, 465, 679 Trace element, 371, 680 Tracer, 680 Trachea, 571, 647, 678, 680 Traction, 578, 680 Transaminase, 9, 680 Transcriptase, 327, 499, 586, 588, 621, 637, 663, 680, 687 Transcription Factors, 662, 680 Transduction, 668, 680 Transfection, 569, 680 Transfer Factor, 614, 680 Transferases, 606, 680 Transfusion, 544, 545, 597, 680 Translating, 680 Translation, 559, 596, 680 Translational, 680 Translocation, 578, 596, 680 Transmitter, 387, 418, 555, 565, 590, 619, 628, 638, 680 Transplantation, 380, 448, 450, 578, 592, 614, 621, 627, 680 Trauma, 286, 359, 521, 522, 564, 567, 596, 608, 643, 677, 680 Treatment Outcome, 680 Trees, 596, 664, 681 Triad, 393, 681 Triage, 681 Trichinosis, 445, 681 Trichloroethylene, 681 Trichomoniasis, 631, 681 Trichotillomania, 541, 681 Tricuspid Atresia, 583, 681 Triglyceride, 416, 417, 613, 681 Trisomy, 561, 681 Tryptophan, 580, 667, 681 Tubal ligation, 383, 405, 681 Tuberculosis, Renal, 449, 681 Tuberculostatic, 620, 681 Tuberous Sclerosis, 505, 681 Tumor marker, 569, 681 Tumor Necrosis Factor, 136, 380, 681 Tumorigenic, 681 Tumour, 681 Tunica, 634, 682

Index 713

Type 2 diabetes, 19, 446, 447, 682 Tyrosine, 590, 648, 682 U Ubiquitin, 682 Ulcer, 591, 632, 645, 674, 682, 684 Ulcerative colitis, 9, 13, 14, 443, 445, 473, 475, 536, 617, 682 Ultrafiltration, 375, 376, 609, 682 Ultrasonography, 346, 594, 599, 604, 682 Umbilical Arteries, 682 Umbilical Cord, 232, 558, 577, 682 Umbilical cord blood, 232, 682 Unconscious, 561, 566, 614, 682 Universal Precautions, 493, 682 Uraemia, 643, 682 Urban Population, 682 Urea, 360, 621, 641, 675, 682, 683 Uremia, 621, 661, 683 Ureters, 661, 683 Urethra, 390, 645, 655, 683 Uric, 606, 613, 658, 683 Urinalysis, 683 Urinary tract, 366, 448, 449, 567, 639, 683 Urinary tract infection, 366, 448, 449, 567, 683 Urinate, 447, 683 Urogenital, 606, 683 Urticaria, 561, 625, 683 Uterine Contraction, 363, 388, 419, 555, 643, 683 Uterine Monitoring, 388, 419, 683 Uvea, 683 Uveitis, 326, 683 Uvula, 669, 683 V Vaccination, 7, 9, 540, 683 Vacuoles, 593, 640, 683 Vagal, 683 Vagina, 383, 389, 390, 397, 398, 401, 420, 576, 588, 614, 629, 662, 684, 685, 686 Vaginal Smears, 684 Vagotomy, 11, 684 Vagus Nerve, 683, 684 Valine, 645, 684 Valves, 139, 684 Varicose, 238, 684 Varicose vein, 238, 684 Vascular endothelial growth factor, 684 Vascular Resistance, 567, 684 Vasculitis, 643, 684 Vasectomy, 383, 684 Vasoactive, 684

Vasoconstriction, 596, 684 Vasodilatation, 620, 684 Vasodilation, 684 Vasodilator, 328, 571, 572, 590, 611, 684 Vasomotor, 684 VE, 231, 684 Vector, 643, 680, 684 Vein, 323, 354, 362, 561, 565, 619, 638, 651, 671, 678, 682, 684, 685 Vena, 684 Venereal, 675, 684 Venous blood, 569, 623, 649, 684 Venous Thrombosis, 140, 685 Venter, 685 Ventilation, 442, 685 Ventral, 343, 613, 671, 685 Ventricle, 560, 564, 566, 583, 611, 622, 632, 657, 676, 681, 685 Ventricular, 583, 675, 681, 685 Venules, 570, 573, 594, 685 Vertebrae, 408, 618, 671, 685 Vertebral, 387, 568, 671, 685 Vesicovaginal Fistula, 685 Vesicular, 601, 607, 610, 631, 685 Veterinarians, 685 Veterinary Medicine, 491, 685 Vial, 357, 685 Villi, 612, 685 Villous, 264, 575, 577, 685 Villus, 612, 685 Vimentin, 685 Viral Hepatitis, 8, 15, 18, 20, 443, 452, 685 Viral Load, 140, 313, 314, 495, 685 Viremia, 324, 325, 685 Virulence, 136, 679, 685 Virus Diseases, 563, 686 Virus Shedding, 686 Viscosity, 555, 686 Visual Acuity, 417, 686 Vital Statistics, 569, 686 Vitamin A, 230, 232, 251, 371, 447, 617, 686 Vitamin U, 247, 686 Vitreous, 587, 622, 662, 686 Vitreous Hemorrhage, 587, 686 Vitro, 137, 234, 324, 338, 339, 345, 346, 350, 357, 364, 403, 409, 417, 418, 592, 610, 616, 650, 667, 679, 686 Vocational Education, 4, 686 Volition, 619, 686 Volvulus, 15, 686 Vomica, 686 Vulgaris, 686

714 Pregnancy

Vulva, 466, 686 W Wetting Agents, 637, 686 White blood cell, 556, 562, 607, 616, 623, 626, 627, 633, 634, 635, 637, 649, 686 Windpipe, 647, 678, 687 Withdrawal, 315, 425, 687 Womb, 349, 385, 404, 513, 515, 662, 683, 687 Wound Healing, 600, 628, 687

X Xenobiotics, 687 Xenograft, 561, 687 X-ray, 451, 570, 581, 601, 634, 638, 658, 659, 665, 687 Y Yeasts, 602, 647, 687 Yolk Sac, 599, 687 Z Zalcitabine, 621, 687 Zygote, 581, 687 Zymogen, 656, 687

Index 715

716 Pregnancy

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