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

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

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Malnutrition: 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: 0-597-84491-7 1. Malnutrition-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 malnutrition. 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 MALNUTRITION ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Malnutrition ................................................................................. 7 E-Journals: PubMed Central ....................................................................................................... 63 The National Library of Medicine: PubMed ................................................................................ 64 CHAPTER 2. NUTRITION AND MALNUTRITION .............................................................................. 87 Overview...................................................................................................................................... 87 Finding Nutrition Studies on Malnutrition................................................................................ 87 Federal Resources on Nutrition ................................................................................................... 95 Additional Web Resources ........................................................................................................... 96 CHAPTER 3. DISSERTATIONS ON MALNUTRITION .......................................................................... 99 Overview...................................................................................................................................... 99 Dissertations on Malnutrition..................................................................................................... 99 Keeping Current ........................................................................................................................ 102 CHAPTER 4. CLINICAL TRIALS AND MALNUTRITION .................................................................. 103 Overview.................................................................................................................................... 103 Recent Trials on Malnutrition................................................................................................... 103 Keeping Current on Clinical Trials ........................................................................................... 104 CHAPTER 5. PATENTS ON MALNUTRITION................................................................................... 107 Overview.................................................................................................................................... 107 Patents on Malnutrition ............................................................................................................ 107 Patent Applications on Malnutrition ........................................................................................ 119 Keeping Current ........................................................................................................................ 123 CHAPTER 6. BOOKS ON MALNUTRITION ...................................................................................... 125 Overview.................................................................................................................................... 125 Book Summaries: Federal Agencies............................................................................................ 125 Book Summaries: Online Booksellers......................................................................................... 131 Chapters on Malnutrition.......................................................................................................... 139 CHAPTER 7. MULTIMEDIA ON MALNUTRITION ........................................................................... 143 Overview.................................................................................................................................... 143 Video Recordings ....................................................................................................................... 143 Audio Recordings....................................................................................................................... 147 CHAPTER 8. PERIODICALS AND NEWS ON MALNUTRITION ........................................................ 149 Overview.................................................................................................................................... 149 News Services and Press Releases.............................................................................................. 149 Newsletter Articles .................................................................................................................... 152 Academic Periodicals covering Malnutrition ............................................................................ 153 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 155 Overview.................................................................................................................................... 155 U.S. Pharmacopeia..................................................................................................................... 155 Commercial Databases ............................................................................................................... 156 Researching Orphan Drugs ....................................................................................................... 156 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 161 Overview.................................................................................................................................... 161 NIH Guidelines.......................................................................................................................... 161 NIH Databases........................................................................................................................... 163 Other Commercial Databases..................................................................................................... 165 APPENDIX B. PATIENT RESOURCES ............................................................................................... 167 Overview.................................................................................................................................... 167

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Patient Guideline Sources.......................................................................................................... 167 Finding Associations.................................................................................................................. 181 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 183 Overview.................................................................................................................................... 183 Preparation................................................................................................................................. 183 Finding a Local Medical Library................................................................................................ 183 Medical Libraries in the U.S. and Canada ................................................................................. 183 ONLINE GLOSSARIES................................................................................................................ 189 Online Dictionary Directories ................................................................................................... 190 MALNUTRITION DICTIONARY.............................................................................................. 191 INDEX .............................................................................................................................................. 273

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

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

Micronutrient Malnutrition: Policies and Programs for Control and Their Implications Source: in McCormick, D.B., Bier, D.M., and Goodridge, A.G., eds. Annual Review of Nutrition. Palo Alto, CA: Annual Reviews Inc. 1999. Volume 19: 303-324. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. PRICE: $53.00. ISBN: 0824328167. ISSN: 01999885. Individual article reprints available from Annual Reviews Preprints and Reprints. (800) 347-8007 or (415) 259-5017. E-mail: [email protected]. Base price $13.50 per article. Summary: Global progress in social and economic development is occurring, although slowly, in the most needy parts of the nonindustrialized world, where nutritional

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deficiencies, including micronutrients, remain significant public health problems. This review article (from an Annual Review of Nutrition monograph) offers an overview of public health policies and programs for control of micronutrient malnutrition (harmful conditions associated with iodine, vitamin A, and iron deficiencies). The authors stress that until empowering benefits accrue from development spin offs, purposeful public health actions can help reduce the toll on health and quality of life from micronutrient malnutrition. Health policies can also interrupt the intergenerational debilitating effects of malnutrition on national development. Narrowly focused control programs including homestead production, plant breeding, fortification, and supplementation are in effect, but in general, they have not been holistically planned and integrated into overall development programs. Such integration is needed to ensure sustainability into the next century. The authors conclude that a new model is needed, including a new way of thinking by nutrition scientists and program implementers that includes partnerships with the poor in all aspects of program planning and implementation. The process leading to micronutrient adequacy must enable changes in people's perceptions, motivations, and behaviors regarding lifestyle and diet. 107 references. •

Taste and Smell: Neglected Senses That Contribute to the Malnutrition of AIDS Source: North Carolina Medical Journal. 58(2): 100-104. March-April 1997. Contact: Available from North Carolina Medical Society. North Carolina Medical Journal, Box 3910, Duke University Medical Center, Durham, NC 27710. (919) 286-6410; Fax (919) 286-9219; E-mail: [email protected]. Summary: Malnutrition and weight loss are characteristic symptoms of HIV infection and AIDS. This article explores how chemosensory loss and distortions may impair nutritional status in HIV-infected patients. The authors first review the anatomy and physiology of taste and smell. They then explore taste and smell losses in HIV infection and the impact of medication use on taste and smell. Undernutrition in AIDS may lead to macronutrient deficiency (protein and calorie malnutrition), but micronutrient deficiency can also occur. The authors provide a brief consideration of potential interventions for HIV-infected patients whose loss of taste and smell sensation impairs nutrition. They conclude that taste and smell loss (due to medications, oral pathology such as candidiasis, and peripheral or central nervous system disease) are well documented in people with HIV infection. These chemosensory abnormalities can impair food intake and contribute to wasting. An understanding of how medications affect the senses of taste and smell may allow clinicians to choose medications with these side effects in mind. Meanwhile, the use of flavor enhancers to improve food intake may help the nutrition of patients who have suffered taste and smell losses. 2 figures. 1 table. 19 references. (AA-M).

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Unresolved Malnutrition of the Dialysis Patient: Is Supplementation Enough? Source: Nephrology News and Issues. 6(10): 40-53. October 1992. Summary: Nutrition in renal disease has become one of the most intriguing, complex, and challenging issues for both nephrologists and nutritionists. In this article, the authors review the therapeutic interventions currently available or being explored for the correction of malnutrition in the dialysis population. Therapies that are discussed are intradialytic parenteral nutrition (IDPN) and recombinant growth hormone in the hemodialysis patient, the addition of amino acids to the dialysate for the peritoneal dialysis patient, and the use of oral enteral products for both patient groups. The authors also summarize research studies in these areas, and provide a chart of the

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composition of enteral products commonly prescribed for poorly nourished dialysis patients. 3 tables. 51 references. •

Malnutrition: A Hazard For Older Americans Source: Diabetes in the News. 11(1): 53-55. February 1992. Contact: Available from Ames Center for Diabetes Education. Ames Division, Miles Laboratories, P.O. Box 3115, Elkhart, IN 46515. (312) 664-9782 or (800) 348-8100. Summary: The author of this article stresses that malnutrition is a health hazard for older Americans, particularly those with diabetes. The article details the problems of adequate nutrition, describing how malnutrition can occur without overt symptoms, taste problems associated with aging, environmental factors contributing to a poor meal plan (poor-fitting dentures, diabetes complications, financial concerns), psychosocial issues of nutrition, the importance of consulting a health care provider for a nutritional assessment, the use of health foods and dietary supplements, the use of a food diary for assessment purposes, and the role of a registered dietitian. One side bar presents a recommended diet plan for seniors.

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Preventing Malnutrition in the Long-Term Peritoneal Dialysis Patient Source: Seminars in Dialysis. 8(6): 347-354. November-December 1995. Contact: Available from Blackwell Science, Inc. 238 Main Street, Cambridge, MA 02142. (617) 876-7000. Summary: This article addresses the issue of preventing malnutrition in the long-term peritoneal dialysis (PD) patient. Topics include the prevalence of malnutrition in this population; the causes of malnutrition, including poor intake, losses into the dialysate, peritonitis, dietary restrictions, and metabolic or hormonal factors; nutritional interventions, including increasing oral intake, parenteral feeding, and peritoneal nutrition; pharmacologic methods; and the nutritional parameters that need to be monitored, including dietary intake, muscle protein stores, serum proteins, and subject global assessment (SGA). The author concludes that the major challenges are to maintain good appetite over time or to institute supplementation if desirable intakes are not achieved through normal appetite mechanisms. 72 references.

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Nutritional Health: Prevention and Treatment of HIV - Associated Malnutrition; A Case Manager's Guide Source: Journal of the International Association of Physicians in AIDS Care; Vol. 3, No. 5, May 1997. Contact: International Association of Physicians in AIDS Care, 33 N LaSalle St Ste 2600, Chicago, IL, 60602-2601, (312) 795-4930, http://www.iapac.org. Summary: This article addresses the relationship between nutrition and HIV/AIDS disease progression and symptom management and provides a case manager's guide to providing appropriate nutritional intervention. Because malnutrition negatively affects immune function and is associated with HIV disease progression, it should be addressed and treated immediately. In HIV disease the presence of malnutrition strongly predicts patient longevity. The article reviews the presenting symptoms of malnutrition and considers the importance of caloric intake, amino acids, lipids, nucleotides, vitamins, minerals, and trace elements. The effects of HIV disease on nutritional status are examined followed by a discussion of the potential factors that

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contribute to poor food intake. The article addresses altered nutrient absorption and metabolism, weight loss, wasting syndrome, and altered hormonal levels. Specific nutrition intervention programs and strategies are described. •

Preventing Malnutrition in Patients on CAPD Source: Professional Nurse. 11(6): 354-356. March 1996. Contact: Available from Macmillan Magazines Ltd. Porters South, Crinan Street, London N1 9XW, England. 0171-833-4000. Fax 0171-843-4699. Summary: This article reminds nurses of the steps to take in preventing malnutrition in patients on continuous ambulatory peritoneal dialysis (CAPD). Topics include factors contributing to malnutrition; nutritional status and outcome; improving nutritional status; and the use of amino acids and alternative osmotic agents. The authors share the clinical experience gained in this area at the Charing Cross Hospital in London. They stress that if dietary counseling and the use of oral supplements fail to bring about a change in nutritional status, intraperitoneal amino acid therapy may improve protein nutrition. 1 table. 15 references. (AA-M).

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Intestinal Transport During Fasting and Malnutrition Source: in McCormick, D.B., Bier, D.M., and Goodridge, A.G., eds. Annual Review of Nutrition. Palo Alto, CA: Annual Reviews Inc. 2000. Volume 20: 195-219. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. PRICE: $53.00. ISBN: 0824328167. ISSN: 01999885. Individual article reprints available from Annual Reviews Preprints and Reprints. (800) 347-8007 or (415) 259-5017. E-mail: [email protected]. Base price $13.50 per article. Summary: This article reviews the dramatic effects that fasting or malnutrition (FM) has on the small intestine mucosal structure and transport function. Fasting often means a voluntary abstinence from food, whereas starvation implies an involuntary cessation of food intake; in this review, they are considered in tandem, as their effects on the gastrointestinal tract are the same. Intestinal secretion of ions and fluid is increased by FM both under basal (basic) conditions and in response to secretory agonists (drug or other substance that causes a response). Intestinal permeability to ions and macromolecules may also be elevated by FM, which increases the potential for fluid and electrolyte losses and for anaphylactic (lifethreatening, hypersensitive)responses to luminal antigens. Mucosal atrophy induced by FM reduces total intestinal absorption of nutrients, but nutrient absorption normalized to mucosal mass may actually be enhanced by a variety of mechanisms, including increased transporter gene expression, electrochemical gradients, and ratio of mature to immature cells. This reduction in absorptive surface area of the intestine reduces its total capacity for nutrition absorption, but also reduces the proportion of total body energy and nutrient stores that must be diverted to the gut for its maintenance. The authors conclude that their observations underscore the value of enteral (supplemental nutrition using the gastrointestinal tract) feeding during health and disease. 1 figure. 104 references.

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Nutritional Health: Prevention and Treatment of HIV - Associated Malnutrition: A Case Manager's Guide Source: Journal of the International Association of Physicians in AIDS Care; Vol.3, No.5, May 1997.

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Contact: International Association of Physicians in AIDS Care, 33 N LaSalle St Ste 2600, Chicago, IL, 60602-2601, (312) 795-4930, http://www.iapac.org. Summary: This journal article presents a case manager's guide to preventing and treating HIV-related malnutrition. The relationship between nutrition and the immune system is reviewed, and the association between malnutrition and negative health outcomes is noted. Macronutrients, vitamins, and minerals involved in immune function and modulation are outlined and the nutrient deficiencies associated with HIV disease are considered. The article addresses protein-calorie malnutrition and the role of amino acids, lipids, nucleotides, vitamins, minerals, and trace elements. The effects of HIV disease on nutrition status, drug therapy, malignancies, nutrient intake, altered nutrient absorption, altered metabolism, weight loss, common gastrointestinal pathogens associated with HIV disease, and HIV wasting syndrome are reviewed. This is followed by a discussion of initial and follow-up nutrition care and alternative feeding options. •

Malnutrition in Hemodialysis Patients Source: American Journal of Kidney Diseases. 21(2): 125-137. February 1993. Summary: This review article covers the problem of protein and energy malnutrition and its effects on mortality and morbidity in hemodialysis (HD) patients. The author presents other indicators of early malnutrition, which range from static measurements of plasma constituents such as transferrin and insulin-like growth factor 1 (IGF-1), kinetic measurements of protein catabolic rate (PCR) derived from urea kinetic modeling, and noninvasive measurements of body composition. In addition, the author discusses the predialytic and dialytic factors that influence nutritional status, including the adverse effects of uremia, inadequate dialysis, membrane bioincompatibility, and intercurrent illness requiring hospitalization, as well as socioeconomic factors. The author emphasizes simple interventions that are likely to benefit the patient, including the delivery of optimal dialysis, appropriate choice of medications, and dietary interventions. Finally, the author addresses the effects of therapeutic substances such as growth hormone (GH) and erythropoietin (EPO) in combination with nutrients that at present appear to be favorable. 2 tables. 104 references. (AA-M).

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

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

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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 malnutrition. The following is typical of the type of information found when searching the CRISP database for malnutrition: •

Project Title: A NEW DEVICE FOR METABOLIC MONITORING IN INFANTS Principal Investigator & Institution: Rising, Russell M.; Emtac, Inc. 5045 Sw 82Nd St Miami, Fl 33143 Timing: Fiscal Year 2004; Project Start 10-FEB-2004; Project End 31-JAN-2007 Summary: (provided by applicant): Backqround. We have developed a novel instrument for energy expenditure measurements in infants The data obtained with this equipment has contributed significantly to the knowledge of infant metabolism and nutrition and has led to four scientific publications in highly ranked peer-reviewed journals. Specific aims: Our major objective is to fabricate the EMTAC 3000i which will be a more portable and user friendly instrument This will allow bedside, as well as metabolic measurements in both in and out patient settings In this manner the EMTAC will be used beyond the laboratory where Phase I testing took place In Phase II of this proposal we have outlined the engineering advancements in order to accomplish the development of the new equipment Moreover, we have established a relationship with three centers of excellence who will lend their resources and expertise to enrich and cross-fertilize the EMTAC These centers include The Sansum Medical Research Institute, Santa Barbara, California, The Primate Behavior Laboratory of the State University of New York, Brooklyn, NY and The Fima Lifshitz Metabolic Unit at The Hospital Universitario Professor Edgar Santos, Salvador, Bahia, Brazil In each one of these centers, the feasibility of EMTAC will be tested in specific models of nutritional entities These include infants born to obese and/or diabetic parents and an experimental animal model of obesity in primates On the other side of the nutritional spectrum, infants with severe primary malnutrition will be studied in Brazil These studies will provide additional data for the understanding of the pathophysiology of each of these entities, thereby helping to improve the health of children world wide The work proposed will also prove that the EMTAC is suitable for use in distant laboratories under a variety of conditions and will set the stage for developing market areas for this instrument Finally, we have already begun the process of obtaining patent protection for the EMTAC Furthermore, we will seek approvals from both the Federal Drug Administration as well as Underwriters Laboratory during the period of this application This is further outlined in a detailed product development plan that is included with this application Summary: We have already proven that the EMTAC is a viable tool in regards to infant energy expenditure assessments Future testing as proposed in this application will provide important information in regards to the performance of EMTAC in different environments Finally, the new work in experimental animals will prove that EMTAC is a viable instrument for use in areas not explored previously. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A RESOURCE FOR BIOMEDICAL MASS SPECTROMETRY Principal Investigator & Institution: Gross, Michael L.; Professor and Director Mass Spectrometry; Internal Medicine; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-JUN-1975; Project End 31-JUL-2004

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Summary: We propose two Specific Aims for Core Research: Specific Aim #1: Apply principles of mechanistic ion chemistry to seek an understanding of the fragmentations ov various classes of biomolecules and their interactions with other molecules, radicals, and ions. The sub-aims focus on lipids and charge-remote fragmentations; DNA bases and oligonucleotides; peptide/metal-ion interactions; H/D exchanges of peptide bound to proteins; reactions of biomolecules ions with radicals; and fragmentation of small molecules upon electron capture. Specific Aim #2: Improve the performance of Fourier transform (FT) by adding the RF-only-mode, which allows operation at relatively high pressure, and the electrically compensated cell. This aim is centered on the development of a superconducting FT mass spectrometer for matrix- assisted laser desorption ionization (MALDI), which should be of interest to many users of this Resource. The addition of the RF-only-mode event will allow the unique instrument to be used in a single experiment as both an ion trap (quistor) and a FTMS ion trap, taking advantage of the features of both. We will continue to develop foundations for instrument improvement (i.e., scaling, frequency focusing, and RF-only-mode stability) and apply strategies that emerge from the foundations to modify a Finnigan FT mass spectrometer with a 3-Tesla magnet and a MALDI source. For collaborative research we propose on Specific Aim (No. 3) to continue collaborations with biomedical investigators to provide new or improved measurement strategies to enable advances in the understanding of various disease stages: diabetes mellitus, atherosclerotic cardiovascular disease; alcohol abuse; malignant neoplastic disease, (particularly breast, skin, and bladder cancers), acquired immunodeficiency syndrome (AIDS), gerontology and aging, obesity and its complications and treatment, protein deprivation and malnutrition. This understanding will be sought by using a variety of now resident mass spectrometers (ion- trap, triple quadrupole, quadrupole, isotope-ratio, FT, magnetic-sector, and time-of-flight) and ionization methods (particularly electrospray, ESI, but also MALDI, fast atom analytes and of H/D exchange of biomolecules will be conducted with a new quadruple/TOF tandem spectrometer, for which funds are requested. Most of the current instrument capabilities were put in place since 1994 during major reorganization of staff and research goals of this Resource. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ACUTE NUTRITIONAL DEPRIVATION: DIAPHRAGM INFLUENCES Principal Investigator & Institution: Lewis, Michael I.; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, Ca 900481804 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2008 Summary: (provided by applicant): The overall objective is to develop a mechanistic approach and improved understanding of potential molecular targets in the management of disordered protein turnover and muscle atrophy in the diaphragm of a clinically relevant animal model of severe short-term nutritional deprivation (ND). Hypothesis 1: Down-regulation of the PI3K/Akt/mTOR signal transduction pathway is an important determinant of disordered synthesis of muscle proteins and atrophy with ND. Reduced IGF-1 levels are a major signal responsible for this down-regulation. Stimulation of PI3K/Akt/mTOR signal transduction pathway by administration of IGF1 will augment the synthesis of muscle proteins by enhancing signal transduction pathways mediating translation initiation with attenuation of muscle atrophy. Aim 1: We propose to measure in a time series (i.e., days 1 & 4) in severe ND, the phosphorylation of Akt and Ser2448,an important regulatory domain in mTOR, together with downstream targets important in translation initiation of muscle proteins (i.e., phosphorylation states of 4E-BPI and p70S6K) and the phosphorylation of ERK1/2 and

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GSK3, 2 other pathways through which IGF-1 could act. The above will be measured with and without the infusion of IGF-1 and correlated with 1) muscle protein synthesis and degradation including an analysis of the turnover of specific protein pools (MHC, sarcoplasmic, mitochondrial); 2) diaphragm mass and fiber size; and 3) diaphragm specific force. Hypothesis 2: The impact of rapamycin, an inhibitor of mTOR, on IGF-1 rescue in the ND model is unknown. Possibilities include marked attenuation of the beneficial effect of IGF-1 or maintained rescue due to activation of alternate pathways. Aim 2: We propose to administer rapamycin to ND animals infused with IGF-I and to measure the key proteins mediating IGF-1 signal transduction pathways together with outcome measures as outlined in aim #1. Hypothesis 3: Enhanced muscle protein degradation with severe ND is mediated in large part by activation of the ubiquitinproteasome pathway. While IGF-1 infusion may potentially attenuate muscle protein breakdown with ND, the addition of an inhibitor of the ubiquitin proteasome mediated proteolysis (eicosapentaenoic acid; EPA) to IGF-1 infusion will further attenuate or reverse muscle fiber atrophy. The provision of EPA alone to ND animals will determine the relative importance of muscle proteolysis to disordered turnover in this model. Aim 3: We propose to administer EPA with and without IGF-1 infusion to ND animals. We will evaluate gene and protein expression of key components of the ubiquitinproteasome pathway. These will include: the newly described muscle specific E3 ligases (MuRF1 and MAFbx), key enzymes mediating the N-end rule pathway (E2-I4k and E3(, polyubiquitin, proteasome subunits (C2 & C8) and ubiquitin conjugated protein content. The above will be correlated with outcome measures as outlined in aim #1. Hypothesis 4: Increased endogenous corticosteroid (CS) production is present with severe ND, which contributes to muscle fiber atrophy by suppressing muscle protein synthesis and enhancing degradation through the ubiquitin-proteasome pathways. Suppression of CS effects by administration of a CS receptor blocker (RU38486) will reverse CS induced effects on muscle protein turnover and enable one to evaluate the contribution of endogenous CS to fiber atrophy. Aim 4: We propose to administer RU38486 to animals subjected to severe short-term ND. We will evaluate gene and protein expression of key components of the ubiquitin-proteasome pathway, as outlined in aim #3, as well as markers of signal transduction and outcome measures as outlines in aim #1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADJUVANT NUTRITION FOR CRITICALLY III TRAUMA PATIENTS Principal Investigator & Institution: Rathmacher, John A.; Metabolic Technologies, Inc. 2625 N Loop Dr, Ste 2150 Ames, Ia 50010 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Of the four million cases of trauma cases each year that will require hospitalization, 200,000 will be classified as severe trauma. During the hospital stay, malnutrition is a major complication in about 50% of the patient population. The result is muscle wasting which is a major risk factor for increased morbidity and mortality. In the study proposal presented we postulate that supplementation with Beta-hydroxy-Beta-methylbutyrate (HMB), arginine and glutamine (HMB/Arg/Gln) to these severely traumatized patients can stem the loss of muscle tissue and whole body nitrogen and in turn decrease morbidity and mortality. This hypothesis is based on two recent studies showing the same nutritional mixture of HMB/Arg/Gln can reverse the muscle wasting associated with AIDS and Cancer. The hypermetabolic state seen in AIDS and cancer have a similar multilifactorial etiology seen in trauma. There is an increase in the mobilization of fat and muscle, increased or normal metabolic rate, increased protein breakdown, and an increased or normal

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glucose turnover. In addition, HMB alone has been shown to reduce nitrogen loss, decrease muscle proteolysis and muscle damage within the first 48 hours to three week after initiating supplementation. Male and female patients (n=100) will be recruited at the time of admittance to the Trauma ICU with an ISS of greater than 18 Patients who meet the inclusion/exclusion will be randomized to receive either 1) standard tube feed plus HMB/Arg/Gln, standard tube feed plus HMB alone, or standard tube feed (control) in a blinded fashion. Clinical outcomes measures will be assessed through out the hospital stay and on a outpatient basis on week 4 and week 12. Muscle proteolysis and nitrogen economy will be evaluated on daily basis while in the hospital and after 4 weeks on an out patient basis. If as expected, Phase I results confirm the effectiveness of the nutrient mixture in trauma patients. Expanded multicenter studies will be proposed in Phase II. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AIR POLLUTION & RESPIRATORY DISEASE TRAINEESHIP Principal Investigator & Institution: Harris, Aaron M.; Family Medicine & Cmty Health; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Acute respiratory infection (ARI) is responsible for 19% of all deaths worldwide among children less than five years old. Environmental factors such as air pollution have been hypothesized to increase the risk of incidence for ARI in young children. Malnutrition is also known to suppress the immune system that renders a child more susceptible to ARI. This five-year traineeship aims to link environmental pollutants, while controlling for host nutritional factors, to an overall increase in the incidence of respiratory diseases in Ecuadorian children. Air pollution in Quito, Ecuador will be closely monitored by the City of Quito and using mobile handheld monitors to allow a time-series and geographical analysis of respiratory disease in a cohort of children already enrolled in an NIH-funded study. These data will be used to statistically analyze adverse respiratory health outcomes in variably malnourished Ecuadorian children as it relates to air pollution. In addition, molecular and microbiologic analysis will establish a spectrum of pathogens that cause disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ALCOHOL LIVER DISEASE AND S-ADENOSYLMETHIONINE Principal Investigator & Institution: Mcclain, Craig J.; Professor of Internal Medicine; Medicine; University of Louisville University of Louisville Louisville, Ky 40292 Timing: Fiscal Year 2002; Project Start 01-MAR-1996; Project End 31-MAY-2006 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANTIHYPERTENSIVE MECHANISMS OF NEGATIVE ENERGY BALANCE Principal Investigator & Institution: Overton, J Michael.; Professor; Nutrition, Food & Exercise Sci; Florida State University 97 South Woodward Avenue Tallahassee, Fl 323064166 Timing: Fiscal Year 2002; Project Start 15-JAN-1998; Project End 31-DEC-2005 Summary: (provided by applicant): Obese individuals must enter negative caloric balance to reduce adiposity. Negative energy balance activates homeostatic mechanisms

12

Malnutrition

that appear to defend body weight. Thus, reduced caloric intake is associated with altered autonomic outflow producing concurrent reductions in energy expenditure, heart rate and blood pressure. The purpose of this proposal is to determine the mechanisms by which heart rate and blood pressure are decreased during reduced caloric intake. Substantial evidence supports the hypothesis that decreased circulating leptin signals reduced caloric availability and engages multiple hypothalamic pathways that stimulate appetite, reduce metabolic rate, and lower heart rate blood pressure. However, studies using animals with dysfunctional leptin signaling support the concept of leptin-independent regulation of cardiovascular function during negative energy balance. Therefore, the first aim of the proposal is to determine if leptin signaling is requisite for cardiovascular and thermogenic responses to reduced caloric intake. The approach will be to continuously determine oxygen consumption via indirect calorimetry and heart rate and blood pressure using telemetry, while infusing low levels of leptin peripherally during caloric restriction. Genetically altered mice have contributed significantly to understanding the potential mechanisms regulating energy balance. Thus, we will utilize both rat and mice models to accomplish the aims of this proposal. In the second aim, we propose to test the hypothesis that glucose sensitive neurons within the hypothalamus are requisite for normal regulation of energy expenditure and cardiovascular function during negative energy balance. In the third aim, we will test the hypothesis that inhibition of melanocortin receptors within the hypothalamus is requisite component of the cardiovascular effects of negative energy balance. Finally, we will examine the role of melanin concentrating hormone in the regulation of cardiovascular and metabolic responses to reduced caloric intake. Taken together, these studies will greatly enhance our understanding of the interrelationship between the regulation of energy balance and cardiovascular function and will have important implications for treatment of obesity and hypertension. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BEHAVIORAL TREATMENT OF EATING PROBLEMS IN CF TODDLERS Principal Investigator & Institution: Powers, Scott W.; Associate Professor; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2002; Project Start 25-JUN-1998; Project End 31-MAY-2004 Summary: Optimal nutritional management for children with cystic fibrosis (CF) is critical for growth, quality of life, and long-term health outcomes. Diagnosis of CF typically occurs between age 6 and 18 months, and one of the first treatment priorities is to get the toddler with CF to eat 50 percent more than an average toddler typically eats. Research is needed to better understand how toddlers with CF (ages 12-36 months) and their families are meeting this biobehavioral challenge because parent-child mealtime interactions learned at this developmental period set the stage for appropriate eating behavior in the future and most older children with CF are not meeting the CF nutritional goals. Two studies will be conducted. Study 1 will identify the mealtime behaviors of toddlers with CF and their parents and compare these behaviors with agematched, non-chronically ill toddlers and their parents. Study 2 will use the information from Study 1 to develop and test the efficacy of an empirically- derived behavioral parent-training intervention designed to prevent and/or treat eating behavior problems and enhance growth and development in this population. A prospective, cross- sectional design comparing 30 toddlers with CF and 30 non-chronically ill toddlers will be used in Study 1. A randomized clinical trial design comparing 20 toddlers with CF randomly assigned to a behavioral parent-training intervention (n=10) or an enhanced standard

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medical care intervention (n=10) will be used in Study 2. For both studies, data will be obtained on child and parent mealtime behaviors, mealtime duration, calorie intake, parent perceptions of mealtimes, and weight. For Study 1 it is hypothesized that toddlers with CF and their families will exhibit more mealtime behavior problems than non-chronically ill toddlers and their families. Data from Study 1 will describe the specific eating problems exhibited by toddlers with CF. For Study 2 it is hypothesized that the behavioral intervention will result in significantly more improvement on behavioral variables such as toddler and parent mealtime behavior, greater calorie intake, and weight gain than the enhanced standard medical care intervention. The long-term objective of this programmatic research plan is to prevent and/or treat the early development of eating behavior problems for children with CF, and therefore decrease the morbidity and mortality associated with malnutrition in CF. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CELLULAR / MOLECULAR BIOLOGY OF INFLAMMATION AND REPAIR Principal Investigator & Institution: Albina, Jorge E.; Professor and Director; Rhode Island Hospital (Providence, Ri) Providence, Ri 02903 Timing: Fiscal Year 2002; Project Start 01-JUL-1989; Project End 31-MAR-2005 Summary: (Verbatim from applicant's abstract) Wounds and their management remain the mainstay of surgical practice. Abnormal repair in diabetes, vascular disorders, malnutrition, infection and other clinical conditions challenge the practitioner and consume a substantial portion of health care dollars. The focal point of this project remains the study of the cellular and molecular biology of normal tissue repair, and is based on the premise that a full understanding of normal wound healing will provide essential footing to clinical intervention in abnormal repair. Specific Aims were designed by selecting among past fmdings those with the greatest potential to expand the mechanistic understanding of the regulation of inflammation and repair. Those observations and Specific Aims are: 1) Wound-derived macrophages actively induce apoptosis in wound polymorphonuclear leukocytes (PMN) through a specific effector mechanism comprising, at least, the expression of b3 integrins and membrane-bound TNF-a on the macrophage surface. Experiments proposed in Specific Aim I will expand on these paradigm-shifting observations by examining the role of TNF-a and its receptors in repair and by further defining the mechanisms of macrophage-dependent PMN apoptosis. 2) Inducible nitric oxide synthase (iNOS) is expressed in wounds mostly in macrophages and during the first 72 h of repair. Lack of iNOS is associated with impaired wound healing. Specific Aim II will focus on the mechanistic role of iNOS-derived NO in the process of tissue repair. 3) Cells producing NO exhibit metabolic injury with suppressed substrate oxidation and increased glycolysis. Work during this period demonstrated that NO induces a novel acyl phosphatase activity in the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase that uncouples carbon flux in glycolysis from ATP production. Specific Aim III will continue work in this area by investigating specifics of glycolytic energy production in inflammatory cells. Completion of the proposed studies should further the understanding of the cellular and molecular events that underlie the processes resulting in normal tissue repair. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CENTER FOR INVIRONMENATL GENOMICS Principal Investigator & Institution: Schwartz, David A.; Professor of Medicine and Genetics; Medicine; Duke University Durham, Nc 27706

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Malnutrition

Timing: Fiscal Year 2002; Project Start 25-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant) Despite the tremendous inter-individual variability in the respond to environmental toxins, the investigators simply do not understand why certain people develop disease when challenged with environmental agents and others remain healthy. Yet, there is emerging consensus that many of the complex (and prevalent) diseases that humans develop occur as a result of multiple biologically unique gene-gene and gene-environment interactions. The recent advances in human and molecular genetics has provided an unparalleled opportunity to understand how genes and genetic changes interact with environmental stimuli to either preserve health or cause disease. The theme of this Center is to use gene expression profiling to understand the effect of environmental stresses on human health. This will be accomplished by establishing an interdisciplinary Center that supports the use of complementary biologic systems (humans, mice, zebrafish and worms) to investigate the role of genetic susceptibility in the pathogenic response to specific types of environmental stress (bacteria, malnutrition, and metals). This approach will enable the investigators to develop and investigate environmental models of human disease that represent biologically unique gene-environment- pathophysiological phenotypes. Microarray analyses will be used to comprehensively evaluate the biological response to environmental stress and to identify pathogenic mechanisms that are relevant to innate immunity, neural tube defects, and transition metal toxicity. The end result is a broad based yet highly integrated program that has the potential to make a number of novel, related observations. The overall hypothesis unifying this research program is that gene expression profiling will identify genes and pathogenic processes that are critical to human environmental health and disease. In aggregates the coupled scientific findings from the proposed Program will substantially enhance our understanding of environmental toxicology and genomics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC RENAL DYSFUNCTION AND ISCHEMIC BRAIN DISEASE Principal Investigator & Institution: Seliger, Stephen L.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 30-NOV-2007 Summary: (provided by applicant): Patients with renal dysfunction suffer from extraordinarily high rates of mortality and marked functional and cognitive impairment compared to the general population, in part due to accelerated vascular disease. Although the majority of reports have focused on risk factors and outcomes associated with cardiac disease, the impact of accelerated vascular disease on cerebrovascular outcomes among these patients are not well defined and may contribute significantly to their marked cognitive impairment. Although a few studies have reported an increased risk of stroke among patients with renal dysfunction, risk factors and outcomes associated with clinical and subclinical stroke have not been identified. We hypothesize that patients with renal dysfunction, through factors which promote accelerated vascular disease, are at a higher risk of clinical and subclinical stroke, which contributes to a high prevalence of cognitive dysfunction and dementia in patients with renal disease. The overall objectives of this study are to determine the association between renal dysfunction and risk of clinical and subclinical stroke, identify specific stroke risk factors, and quantify the associated cognitive dysfunction among patients with chronic renal insufficiency (CRI) and end-stage renal disease (ESRD). The proposed research will involve a series of observational studies. First, the association between renal

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dysfunction and clinical stroke will be estimated and stroke risk factors among CRI and ESRD pts will be identified, using data from multicenter prospective cohort studies. Next, using MRI and neuropsychiatric data collected as part of one these studies, we will determine whether patients with CRI are at higher risk for subclinical brain infarcts, and whether this contributes to a higher risk of dementia. Finally, MRI imaging and longitudinal measurements of cognitive function will be performed on hemodialysis patients, to determine risk factors for subclinical brain infarcts and define the relationship between these infarcts and cognitive decline. These studies, by clarifying associated risk factors and adverse outcomes of stroke, could result in the development of new strategies to diagnose and prevent ischemic brain disease in patients with renal disease, ultimately leading to an improved prognosis for these patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CNS DEVELOPMENT UNDER HYPERGRAVITY : MODULATION BY TH? Principal Investigator & Institution: Sajdel-Sulkowska, Elizabeth M.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-MAY-2005 Summary: (provided by applicant): To evaluate the potential risks associated with space exploration, the proposed studies will assess the impact of altered gravity on the developing CNS. Specifically, these studies will probe the hypothesis that changes in gravity affect cerebellar development and that this effect is mediated by altered thyroid status. This hypothesis is based on the following: (1) both the CNS and thyroid status are inhibited in astronauts and in adult animals exposed to micro- and hypergravity; (2) thyroid hormone (TH) is critical for normal CNS development; and (3) motor coordination, controlled by the cerebellum, is affected in both astronauts and animals under altered gravity. The experiments designed to test this hypothesis will utilize the hypergravity paradigm of a 24-ft centrifuge, since it provides the most adaptable system for studying the effect of altered gravity on developing mammals. Based on preliminary findings suggesting that exposure to centrifugation from gestation through weaning results in changes in the developing cerebellum and altered thyroid status in rat neonates, we predict that: (1) changes in cerebellar size and structure observed at 15G will become more pronounced at higher gravitational loading; (2) the mild hypothyroidism observed at 1.5 G will become more severe at higher gravitational loading. The effect of hypergravity on neonatal cerebellum will be evaluated primarily in terms of the celebellar size and number of Purkinje and granule cells; the thyroid status of dams and neonates will be assessed primarily in terms of plasma thyroid stimulating hormone (TSH), free T3 and T4, and neonatal cerebellar T3 and T4 at P6 to P21. These parameters will be compared between stationary controls (SC), rotational controls (RC) and hypergravity-exposed (HG, 1.5G. 1.65G. and 1.75G) dams and/or pups during one of the three developmental periods: (1) the second part of embryonic development through the neonatal period (Gil to P21); (2) the second part of embryonic development only (Gil-P 1); and (3) the neonatal period only (P1 to P21). To examine the possible contribution of other factors such as malnutrition, pair-fed controls will be included to evaluate the contribution of maternal-offspring interactions, HG neonates will be cross-fostered to SC dams. The status of the hypothalamic-pituitary-thyroid (HPT) axis will be examined by measuring neonatal serum thyroid-binding proteins (TBG, TTR) and thyroid size. Should these studies support the direct involvement of THin the neonatal response to hypergravity, a TI! supplement will be given to dams or pups to attempt to prevent the adverse effects of altered gravity. Additional molecular

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Malnutrition

studies, including immuno-chemical immunohistological, and gene expression analyses (northern blots, RPA, and rat-specific cDNA arrays, focusing on TH-regulated genes) will probe the molecular mechanism(s) involved in gravity response. These studies will aid in developing an understanding of how altered gravity affects CNS development, what role the thyroid hormone plays in that response, and whether this response can be modulated by hormonal therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COULD TRANSCRIPTION INDUCED MUTATIONS CAUSE CANCER? Principal Investigator & Institution: Wright, Barbara E.; Div of Biological Sciences; University of Montana University Hall 202 Missoula, Mt 598124104 Timing: Fiscal Year 2001; Project Start 09-APR-2001; Project End 31-MAR-2004 Summary: (Adapted from the investigator's abstract) There may be a connection between malnutrition, transcription, mutations and cancer. In mammals, a number of genes are derepressed in response to caloric restrictions, and amino acid limitation can also induce gene expression, which increases mutation rates. In a model system, the effect of transcription (activated by guanosine tetraphosphate, or ppGpp) on mutation rates and mutations in the leu operon of E. coli will be examined. Specific aims are to determine the: A. Kinetics of mRNA turnover during logarithmic growth and during leucine starvation. B. Effect of ppGpp on the kinetics of transcription initiation in leuB and pyrD. C. Effect of antisense RNA and DNA on leuB. The proposed investigations have implications for understanding mechanisms of mutations and cancer. It is estimated that the majority of cancers are caused by environmental (including nutritional) conditions. Data indicate that transcription can enchance the rate of both point mutations and frameshifts, suggesting that genetic derepression may be a major cause of background mutations. If so, this mechanism provides the critical link to metabolic activities evoked by malnutrition, and could play a role in directing which mutations occur. Basic research on the vulnerability of single-stranded DNA to mutation and repair may well reveal insights into the mechanisms of tumorgenesis, and thus aid in the prevention or treatment of cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIETARY FATTY ACIDS AND PHOTORECEPTOR FUNCTION Principal Investigator & Institution: Neuringer, Martha D.; Professor; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2004 Summary: (provided by applicant): Docosahexaenoic acid (DHA, 22:6n-3) is a longchain, highly polyunsaturated n-3 fatty acid. It accounts for about 5O percent of the fatty acids within photoreceptor outer segment disk membranes, the site of phototransduction. Retinal function is altered by changes in retinal membrane DHA content. Rhesus monkeys fed low levels of n-3 fatty acids during development had reduced retinal DHA, impaired visual acuity development and several changes in the electroretinogram (ERG), including prolonged recovery of isolated rod photoreceptor responses to bright, a-wave-saturating flashes. Human infants fed formulas lacking DHA, or containing low levels of its precursors, also showed impairments in the ERG and visual acuity development. In addition, low DHA levels are found in the blood and tissues of many human patients with retinitis pigmentosa and in animal models of retinal degeneration, and dietary DHA is being tested as a possible therapeutic

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treatment. Despite these indications of DHAs importance in the retina, the nature of the changes in retinal function associated with altered fatty acid composition have not been explored in detail and little is known about their underlying mechanisms. We plan to examine several aspects of retinal function in rhesus monkeys raised on diets with different levels of n-3 fatty acids known to result in widely differing retinal DHA levels. A series of recently developed non-invasive ERG methods will allow us to define effects on phototransduction and photoresponse recovery as well as on rhodopsin regeneration. Specific aims include testing the effects of DHA status on: (1) the activation and deactivation kinetics of isolated rod photoresponses over a wide range of flash intensities; (2) the desensitization of rod responses by background light; and (3) the time-course of dark adaptation over a range of bleaches. In addition, aim 4 will be to test whether any of these alterations in photoreceptor function are reversible after dietary DHA repletion. These studies will provide new information about the modification of retinal function, particularly adaptive processes, by membrane DHA content. Together with in vitro studies of model membranes, these data will help to provide the basis for hypotheses about the underlying processes that are altered by differing retinal fatty acid compositions. They also will contribute to understanding the changes in retinal function found in human infants fed diets lacking DHA or its precursors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENTS

DIETARY

PROTEIN

REQUIREMENTS

IN

HEMODIALYSIS

Principal Investigator & Institution: Kopple, Joel D.; Professor; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2003; Project Start 16-MAY-2003; Project End 31-JAN-2008 Summary: (provided by applicant): A high proportion of maintenance hemodialysis (MHD) patients have protein-energy malnutrition (PEM), which is a powerful predictor of high morbidity and mortality. Although inflammation may contribute to PEM, low dietary protein intake (DPI) is often a contributing factor. The usual DPI of MHD patients is about 1.0 g protein/kg/day, whereas expert groups recommend = 1.20 g protein/kg/day. However, these recommendations are based upon few studies, often of insufficient duration, that were usually carried out with obsolete types of dialysis therapy. This project has two primary aims: Study 1. To assess dietary protein requirements in clinically stable MHD patients. It is hypothesized that the average DPI that will maintain nitrogen balance is 1.00 g protein/kg/day, but that a safe intake that maintains balance in almost all MHD patients is about 1.25 g protein/kg/day. Study 2. To test the hypothesis that in clinically stable MHD patients with PEM, treatment for 5 months with a DPI of 1.30 g/kg/day, but not 1.00 g/kg/day, is associated with a significant increase in urea-free total body nitrogen (TBNuf). In Study 1, 9 patients will be studied in a clinical research center while they are fed, in random order, the following 5 DPIs, each for 17 days: 0.60, 0.80, 1.00, 1.15 and 1.30 g/kg/day. Energy intake for each patient will be based on their indirect calorimetry. The key outcome measure is nitrogen balance. We will assess the effects of these DPIs on total body (13Cleucine) protein synthesis and degradation and 13C-leucine oxidation during fasting and feeding, plasma amino acids, dialysate amino acids, peptides and proteins, and body composition (anthropometry, dual x-ray photon absorptiometry (DXA)). We will attempt to define more precisely the relationships between urea nitrogen appearance (UNA), protein nitrogen appearance (PNA) and DPI and investigate the validity of urea kinetic equations for estimating UNA, PNA, DPI and urea pools. In Study 2, 70 MHD outpatients will be randomly assigned to a DPI of 1.00 or 1.30 g/kg/day for 5 months

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each, utilizing dietary counseling and food supplements. Before and after these 5 months, total body protein will be assessed by TBNuf, body cell mass (TBK), and other components of body composition using anthropometry, DXA, and near infra-red interactance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF ANTIOXIDANTS AND INFLAMMATION IN OLDER PEOPLE Principal Investigator & Institution: Hu, Peifeng; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2008 Summary: (provided by applicant): The candidate, Peifeng Hu, M.D., Ph.D., seeks support for further training in clinical epidemiology research. Specifically, he will focus on exploring the interactions of serum antioxidant levels and inflammation in predicting adverse health outcomes in older persons. His long-term goals are to develop an independent research program studying antioxidants and their relations to inflammation markers and cardiovascular risk. Dr. Hu's previous research experience includes: examining the predictive value of natural killer cells in the progression of HIV disease; exploring the association between serum uric acid and mortality; investigating whether the low cholesterol-high mortality association in older persons is attributable to inflammation and malnutrition; and analyzing the effects of managed care on the duration of ambulatory visits by older patients. Dr. Hu's sponsors are Drs. David Reuben, Teresa Seeman, and Alan Fogelman. The sponsors have extensive experience in clinical and basic research into the effects of inflammation and antioxidants on atherosclerosis and mortality risk. As part of his training activities, Dr. Hu will participate in a series of courses, seminars and tutorials to develop additional content expertise regarding antioxidants and atherosclerosis and enhance his ability to analyze complex physiologic data. He will receive training in primary data collection and bioassay techniques. He will also conduct new studies using stored serum specimens from the cohort to examine the basic mechanism of the effects of antioxidants and inflammation. The primary objective of his proposed research is to elaborate the relations between antioxidants and inflammation in elderly persons and explore how an understanding of these relations will enhance our ability to predict overall, cardiovascular, and cancer mortality; incident cardiovascular and cancer events; and decline of cognitive and physical functioning. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FACILITATING INTERNAL REGULATION OF EATING Principal Investigator & Institution: Chatoor, Irene; Professor; Children's Research Institute Washington, D.C., Dc 20010 Timing: Fiscal Year 2002; Project Start 01-DEC-1998; Project End 31-MAY-2003 Summary: The number of adolescents and adults with eating disorders has been increasing, and it has been reported that up to one third of elementary school children are preoccupied with dieting and weight. Although longitudinal research suggests that feeding problems and eating disorders often start early and are stable over time, little is known about how the regulation of eating develops in infants and young children. It is proposed that the regulation of eating in infancy develops in the context of parent-infant interactions. Feeding disorders develop when specific infant and parent vulnerabilities interact and difficulties arise during feeding. The specific aims of this project are

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twofold: 1) To further validate this transactional model for the regulation of eating in infants and young children; 2) To test the effectiveness of a short-term intervention based on this transactional model for a specific feeding disorder-Infantile Anorexia. Infantile Anorexia is characterized by the onset of persistent food refusal during the transition to self-feeding, malnutrition, parental anxiety about the infant's poor food intake, and mother-infant conflict during feeding. It is the most severe form of a spectrum of feeding problems in infants and young children. A partial dismantling design has been chosen to test the transactional model and the efficacy of a brief intervention, based on this model, to treat infantile anorexia. There will be two treatment groups with 55 infants in each group. The infants will be randomly assigned to one of two interventions. Intervention Group I will receive the full treatment model: a Psycho-Educational Treatment which will address the infant's temperament and the parent's vulnerability in regards to limit setting. This intervention will prepare the parents for the second part of the intervention, the Parent Training, which gives the parents specific suggestions on feeding routines and behavior management of the infant in order to facilitate internal regulation of eating. Intervention Group II will receive Parent Training plus four hours of therapist contact which serves as a Control Condition. This Control Condition was chosen to be as non-specific and as different as possible from the Psycho-Educational Treatment. If, as hypothesized, the PsychoEducational Treatment plus Parent Training brings the greatest improvement in parentinfant interactions and thus facilitates the infant's eating and gaining weight, these data will further validate the transactional model for Infantile Anorexia. In addition, these data will clarify how to facilitate internal regulation of eating in infants and young children in general. The principles of internal regulation of eating can be applied to the prevention and treatment of other eating disorders of children and adolescents as well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FETAL MECHANISMS

ORIGINS

OF

DISEASE:MARKERS,MODULATIONS,

Principal Investigator & Institution: Myers, Michael M.; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 25-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): The proposed studies provide new knowledge for understanding how events early in life shape physiology, behavior, and susceptibility to disease later in life. They focus on variation in nutrient availability in the perinatal period. The long-term health related objectives of the work are to improve early identification of individuals at risk for adult disease, to discover new prevention strategies, and to identify epigenetic alterations that account for the persistence of the effects of early experiences. Both animal models and human infants are studied. Assessments include measures of physiological, biochemical and behavioral characteristics of infants in both species in the first few days after birth. Indices derived from animal studies will be incorporated into human studies, and the underpinnings of correlative findings from human studies will be pursued in animal models. The presupposition for the work is that individuals, undergrown during gestation, express adaptations that can be seen as changes in autonomic nervous system (ANS) development, cardiovascular (CV) regulation, and feeding behavior. Aim 1. To determine if human infants with low birth weights express differences in CV and behavioral responses to feeding, differences in heart rate and blood pressure responses to postural challenge, and differences in physiologic and behavioral responses to changes in taste and/or formula composition. Aim 2. To determine, in rats, the effects of

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Malnutrition

reduced food availability during gestation on physiologic and behavioral characteristics during the preweaning period. Key measurements will include assessments of Newborn feeding behaviors and food preferences and CV and responses to food and feeding. Aim 3. To determine, in rats, how variations in nutrient availability after birth alter the effects of gestational malnutrition. Does experimental manipulation of food intake during the postnatal period reprogram the effects of fetal undergrowth and, if so, is there a critical period for this intervention? Aim 4. To determine, in rats, if there are changes in patterns of DNA methylation in kidney, liver, hypothalamus, placenta, and blood samples obtained from animals reared under the conditions of Aims 2 and 3. If so, the DNA sequences with alterations in methylation will be identified and this information will guide methylation studies targeted to specific genes in the placenta and cord blood samples from humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FOOD PROGRAMS AND NUTRITIONAL SUPPORT OF THE ELDERLY Principal Investigator & Institution: Lamb, Vicki L.; Center for Demographic Studies; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The major focus of this exploratory study is on nutritional programs and support, and their effects on risks of institutionalization, hospitalization and mortality. The analyses will use the National Long Term Care Survey (NLTCS), linked Medicare records, and additional data to characterize available nutritional support programs at the local and state level. The NLTCS is a large nationally representative longitudinal survey of health and disability of the US population aged 65 years and older. Questions on nutritional status (participation in Elderly Nutritional Programs, weight and physical activities) were added in 1994. A food frequency questionnaire (FFQ), a series of questions about patterns of food consumption, was added in 1999. This study will focus on the last two waves of the NLTCS, which contain this nutritional information, to pursue the following specific aims: Aim 1. To model participation in Elderly Nutrition Programs (ENPs: home delivered meals, and congregate meals), and the food stamp program among those eligible for such programs. We will estimate probit models that will be used to adjust for the propensity to participate in these programs. Aim 2. To model whether those participating in the ENPs and/or receiving food stamps in 1994, compared with those in other nutritional support arrangements, have reduced risks of institutionalization, hospitalization and mortality between 1994 and 1999. We will use hazard models to estimate the risk of these health outcomes. Aim 3. To model patterns of dietary intake in 1999, using a modified short FFQ, to explore the impact of current receipt of ENP services. Models of dietary intake will be estimated in two ways: k-means clustering, and grade of membership clustering. Regression models will be used to estimate the effects of receipt of nutritional services, health, sociodemographic and location correlates. This study will generate important hypotheses to be examined in future research on the effect of nutritional programs on elderly health outcomes, and the role of nutritional support programs as a significant factor in the provision of community based long-term care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GROWTH AND PHYSICAL MATURATION IN CEREBRAL PALSY Principal Investigator & Institution: Stevenson, Richard D.; Associate Professor of Pediatrics; Pediatrics; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2003; Project Start 08-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): This Mid-Career Award is requested to support the continued research development and mentoring activities of Richard D. Stevenson, MD, Associate Professor of Pediatrics at the University of Virginia (UVA). Over the past 10 years, Dr. Stevenson has shown a commitment to patient-oriented research and mentoring of new investigators. He is the principal investigator of a focused research effort investigating the importance of growth, nutrition, and physical development on the health and quality of life of children with cerebral palsy (CP). The goals of this proposal for research training, mentoring, and clinical research (respectively) are to (1) transition the applicant's research program of descriptive studies that have identified problems and trends to clinical trials that will test hypotheses toward the improvement of child health, (2) provide training and mentorship in clinical research (in general) and clinical research in persons with disabilities (specifically), and (3) maximize the health, participation and quality of life of children with CP and their families through the management of growth, nutritional status and other secondary conditions. The applicant is requesting K-24 funding to devote 50% of his time toward these pursuits. The next 5 years are critical to the consolidation of the applicant's research program and the expansion of his efforts through the mentoring and training of new investigators. The research training plan has been significantly expanded with this revision in response to the last review. It includes coursework, study, and practice in the development and conduct of clinical trials in persons with disabilities. This training will be accomplished through enrollment in the Multidisciplinary Training Program in Clinical Investigation, formal coursework through UVA's Department of Health Evaluation Sciences, and through collaborative efforts with colleagues. The mentoring plan has been simplified and includes (1) development of a patient-oriented research curriculum for residents, fellows, and faculty in pediatrics, developmental medicine and rehabilitation, using all resources available at UVA, (2) focused mentoring of the new investigators with the development of individualized research plans with each mentee, and (3) mentored completion of discrete research projects by each mentee. The research plan consists of studies that are part of the North American Growth in Cerebral Palsy Project (NAGCPP), and focuses on the development of clinical trials of nutritional interventions for the treatment and prevention of malnutrition. As poor growth and malnutrition are common, and as children with CP can be considered a clinical model of individuals with disabilities at large, this work is important and highly relevant to populations of children and adults with developmental and acquired disabilities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GROWTH ENHANCEMENT FOR MEXICAN AMERICAN CHILDREN Principal Investigator & Institution: Reifsnider, Elizabeth G.; Chronic Nursing Care; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-AUG-2003 Summary: Growth deficiency is a complex child health phenomenon that, if not corrected, can contribute to developmental delay, cognitive deficits, and small constitutional size. The proximal cause of growth deficiency is malnutrition, but the cause for the malnutrition varies with each child and family. Treatment for growth

22

Malnutrition

deficiency in multidisciplinary, tertiary-care clinics has been shown to be effective in the amelioration of growth deficiency. Home visits by lay community workers or community health nurses have also been shown to be effective in correcting growth deficiency. However, both of these modalities are expensive, and may not be available to all communities. What has not been determined is the most effective way to treat growth deficiency in a community setting, available to all communities. Communitybased strategies targeting growth deficiency, especially in the Mexican-American community, are needed to prevent long-term growth deficiency and its associated sequela. As shown by the Health Status Objectives for the Nation, Mexican-American children are at particular risk for growth deficiency and concomitant problems but interventions have not focused on this population. Moreover, specialized interventions are needed for this population that are culturally appropriate. Based on preliminary studies and experience, the proposed project will test an innovative model that will reduce growth deficiency and concomitant morbidity. This study will provide an easilyaccessed, culturally-appropriate intervention through community-based WIC clinics to Mexican-American children with growth deficiency. With the knowledge gained from this project, a model for the treatment of growth deficiency in a Mexican- American population can be established that can be widely disseminated in WIC clinics nationwide. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BOTSWANA

HEALTH

OF

HIV-INFECTED

MOTHERS

AFTER

PMTCT,

Principal Investigator & Institution: Lockman, Shahin; Immunology/Infections Diseases; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Maternal health concerns are an important but understudied aspect of programs designed to prevent mother-to-child HIV-1 transmission (MTCT) in the developing world. Two of the most important and urgent questions regarding maternal health in this context are 1) whether breastfeeding by HIV-infected women is associated with excess maternal morbidity and mortality, and 2) the response to nevirapine (NVP)-containing combination antiretroviral therapy (ART) among women who have previously taken single-dose NVP for the prevention of MTCT, given the frequent emergence of drug resistant HIV-1 after single-dose NVP. HIV-infected mothers are currently being enrolled in a NICHD-funded randomized clinical trial in Botswana that is studying strategies for MTCT prevention. Women are randomized to either perinatal prophylaxis with short course zidovudine + single-dose NVP or to zidovudine alone, and to either breastfeed while giving their infant prophylactic zidovudine or to formula-feed. Women with AIDS in this study will be offered the Government ART program first-line NVP-containing ART regimen. The primary objectives of this proposal are: 1.To examine the association between randomized infant feeding strategy (breast- versus formula feeding) and time to maternal AIDS or death, and 2. To assess the proportion of women with virologic response (plasma HIV-1 RNA < 400 copies / mL) at 52 weeks after initiating NVPcontaining ART among women who previously received single-dose NVP versus placebo during labor. Secondary objectives include elucidation of the etiology of possible excess maternal morbidity and mortality associated with breastfeeding by HIVinfected mothers, including micronutrient deficiency; the emergence of genotypic resistance and virologic failure in women who previously received single-dose NVP versus placebo during labor; and the tolerability and safety of and adherence to ART

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among pregnant and postpartum women in Botswana. This already-existing cohort with access to ART provides a unique opportunity to answer questions that have significant public health implications with a relatively small investment of additional resources. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEPATITIS VIRUS, ALCOHOL EXPOSURE AND OXIDATIVE STRESS Principal Investigator & Institution: Hassan, Manal M.; Gastrointestinal Med Oncology; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant) Hepatitis C virus (HCV) infection and alcohol abuse are the 2 major risk factors for hepatocellular carcinoma (HCC) in this country. The higher prevalence of HCV infection in the general population has resulted in a significant increase of the incidence of HCC in the United States. Although both HCV and alcohol can independently induce liver disease, exposure to both agents may accelerate the course of liver pathology and/or lead to more severe injury. The mechanism underlying the synergistic effect of HCV and alcohol intake is not well understood. One hypothesis is that both HCV and alcohol intake may contribute to chronic hepatitis, cirrhosis and subsequent liver cancer through enhanced oxidative stress. It is known that alcohol could induce oxidative stress and lipid peroxidation. Interestingly, a recent study has reported that HCV encodes a selenium (Se)-dependent antioxidant enzyme, glutathione peroxidase, GPx, and GPx may have a regulatory role in HCV replication. The virus-induced overexpression of GPx may lead to a decreased level of Se in the host due to the competition of HCV for Se. In fact, patients with HCV have been shown to have a significant decline in their serum Se. On the other hand, the hepatotoxicity of ethanol and its associated malnutrition will further reduce the cellular Se level. This additive decline in the Se level will make the cell more susceptible to reactive oxygen species (ROS). Previous studies have shown an association between oxidative DNA damage and either alcohol exposure or chronic viral infection. It seems that chronic HCV infection may lead to an increased ROS, overexpression of GPx and reduced serum level of Se. When the Se-GPx level is low, the virus will be more provoked for replication, leading to a higher viral load in the infected cell. Eighty newlydiagnosed HCC patients will be recruited from University of Texas MD Anderson Cancer Center (UTMDACC). The current project will explore the effect of dietary selenium intake and its interaction with HCV and alcohol intake in HCC in a casecontrol study. Eighty healthy individuals (first control group), matched with cases by age, sex and ethnicity, will be recruited from the patients non-blood relatives and friends from UTMDACC. To have a control group with comparable prevalence of HCV infection, 80 patients with liver cirrhosis, who have no evidence of HCC (second control group), will be recruited from Baylor College of Medicine. Information on alcohol intake, dietary Se intake and other risk factors will be collected by a questionnaire. The frequency and profile of hepatitis B virus (HBV) and HCV infection will be determined by measuring serum HBsAg, anti-HBC, anti-HCV, and HCV-RNA. Oxidative stress will be evaluated by measuring the levels of serum Se, GPx activity, lipid peroxides, and 8hydroxy-deoxyguanosine (8-OH-dG), a marker of oxidative DNA damage. The expression of GPx and the level of 8-OH-dG will also be measured in tissue samples from cirrhotic and HCC patients. Serum Se, GPx activity, lipid peroxides and oxidative DNA damage will be measured in relation to HCV and alcohol intake history. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Malnutrition

Project Title: HUMAN AMINO ACID REQUIREMENTS Principal Investigator & Institution: Young, Vernon R.; Professor of Nutritional Biochemistry; None; Massachusetts Institute of Technology Room E19-750 Cambridge, Ma 02139 Timing: Fiscal Year 2004; Project Start 01-AUG-1990; Project End 30-NOV-2008 Summary: (provided by applicant): Sound knowledge about the quantitative requirements for the nutritionally indispensable amino acids in adult human protein nutrition is fundamental to the assessment of diet adequacy and planning of diets for population groups. The goals of this research are to firmly establish the requirements for these nutrients, driven by the hypothesis that earlier national and international recommendations for the amino acid requirements of adults were far too low. Previous work on this grant has supported this hypothesis. In consequence, the earlier estimates are now undergoing substantial, upward revision at the international and national levels and in a major way dependent on the work that we have carried out during this grant period. There remain significant, unresolved major issues and these require investigation before a profile of the indispensable amino acid requirement for healthy adults world-wide can be stated with some confidence. Hence, we will continue a series of stable isotope-labeled amino acid tracer studies, to close the gap in present knowledge, in healthy subjects from two geographic regions (US-Boston; IndiaBangalore) and in undernourished subjects (Bangalore) to assess the general applicability of the requirement estimates in healthy populations and to better understand the consequences of under nutrition on the utilization of and requirements for these indispensable amino acids. The specific aims of this research are: 1) to complete and evaluate ongoing studies on the requirements for the sulfur amino acids, methionine (with and without cystine); 2) to explore the impact of different methionine/cysteine intakes on glutathione homeostasis, methionine cycle activity and methyl group metabolism. This aim will be conducted in both healthy US and Indian subjects and undernourished Indian adults; 3) to further establish the requirements for the total aromatic amino acids from phenylalanine alone; 4) to explore the impact of dietary tyrosine on the requirement for phenylaIanine alone; 5) to confirm the predictions of the requirements for valine as derived from the requirements for leucine; 6) to examine the consequences of adaptation to a low lysine and low threonine diet on the post-prandial utilization (PPU) of a protein meal limiting in either lysine or threonine. The long-term objective of these studies to improve the quantitative knowledge about human nutrient requirements and factors that affect them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMMUNE RESPONSES TO V. CHOLERAE INFECTION IN BANGLADESH Principal Investigator & Institution: Calderwood, Stephen B.; Chief, Div of Infectious Diseases; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 05-SEP-2000; Project End 31-AUG-2003 Summary: (adapted from application abstract): Vibrio cholerae causes a severe, dehydrating, and occasionally fatal diarrhea in humans. There are an estimated 5-7 million cases worldwide of cholera, with more than 100,000 deaths. Much of the impact of cholera occurs in developing areas of the world, particularly in South and Southeast Asia such as Bangladesh and India. Infection with V. cholerae induces long-lasting protective immunity to subsequent cholera, although the immune responses mediating protection are not fully understood. Many of the previous field studies of immune

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responses to V. cholerae infection were done in the 1970s, prior to the advent of more modern techniques for measuring mucosal immune responses, such as the use of antibody-secreting cell assays. More recent studies of V. cholerae infection in normal volunteers, many done in the United States, have provided important information on immune responses to infection with this pathogen, but these responses may differ substantially than those in patients in endemic areas, particularly as relates to the influence of age, morbidity, malnutrition and prior exposure to related antigens. Much work has been done recently on development of effective live, oral, attenuated V. cholerae vaccines, both for prevention of clinical cholera and as vectors for expressing heterologous antigens to protect against other infections at mucosal surfaces. This proposal would establish a long-term collaboration between scientists in the US and at the International Centre for Diarrhoeal Disease Research in Bangladesh to elucidate immune responses and protection from cholera infection in an endemic population. The Long-Term Goals of this project are to better understand mucosal immune responses after V. cholerae infection and vaccination, and to assess the effect of patient and microbial factors on these responses that may explain differences observed between patients from endemic areas and normal human volunteers. The Specific Aims of the proposal are: 1) determine the full range of immune responses, particularly mucosal antibody responses, in patients with cholera in Bangladesh, comparing vibriocidal and mucosal antibody responses and stratifying these responses by patient and microbial characteristics. We will test the hypothesis that the serum vibriocidal response represents a surrogate marker for a mucosal response to a relevant antigen or antigens that is actually protective: 2) correlate mucosal anti-V cholerae antibody levels on exposure to the organism with protection from subsequent clinical cholera. We will examine the hypothesis that pre-existing secretory immunity to LPS. CtxB, MSHA and/or TcpA at the time of colonization of V. cholerae protects against subsequent illness: 3) assess immune responses to CtxB at distant (non-intestinal) mucosal sites after clinical cholera, as a model for immune responses to heterologous antigens expressed by live, oral, attenuated V. cholerae vaccine vectors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPACT OF EGG QUALITY ON GENE EXPRESSION AND BEHAVIOR Principal Investigator & Institution: Schultz, Richard M.; Professor; Biology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): It is now clearly recognized from egg donation studies that it is the egg and not the reproductive tract that is the cause of reduced fertility or infertility. Remarkably, the molecular underpinnings of what constitutes an egg of "high" quality are essentially unknown. Specific Aim 1 will test the hypothesis that a specific pattern of gene expression characterizes eggs of high quality by using suppression subtractive hybridization to identify genes that are differentially expressed in meiotically and developmentally competent high quality mouse eggs. These genes will be used to construct an "oocyte chip" that will be used to ascertain if a specific set of these genes is mis-expressed, or inappropriately expressed, in oocytes whose developmental competence is compromised, e.g., oocytes that develop during in vitro culture; oocytes derived from small antral follicles, oocytes obtained from hyperstimulated mice, and oocytes obtained from aged mice. The Fetal Origins of Adult Disease hypothesis posits that specific diseases in the adult are the result of the fetus's adaptations in utero to maternal under nutrition or malnutrition. This hypothesis may

26

Malnutrition

extend to the preimplantation stage, since reducing protein intake during this time in the rat results in such long-term changes, and the culturing of preimplantation embryos leads to offspring that exhibit altered behavior. Specific Aim 2 will test the hypothesis that low quality eggs give rise to offspring that exhibit perturbations in behavior by analyzing these offspring with a battery of behavioral assays. Treatment of human infertility with Assisted Reproductive Technology (ART) entails embryo culture that can result in changes in gene expression. Even eggs of high quality (and the resulting preimplantation embryos) that are used in ART may be at risk simply due to embryo culture conditions. Specific Aim 3 will test the hypothesis that modifications of culture conditions can alleviate the effect of embryo culture on the culture-associated perturbations observed in gene expression and behavior in the offspring. Results of these experiments will establish the molecular basis of egg quality and will provide critical information regarding the effect on behavior in offspring derived from low quality eggs, as well as the effect of ART procedures on gene expression and behavior. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INHIBITION OF COLONIC TUMORS IN MICE CARRYING A TRUNCATED APC GENE Principal Investigator & Institution: Yang, Kan; Sloan-Kettering Institute for Cancer Res New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 10-SEP-2002; Project End 31-MAR-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RESEARCH

INTERNATIONAL

TRAINING

IN

AIDS/TB

PREVENTION

Principal Investigator & Institution: Prasad, Vinayaka R.; Professor & Director; Microbiology and Immunology; Yeshiva University 500 W 185Th St New York, Ny 10033 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-MAY-2005 Summary: This international training program in AIDS/TB prevention research at the Albert Einstein College of medicine (AECOM) focuses mainly on India and includes a small program for Eritrea. Towards our goal of capacity building in these countries, we aim to train Indian and Eritrean scientists in critical biomedical research, behavioral/epidemiological studies, as well as clinical research. Short-term training will involved specialized workshops in New York City was well as in-country sites that are going to be coordinated with sites in India where vaccine trials are going to conducted by international agencies such as IAVI. Medium-term training will include both graduate students of their Research Mentors who will perform collaborative research for acquiring training in the areas including but not limited to: characterization of the Indian clade of HIV-1; measurement of drug-resistance in HIV; use of small animal models to study the effect of malnutrition on HIV infection; administration of V3-loop peptide vaccine to prevent materno-fetal transmission, the use of a rapid, inexpensive detection system for drug- resistant strains of Mycobacterium tuberculosis, and the development of diagnostic antibodies and other serodiagnostic and molecular tools specific to the Indian subtype of Cryptococcus neoformans. Furthermore, a Master's degree in Clinical Research Training Program and a Post- doctoral Research Training Program are offered in AIDS/TB research. Furthermore, the program will help develop low-cost HIV/AIDS technologies, mediate the creation of an Indian reposition of

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essential, HIV clade C-specific reagents and plans to help former trainees independent establish independent AIDS research programs upon their return to their home countries and to interact with them in this capacity- building effort. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERSTITIAL CELLS OF CAJAL IN DIABETIC GASTROPATHY Principal Investigator & Institution: Ordog, Tamas; Physiology and Cell Biology; University of Nevada Reno 204 Ross Hall Mailstop 325 Reno, Nv 89557 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Upper gastrointestinal symptoms arising from diabetic gastropathy, and gastroparesis, the irreversible, end-stage form of gastropathy, have been reported in 30-60% of patients after approximately 10 years of both insulindependent and non-insulin-dependent diabetes mellitus. These gastric motor abnormalities can seriously affect the patients' quality of life, may affect glycemic control and can occasionally result in incapacitating symptoms like malnutrition, water and electrolyte imbalance or even aspiration. Most basic and clinical scientists view these complications of diabetes as a manifestation of autonomic neuropathy but their exact pathomechanism remains unclear. In the present proposal we offer a novel hypothesis. Recently, interstitial cells of Cajal (ICC), a mesenchymal cell type residing in the myenteric region (ICC-MY) and within smooth muscle layers (ICC-IM) of the stomach, have been identified as pacemakers and mediators of neurotransmission, respectively. Because both functions are seriously affected in diabetic gastropathy, it is possible that disruption of ICC networks could underlie some of the pathological changes characteristic of this disease. Our published work and additional preliminary studies using non-obese, spontaneously diabetic (NOD) mice, as well as a recent report about the human gastrointestinal complications of diabetes (He et al., Gastroenterology 121: 427-434, 2001) support the validity of this hypothesis. Thus, NOD mice offer an exciting new animal model for studies of diabetic gastropathy. In this project we plan to characterize and use this model to: (1) study how networks of gastric ICC are altered in diabetic gastroparesis and how alterations in ICC-MY number and distribution could lead to gastric arrhythmias and impaired gastric emptying; (2) to investigate whether ICC depletion in the stomach of diabetic NOD mice is due to hyperglycemia or hypoinsulinemia and to study the mechanisms by which these factors influence ICC phenotype and function; and (3) to examine what cellular mechanisms (e.g. apoptosis, necrosis or transdifferentiation) lead to the reduction of ICC in the distal stomach. The proposed experiments could provide the basic concepts needed for the development of novel, more effective treatment options for patients with diabetic gastropathy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INTESTINAL METALLOTHIONEIN?

ENDOGENOUS

ZINC:

ROLE

FOR

Principal Investigator & Institution: Krebs, Nancy F.; Pediatrics; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2004 Summary: (Provided by applicant): Zinc (Zn) deficiency is a public health problem of global proportions, and is of clinical significance in many disease states. Our understanding of Zn homeostasis remains, however, far from complete, especially in the regulation of the major route of loss of Zn from the body: secretion into the intestine and excretion via the feces. A large database from human whole body Zn metabolism

28

Malnutrition

studies now indicates that endogenous fecal Zn is related to the amount of absorbed dietary Zn, to Zn "status" of the host, and to the size of rapidly exchanging zinc pools (EZP). The proposed pilot studies examine the potential role of metallothionein (MT) in pancreaticobiliary secretions as a modulator of Zn secretion into the human gastrointestinal tract. Metallothionein is proposed for this process on the basis of animal data indicating that the pancreas is a site of MT gene expression and synthesis that is responsive to parenteral and enteral Zn, and that MT is a normal constituent of pancreaticobiliary secretions. The specific aims are to determine in pancreaticobiliary secretions if: (1) the amount of MT is directly related to endogenously secreted Zn; (2) the amount of MT is responsive to changes in dietary Zn intake, absorbed Zn, and EZP size; and (3) the amount of MT is increased with "stress" in pancreaticobiliary secretions, and thereby associated with increased endogenous Zn secretion. Proposed methods include gastroduodenal intubation and aspiration of pancreaticobiliary secretions, in which MT and Zn will be measured, and Zn stable isotope techniques by which key variables of Zn homeostasis will be measured. One study will be conducted in 10 normal adult subjects on their habitual Zn intake and repeated after either Zn restriction or Zn supplementation. A second study will examine the effects of cytokine stimulation by interferon-7 on MT and endogenous Zn secretion while Zn intake is constant. Measurement of MT will be made using the well established but indirect cadmiumhemoglobin affinity assay and by a proposed new immunoassay, which will yield more accurate and precise measurements of human MT. Proposed data analyses include correlations between total flow of MT and endogenous Zn to determine temporal and quantitative relationships between these 2 variables within and between subjects; stepwise multiple regression to examine effects on MT and variables of Zn homeostasis; and paired comparisons between MT and endogenous Zn secretion on habitual Zn intake and either Zn restricted or supplemented diets, and before and after interferon-y administration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON DEFICIENCY, HIPPOCAMPAL DEVELOPMENT, AND LEARNING Principal Investigator & Institution: Mcechron, Matthew D.; Neural and Behavioral Sciences; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2003; Project Start 11-AUG-2003; Project End 31-MAY-2005 Summary: (provided by applicant): The goal of this project is to identify the neural mechanisms involved in the well-established link between dietary iron deficiency (ID) and developmental impairments in learning and cognition. The hippocampus is the most important learning and memory structure in the mammalian brain. The hippocampus is critical for learning tasks that require the association of complex sets of information, and in humans it is critical for cognitive performance. Numerous studies in animals have shown that the hippocampus is more susceptible to ID during early development compared to other brain regions. An extensive list of animal and human studies has shown that ID impairs the development of learning and cognitive ability, and some of these studies suggest that these learning impairments persist well into adulthood. Together these lines of evidence strongly suggest that dietary ID alters the development of the hippocampus, and these alterations in turn significantly impact the development of children's cognitive and learning ability. Very little is known about how the functional physiology of the hippocampus is affected by ID during development. Experiment 1 in this proposal will determine if ID in postnatal developing rats impairs

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hippocampal synaptic responsiveness. This experiment will also determine if these physiological impairments are related to deficits in hippocampus-dependent learning. The animal learning paradigm that will be used in all of the experiments in this proposal combines trace and contextual fear conditioning, both of which have been shown to be dependent on the hippocampus. Our preliminary data demonstrate that ID in developing postnatal rats impairs learning in both of these hippocampus-dependent tasks. Our previous studies in normal adult animals have shown that single neurons in the hippocampus exhibit learning-specific encoding of the trace interval duration. Experiment 2 in this proposal will determine if ID in postnatal developing rats impairs hippocampal single neuron encoding of the trace interval duration during trace fear conditioning. Experiment 3 will determine if ID during postnatal development produces long-term impairments in hippocampal neurogenesis and hippocampus-dependent learning in young adult rats. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON DELIVERY VIA HEMODIALYSATE IN ESRD Principal Investigator & Institution: Gupta, Ajay; Internal Medicine; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, Ca 90059 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2006 Summary: (provided by applicant): Erythropoietin (EPO) is an effective therapy for anemia of end-stage renal disease (ESRD) and is used in almost all ESRD patients receiving chronic hemodialysis. EPO stimulated iron utilization, coupled with small but unavoidable loss of extra corporeal blood with hemodialysis, leads to iron deficiency in almost all patients. Adequate iron delivery, by oral or parenteral supplementation, is necessary for optimal EPO action. Compliance with oral iron is poor due to gastrointestinal toxicity. Therefore intravenous (i.v.) iron is administered to 50-75 percent of hemodialysis patients, either intermittently when iron deficiency develops or at regular intervals to prevent iron depletion. Parenteral iron is a pro-oxidant, and may increase the risk of infections, inflammation and atherosclerosis by further enhancing oxidative stress and inflammation present in the majority of hemodialysis patients. Unlike the large polymeric iron complexes that are administered i.v., ferric pyrophosphate (FePPi), a monomeric iron salt (745 Da), can be delivered directly into the circulation when added to dialysis solutions. Fe(III) complexes tightly with pyrophosphate (PPi), thereby reducing dissociation and release of free iron. PPi anion is an antioxidant that promotes direct delivery of iron to transferrin, and iron transfer from transferrin to ferritin. FePPi is highly soluble in the acid concentrate and a concentrate fortified with FePPi can be used to generate a dialysate with defmed concentration of FePPi (Fe-HD). This is a double-blinded, randomized, controlled Phase II clinical trial to determine the safety and efficacy of FePPi added to the hemodialysis solutions in ESRD patients over a period of 9 months. Iron replete patients in=30) with no evidence of iron overload (transferrin saturation or TSAT< 40 percent, and ferritin < 800 lag/L), who have needed intravenous iron in the previous 2 months will be enrolled. Patients will be randomized to receive hemodialysis using Fe-HD or C-HD with every dialysis session for a total period of 9 months. The initial dose of dialysate iron will be 9 lag/dl if TSAT is 30-40 percent, and 11 lag/dl if TSAT is < 30 percent. Serum iron parameters (TSAT and ferritin) will be monitored every month. The dialysate iron concentration will be reduced to 9 lag/dl if pre-dialysis TSAT increases to 35-40 percent, and dialysate iron will be held if TSAT exceeds 40 percent. Dialysate iron will be restarted at 11 lag/dl if TSAT is < 30 percent and at 9 lag/dl if TSAT is 30-40 percent. Patients in both groups will receive 500 mg i.v. iron saccharate (Venofer(r)) in 5 divided doses at 5 consecutive

30

Malnutrition

dialysis sessions if TSAT is 800 lag/L). The acute and chronic effects of dialysate iron on serum levels of catalytically active iron and markers of inflammation and oxidative stress will be measured at the beginning and the end of the study. This Phase II study will provide preliminary evidence of the safety and efficacy of ferric pyrophosphate infusion via the dialysate, with the aim of preventing iron deficiency, and pave the way for a large, clinical trial of dialysate iron therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LEUKOCYTE MICROCIRCULATION

ADHESION

IN

COPPER

DEFICIENT

Principal Investigator & Institution: Schuschke, Dale A.; None; University of Louisville University of Louisville Louisville, Ky 40292 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-JUL-2003 Summary: It is well established that there are a number of important copper-dependent enzyme systems that are intimately involved in immunologic and inflammatory responses. Even though overt copper deficiency is rare and the copper requirement is small (1.5-3.0 mg/day), the intake of copper is often near or below the recommended U.S. Estimated Safe and Adequate Daily Dietary Intakes suggesting that marginal copper deficiency may be relatively common. Hopkins and Failla have shown that marginal copper intake reduces neutrophil function under conditions where the usual conventional indicators of copper are not markedly affected. Charges in neutrophil function may be even more consequential in some populations such as premature infants where copper deficiency is common. Yet, despite the importance of copper and the potential of even marginal copper deficiency to present a health hazard, the mechanisms by which copper modulates inflammatory reactions and the level of copper deficiency necessary to induce such effects are not known. The proposed research will focus on mechanisms underlying the relationship between dietary copper and the mobilization of leukocytes during injury or infectious stimuli in the microcirculation. Our previous research identified the endothelium as one of the major tissues affected by dietary copper deficiency. Since circulating leukocytes must interact with the endothelium prior to transmigration to sites of infection or injury, we will determine how marginal and deficient copper intake affect endothelial interactions with leukocytes. The studies will demonstrate how minimal decreases in dietary copper intake can significantly influence the response to inflammatory stimuli. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LONG-TERM IMPACT AND INTERVENTION FOR DIARRHEA IN BRAZIL Principal Investigator & Institution: Guerrant, Richard L.; Professor; Internal Medicine; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-MAY-1989; Project End 31-JUL-2004 Summary: Having defined the magnitude, major new etiologies, key novel mechanisms and short-term impact of persistent diarrheal illnesses and even certain "asymptomatic" enteric infections in a model collaboration and cohort of children born into active prospective surveillance in an urban shantytown in Northeast Brazil, we are now have a unique opportunity to define for the first time the long-term DALY (disability adjusted life years) impact of early childhood enteric infections on nutritional status defined by anthropometry, physical activity and fitness, and cognitive function over extended periods (even years later). We postulate, based on our short-term impact data, that the

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greatest long-term impact will occur in children with persistent diarrheal illnesses and in those with low height-for-age Z (HAZ) scores. Having also shown the potential shortterm benefits of a new glutamine-based oral rehydration and nutrition therapy (ORNT) and of vitamin A (with studies of zinc pending) on speeding the repair of damaged intestinal barrier function, we can now determine the potential long-term benefits of glutamine-based ORNT, with vitamin A and zinc therapy (targeting children with persistent diarrhea or reduced HAZ, as noted above). We shall also examine the intermediate (ie 1- 6 months) and long-term (greater than 6 months) effects of specific emerging enteric infections we have found to be important, enteroaggregative E. coli, and Cryptosporidium parvum. Coupled with our new developments of stable glutamine derivatives, the above data on full long-term DALY impact of persistent diarrhea, enteric infections and malnutrition, and the data on benefits of glutaminebased ORNT with vitamin A and zinc will ultimately allow us to calculate a much more meaningful cost-effectiveness (in "dollars per DALY averted) of selected treatment of high risk children (ie any with a persistent diarrheal illness that extends greater than 14 days, or a height for age Z score of less than 0.5). This model, longstanding collaboration and prospective field cohort surveillance will also enable the use of molecular tools currently being developed to define the epidemiology and microbiology of such newly recognized major agents as enteroaggregative E. coli as well as opening new opportunities to train both US and international scientists in highly relevant bench and field investigation. This pioneering work builds on our unique opportunity to define for the first time the potentially huge (developmental and economic) burden of early childhood enteric infections, as well as holding promise for demonstrating a key intervention targeted at the most vulnerable subset of the population in greatest need. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAGNESIUM DEFICIENCY: GLOBAL GENE EXPRESSION STUDY Principal Investigator & Institution: Schultheis, Patrick J.; Biological Sciences; Northern Kentucky University University Dr Highland Heights, Ky 41076 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Magnesium (Mg2+) is the second most abundant cation in cells. Because Mg2+ serves as a cofactor in hundreds of enzymatic reactions, it has a profound influence on many biological activities including DNA and protein synthesis, ion transport, intracellular signal transduction, and cell growth and differentiation. Consequently, it is not surprising that Mg2+ deficiency has been implicated in various disease states such as atherosclerosis, hypertension, diabetes, asthma, and alcoholism. Yet, our understanding of Mg2+ homeostasis lags far behind that of other cations such as Ca2+, Na+, K+, and H+, largely because the transporters of Mg2+ have not been identified at the molecular level. In addition, little work has been conducted concerning the effects of Mg2+ deficiency on gene expression, especially with respect to its role in various pathological conditions. Gene expression profiling using cDNA microarrays represents a powerful method for identifying genes involved in specific cellular or disease processes. We propose to use this technology to identify genes involved in magnesium homeostasis and to elucidate the mechanisms by which magnesium deficiency leads to various disease states. By comparing global gene expression patterns of select organs of normal mice to their counterparts in magnesiumdeficient mice, it should be possible to identify genes involved in magnesium homeostasis, such as those encoding magnesium transporters. Genes that are aberrantly expressed under magnesium-deficient conditions should also be identified. This should lead to a better understanding of magnesium's role in health and disease. In Aims 1 and

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2 commercial cDNA microarrays will be used to investigate the effects of acute and chronic magnesium deficiency on gene expression, respectively. In Aim 3 suppression subtraction hybridization libraries will be constructed from various organs of magnesium-replete and magnesium-deficient mice. Clones from the library will then be used to construct custom cDNA microarrays for gene expression profiling. This combination of techniques should lead to the identification of all genes that are differentially expressed during magnesium deficiency. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS OF NEONATAL PROTEIN ACCRETION Principal Investigator & Institution: Denne, Scott C.; Professor; Pediatrics; Indiana UnivPurdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2003; Project Start 01-MAY-1992; Project End 31-DEC-2007 Summary: (provided by applicant): Despite continually improving survival rates, growth outcomes for premature extremely low birth weight (ELBW) infants remain exceptionally poor. Growth failure is nearly universal in these infants as they near term gestation. High rates of protein loss and elevated energy expenditures uncompensated by adequate nutritional intake appear to be primary factors in producing this growth failure, perhaps producing metabolic changes that prioritize survival over growth. There is accumulating experimental, clinical, and epidemiologic evidence that abnormal fetal growth can result in adaptations which persist throughout the lifespan and increase the risk of disease. Growth restriction in ELBW infants occurs in the extrauterine environment during the last third of gestation, and although adaptive responses might be expected, they have not been examined. The goal of the present proposal is to test the overall hypothesis that nutritional inadequacies of the extrauterine environment induce adaptive responses in protein metabolism, energy expenditure, insulin sensitivity, and endothelial function in ELBW infants which persist throughout infancy. Studies will be performed in ELBW and normal control infants at term gestation, 4 and 18 months of age. The following specific aims will be pursued: 1) To assess protein kinetics and protein catabolism during enteral feeding and in response to increased protein intake in ELBW infants throughout infancy. Proteolysis, protein synthesis and protein catabolism will be measured using stable isotopic tracers of leucine, phenylalanine, and urea 2) To determine the rate of total energy expenditure, resting energy expenditure, and energy of activity in ELBW infants throughout infancy. Total energy expenditure, resting energy expenditure and the energy of activity will be assessed using the doubly labeled water method and respiratory calorimetry 3) To examine insulin sensitivity in ELBW infants throughout infancy. A glucose tolerance test will be performed and glucose oxidation measured. 4) To evaluate endothelial function in ELBW infants throughout infancy. Endothelial function will be by determining acetylcholine induced vasodilation using the laser doppler technique. These studies may form the basis for improved clinical and nutritional strategies for these infants, as well as a future opportunity to more thoroughly explore the potential mechanisms underlying these adaptations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MICRONUTRIENTS, STROKE AND COGNITION IN AGING Principal Investigator & Institution: Folstein, Marshal F.; Professor and Medical Director; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533

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Timing: Fiscal Year 2002; Project Start 15-JUN-2002; Project End 31-DEC-2002 Summary: A major determinant of the quality of life for elderly individuals is the efficiency of their mental processes. Loss of neurocognitive functioning has been noted in elderly individuals; the severity of this loss ranges from simple memory deficits to profound dementia of the Alzheimer's variety. It is important to discover to what extent such functional decline is preventable and reversible. Specific to this project is the possibility that nutritional factors are important. Since estimates of the incidence of micronutrient deficiency in the elderly is quite large, intervention could significantly reduce the public health burden. The aim of this multidisciplinary study is to determine the prevalence of elevated homocysteine, brain disease, and cognitive decline in the homebound elderly. From 7500 homebound elderly, representative of all registered cases from a specified geographical area, a cohort of 1600 elders will be assessed. The assessment will include dietary history and serum nutrient levels, as well as comprehensive neuropsychological testing. Clinical examination and MRI scans will be performed on a subset of 400 subjects. Known risks for cognitive impairment such as diagnosed depression, anxiety, hypertension, diabetes, atrial fibrillation, medications, APOE, saturated fat intake, and mutations of MTHFR will be measured and included in analyses as covariates and effect modifiers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR GENETICS OF HUMAN TOOTH DEVELOPMENT Principal Investigator & Institution: Patel, Pragna; Professor; Neurology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2006 Summary: Elucidating the genetic control of morphogenesis and cell differentiation during tooth development is crucial to our understanding of the pathogenesis of genetic and acquired diseases that involve dentition. Hypodontia constitutes the most commonly encountered dental defect. The lack of teeth, primary or permanent, is an important public health concern predisposing to malnutrition and secondary infections, and is of high clinical relevance. Our goal is to elucidate factors important for tooth development in humans and to understand how mutations within genes encoding these factors contribute to hypodontia. We have previously identified a mutation in PAX9 in a family with hypodontia involving molars. We propose to identify (i) additional families and sample these and previously identified families segregating non-syndromic hypodontia of unknown etiology and (ii) the gene(s) underlying hypodontia by genome-wide linkage analysis, candidate gene identification and mutation analysis. Linkage analysis will be conducted by parametric and non-parametric approaches. Candidate genes will be prioritized by bioinformatics and molecular approaches including a microarray approach. Mutation analysis of selected candidate genes and validation in families will identify the hypodontia gene(s). Our studies will map and identify genes underlying hypodontia. This information will add to our knowledge of human tooth development and enable design of better diagnostic and treatment strategies for hypodontia patients in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MORTALITY AND MORBIDITY IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Allon, Michael; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004

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Summary: End-stage renal disease (ESRD) is associated with a markedly reduced patient survival and substantial morbidity. The life expectancy of a 40 year-old dialysis patient is 8.8 years, as compared with 37.4 years for the general U.S. population of the same age. Retrospective studies have suggested that higher Kt/V and use of dialysis membranes with higher flux and greater biocompatibility may decrease morbidity and mortality in maintenance hemodialysis patients, but few prospective studies have evaluated the effects of such manipulations. This prospective, randomized, multicenter investigation will test the following hypotheses: (1) Hemodialysis achieving higher Kt/V results in decreased mortality in ESRD patients undergoing maintenance hemodialysis. (2) Hemodialysis with membranes of higher flux decreases mortality and morbidity. (3) These two interventions are safe and acceptable to hemodialysis patients. In-center hemodialysis patients will be randomized to receive dialysis treatments with either standard or high Kt/V (1.0 vs 1.4, double pool) and using either high flux membranes or low flux membranes. Subjects will be randomized to one of four experimental groups: a. Kt/V 1.40; High flux membrane b. Kt/V 1.40; Low flux membrane c. Kt/V 1.00; High flux membrane d. Kt/V 1.00; Low flux membrane All other aspects of the patients' medical and dialysis care will follow the usual standards of care. The study subjects will be followed prospectively for five years to determine: a. Patient mortality (primary endpoint) b. Patient morbidity (secondary endpoint) i. Nonaccess related hospitalization (especially cardiovascular events or serious infections) ii. Malnutrition (a decline in serum albumin) The results will be analyzed to determine whether there are significant differences in patient survival or morbidity among the four treatment groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATURAL HISTORY OF HEPATITIS C INFECTION IN HIV DISEASE Principal Investigator & Institution: Horsburgh, C Robert.; Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Each year more than 20 percent of the 3.5 million Americans infected with hepatitis C progress to cirrhosis and ten to fifteen thousand develop end-stage liver disease. Because hepatitis C and HIV disease share common modes of transmission, coinfection occurs in 8-10 percent of all HIV-infected individuals overall and is present in over 70 percent of those with parenteral risk factors. There are few data available on the natural history of HIV and HCV co-infection in specific risk groups, as most previous studies have not assessed the impact of confounding variables such as alcohol use, continuing substance abuse, malnutrition, duration of HCV infection, and degree of HIV-related immune suppression. Moreover, current data regarding the impact of HIV on HCV infection are changing rapidly due to the widespread use of highly active antiretroviral therapy (HAART). New cases of HIV and HCV are expected to continue to occur in substance abusers, since HIV infection is increasing rapidly in inner-city populations. The purpose of this study is to examine the natural history of HIV and HCV co-infection in a large inner city cohort who are predominately minority and have a history of polysubstance abuse. We will compare three groups: 1) HIV and HCV infected, 2) HCV infected alone, and 3) HIV infected alone. Epidemiologic studies will be conducted to explore the risk factors associated with HCV progression, morbidity, and mortality, using both standard clinical parameters and novel surrogate markers of liver fibrosis. Additional targeted substudies will examine the important clinical question of whether therapy of either the HCV or HIV disease alters progression of liver disease. Finally, immunologic studies aimed at increasing our understanding of the

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pathogenesis of liver injury and why it may be accelerated in HIV disease will be performed. The central hypothesis of this proposal is that alterations in immune function associated with HIV infection are the main determinant of poorer hepatitis C outcomes. The specific aims of this grant are: 1) to identify the variable(s) that impact the progression of HCV infection in HIV-infected individuals; 2) to determine the effect of HAART on HCV in dually infected persons; and 3) to define the immunologic variables that predict more rapidly progressive liver disease. These studies are expected to improve our understanding of the natural history and pathogenesis of HCV in immunosuppressed hosts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NCMHD CENTER OF EXCELLENCE IN NUTRITIONAL GENOMICS Principal Investigator & Institution: Rodriguez, Raymond L.; Professor; Molecular and Cellular Biology; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2003; Project Start 15-JAN-2003; Project End 31-DEC-2007 Summary: (provided by applicant): The landmark 1985 report, the Secretary's Task Force Report on Black and Minority Health revealed that certain minority populations exhibit higher incidence and severity of many chronic diseases including diabetes obesity, asthma, cardiovascular diseases (CVD), and certain cancers. Men with African admixture have 60% greater risk of prostate cancer diagnosis and 2 to 3 times greater mortality than European admixture men. Our working hypothesis is that individual genetic variation may exacerbate diet as a risk factor for disease and that dietary intervention based upon knowledge of nutritional status, nutritional requirements, and genotype - that is, intelligent nutrition - can remedy or ameliorate disease symptoms. Certain genotypes will be more severely affected by specific kinds of malnutrition than other genotypes -and no genotype is immune to deleterious effects of all diets. Our scientific program can best be summarized by the term nutrigenomics: nutrition individualized to a person rather than a population. The science of nutrigenomics seeks to identify and characterize genes regulated by naturally-occurring chemicals in foods and the subset of those genes that influence balance between healthy and disease states. Such knowledge is necessary but not sufficient to address health disparities observed in ethnic populations and the poor. Genetic differences alone however, cannot explain these health disparities. Social and cultural attitudes among health care workers, researchers who design health studies to identify causative genes and environmental factors, and attitudes in both the minority and general population also contribute significantly to minority health disparities. Achieving and maintaining optimum health care can be assisted by (i) developing better approaches to human association studies that recognize the importance of population stratification in ethnically mixed populations, (ii) educating health care professionals about the non-biological factors contributing to health disparities such as stereotyping, bias, racism and other bad practices in biomedical research and health care delivery, and (iii) establishing community outreach programs whose goals include informing minorities and the poor about the importance of good nutritional habits as they relate to their particular genetic makeup, and disseminating existing information about health matters, including health disparities, that is relevant to these communities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROENDOCRINE CONTROL OF ANTERIOR PITUITARY HORMONES Principal Investigator & Institution: Kineman, Rhonda D.; Assistant Professor; Medicine; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 02-JUL-1981; Project End 31-JAN-2007 Summary: (provided by applicant): Growth hormone (GH) promotes protein synthesis and lipolysis. In turn, metabolic disturbances are associated with alteration in GH production which contribute to the pathophysiology of clinically relevant disorders such as malnutrition, anorexia nervosa, obesity and diabetes. Despite the strong association between metabolism and GH, little is known regarding the basic mechanisms by which perturbations in metabolic pathways bring about changes in GH synthesis and release. Therefore, this application will determine the mechanisms by which alterations in nutrient availability; 1) regulate hypothalamic expression of neuropeptides essential for normal pituitary GH production (GH-releasing hormone [GHRH] and somatostatin [SRIF]), and 2) modify pituitary sensitivity to the GH-stimulatory peptides, GHRH and ghrelin. It has been proposed that changes in circulating leptin (an adipocyte factor) and ghrelin (a GH-releasing peptide produced in the stomach) mediates hypothalamic expression of GHRH and SRIF through activation of neuropeptide Y (NPY) neurons. To test this hypothesis, the effects of fasting on neuropeptide mRNA levels, in mice harboring defects in leptin synthesis (ob/ob), tissue source of leptin (AZIP-F1), NPY synthesis (NPY-/-), SRIF synthesis (smst-/-) and SRIF signaling (ss1l/2-/-) will be examined by ribonuclease protection assay and in situ hybridization. Also the effects of fasting in normal mice following exogenous hormone replacement (to increase NPY, leptin or ghrelin), pharmacological treatment (to block endogenous NPY production) or passive immunoneutralization (to block the actions of ghrelin) will be tested. Fasting not only alters expression of GH-regulatory neuropeptides but also enhances pituitary sensitivity to GHRH and ghrelin by increasing GHRH-R and GHS-R mRNA levels. In vitro, FFAs alone or in conjunction with glucocorticoids increase GHS-R synthesis. Therefore it is hypothesized that fasting induced elevations in FFA and glucocorticoids are required to enhance pituitary receptor synthesis and sensitivity, and thus compensate for fasting-induced alteration in central signals. To test this hypothesis, studies will examine the ability of fasting to alter pituitary receptor expression (by quantitative RT-PCR) and dynamic GH release (by RIA of serial blood samples) following blockade of FFA formation (by the anti-lipolytic Acipimox) or glucocorticoid actions (by the glucocorticoid receptor antagonist, RU-486). Also primary rat and nonhuman primate (baboon) pituitary call cultures will be used to determine if FFA and glucocorticoids mediate their effects on receptor synthesis via transcriptional or posttranscriptional processes and if the effects of FFA can be mimicked by activation of the putative FFA nuclear receptors, peroxisome proliferator-activated receptors (PPAR). This is the second revision of a competitive renewal of an RO1 application which continues to study the regulation of the GH axis. The current application centers on the interrelationship between changes in metabolic function and the GH axis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROENDOCRINOLOGY OF PUBERTY Principal Investigator & Institution: Foster, Douglas L.; Professor & Research Scientist; Obstetrics and Gynecology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-MAR-1984; Project End 31-JAN-2005

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Summary: When nourishment is inadequate or energy expenditure is great, fertility is reduced in the adult, and puberty is delayed in the developing individual. This suppression of reproductive activity is not understood mechanistically. We believe this to be an integrative problem at this stage of inquiry that requires both physiologic and pharmacologic approaches to answer broad questions about how the brain discriminates how well nourished and how mature the body is. Our broad objective is to understand the physiological mechanisms by which changes in nutrition and metabolism control reproduction, specifically the signals, sensors, and pathways whereby blood-borne information regulates GnRH secretion. To progress further in understanding the relationship between growth, metabolism and production of high frequency GnRH pulses during development, we must first determine how energy metabolism regulates GnRH secretion. To progress further in understanding the relationship between growth , metabolism and production of high frequency GnRH pulses during development, we must first determine how energy metabolism regulates GnRH secretion in the adult. Thus, we will first evaluate how changes in glucose availability and leptin modify GnRH secretion during adulthood and then determine if such a mechanism might be timing puberty during growth. The sheep will be used because its large size and long lifespan permits individuals to be studied longitudinally through their development and permits detailed studies in adults. Importantly, it is well suited for the characterization of hypophysiotrophic hormone patterns. Specific Aim 1 will determine if the hindbrain and the liver contain sensors that transmit information about glucose availability to regulated GnRH secretion. We will both increase and decrease availability locally in each site to establish their function and their interrelationships. Specific Aim 2 will determine the role of leptin as a signal to regulate the pulsatile secretion of GnRH. This will be achieved through central administration of leptin during both acute fasting and chronic low nutrition. Although widely studied in feeding behavior, we have little understanding of its physiologic role in regulating GnRH secretion. Specific Aim 3 will assess "nutritional stress" as a cause hypogonadotropism through reduced GnRH secretion by monitoring of stress peptides in the pituitary portal circulation and by antagonizing their action during acute fasting and chronic low nutrition. Specific Aim 4 will determine if glucose availability times the pubertal GnRH increase by using the power of our large animal model in which we can chronically administer metabolically important signals such as insulin and leptin. Understanding the metabolic control of GnRH secretion has broad application both to growth and maturation and to other physiologic conditions in which reduced GnRH secretion may contribute to infertility because of altered energy metabolism. These include dietary malnutrition from eating disorders; during high-energy expenditure, as in exercise- induced amenorrhea and lactational anovulation; during type 1-diabetesinduced infertility. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NURSING HOME FACTORS AND WEIGHT LOSS IN RESIDENTS Principal Investigator & Institution: Collier, Eric J.; Social and Behavioral Sciences; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The proportion of the United States (U.S.) population who will be older than age 65 is projected to increase from 13 to 20%, reaching 69.4 million individuals, by 2030. Projections indicate that as many as 3 million of these elderly persons (vs. today's 1.5 million) will need some formal type of costly institutionalized care by 2030. The poor quality of care in the nation's NHs has been

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widely addressed. The prevalence of malnutrition and dehydration has received substantial attention in the literature. Malnutrition and dehydration, if left untreated or undiagnosed, is associated with the following adverse outcomes: (1) unintentional, and in some cases life-threatening, weight loss; (2) greater rates of acute infections; (3) increased incidence of pressure ulcers; (4) higher rates of costly acute care hospitalization; (5) reduced functional status and, (6) in the most serious of circumstances, premature death. The primary goal of this proposal is to describe and analyze the prevalence of malnutrition and/or dehydration (measured by weight loss) for a sample of California nursing homes (NHs, n = approximately 1,600 NHs). The study will entail secondary analyses of facility, resident, financial and staffing-related variables that are available in nine databases maintained by (or derived from) four wellestablished state and federal programs. The target variables and the hypothesized relationships among the various independent and dependent variables are depicted in Figure 1 on page 9 of this proposal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NUTRITION AND METABOLISM IN DIALYSIS PATIENTS Principal Investigator & Institution: Ikizler, Talat A.; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 31-DEC-2007 Summary: (provided by applicant):This is a K24 application for Talat Alp Ikizler, M.D. The candidate is faculty at Vanderbilt University Medical Center (VUMC), Division of Nephrology in the "Physician-Scientist" track with 80 % effort commitment to research. The candidate has focused his research efforts on the elucidation of multiple aspects of nutrition and metabolism in renal failure patients. At the time of this application, the candidate is the principal investigator of 3 federally and 2 non-federally funded grant awards and published 31 manuscripts and 6 book chapters. He is involved in mentoring of 5 past trainees and 3 current trainees. The immediate and long-term objectives of this grant application are to provide protected time for the applicant to focus on research and mentoring activities, specifically facilitate the independence of the current trainees and recruit beginning investigators interested in a rigorous approach to clinical investigation. In addition, the candidate will take a leadership position in clinical research enterprise at the Division of Nephrology. VUMC provides excellent resources for clinical research and mentoring, including the Nephrology Training Grant, Master of Science in Clinical Investigation and Master of Public Health programs (2 current and 1 future trainee enrolled in these programs), General Clinical Research Center and Clinical Nutrition Research Unit. In this proposal, we will investigate three promising approaches to improve the nutritional status of chronic hemodialysis (CHD) patients. First, we will examine the nutritional effects of chronic inflammation on protein and energy metabolism in hemodialysis patients and test the potential beneficial effects of an anti-inflammatory agent on these parameters. Second, we will examine the comparative effectiveness of two nutritional supplementation regimens on protein and energy metabolism in malnourished patients. These protocols will incorporate detailed protein and energy balance studies utilizing stable isotope infusion techniques. In a third study, we will test the hypothesis that recombinant human growth hormone interacts with nutritional supplementation to improve nutritional parameters in 150 CHD patients with overt signs of malnutrition using a prospective, randomized, placebo-controlled study clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NUTRITION AND VIRUS INDUCED OPTIC NEUROPATHY Principal Investigator & Institution: Beck, Melinda A.; Associate Professor; Pediatrics; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 15-APR-1999; Project End 31-MAR-2003 Summary: The effect(s) of nutrition on viral disease has not been well studied. The currently accepted model for the influence of nutrition on viral pathogenesis invokes host factors, such as a decreased immune response, which are responsible for the increased susceptibility of malnourished individuals to disease. However, little attention has been focused on the pathogen itself, which is replicating in a nutritionally deficient host. Previous work in our laboratory demonstrated that increased oxidative stress in a coxsackievirus-infected mouse, due to a dietary deficiency in either selenium or vitamin E, led to mutations in a normally avirulent strain of coxsackievirus, causing it to become virulent. Once the avirulent virus had mutated in the nutritionally deficient host, it could now cause disease even in hosts with normal nutriture. Thus, we showed for the first time that the nutritional status of the host can have a profound effect on the genome of a virus, changing an avirulent virus to a virulent one. For this application, we propose to study the outbreak of optic and/or peripheral neuropathy which occurred in Cuba in the early 1990's. The disease was associated with major changes in the Cuban diet resulting in decreases in vitamins A, B complex and E and selenium, with smoking as a co- factor. In addition to the nutritional deficiency, a coxsackie- like virus was isolated from the cerebrospinal fluid of 105 out of 125 patients tested, suggesting a co-factor role for this virus in the etiology of the disease. Again, the virus was altered compared to the prototype coxsackievirus from which it may have arisen, and the clinical syndrome differed from those previously associated with coxsackievirus infections of the central nervous system. We have sequenced one variant isolate from a patient diagnosed with nutritionally-induced optic neuropathy and found that although it is closely related to coxsackievirus A9, mutations in various regions of the virus suggest that alterations in its pathogenic expression is possible. We propose to use the Cuba epidemic as a model for a viral disease induced by a nutritional deficiency. We propose to use sequence analysis to study the evolution of the variant virus during the epidemic of optic neuropathy in order to understand the role of nutrition in the emergence of this disease. In addition, we will utilize cell culture techniques to further dissect the mechanism by which the viral mutations occur. Taken as a whole, we believe these studies will provide important new information on the critical role nutrition plays in the development of new viral variants with unpredictable pathogenic properties, a long neglected area of study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NUTRITION SUPPLEMENTATION STUDIES IN SICKLE CELL DISEASE Principal Investigator & Institution: Stallings, Virginia A.; Professor; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 22-JUL-2003; Project End 31-MAR-2008 Summary: For several decades it has been recognized that children with sickle cell disease(SCD), especially those with HbSS genotype SCD (SCD-SS), have poor growth and delayed maturation. In addition, children with SCD experience frequent SCDrelated pain and fever episodes and also infection. Increased nutrient requirements and/or poor nutritional status have been documented in children with SCD suggesting

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that chronic undernutrition may contribute to poor health outcome, growth failure and delayed development. Low serum levels of vitamin A and vitamin B6 have been documented in children with SCD suggesting that dietary intake of these micronutrients may not be adequate to meet the increased nutrient needs of children with SCD. The proposed study consists of two projects to determine whether supplementation of vitamin A or vitamin B6, can improve health outcomes, nutritional status, growth and hematologic status in children with SCD-SS. Our preliminary data from prepubertal children with SCD show that 66% have suboptimal vitamin A status (serum retinol< 30 mu g/dL), and that those children with suboptimal status have more frequent hospitalizations, have reduced body mass index, and poorer hematologic status than those with normal vitamin A status. Furthermore, preliminary studies in children and adolescents with SCD show that suboptimal vitamin B6 status (serum pyridoxal 5'phosphate [PLP]< 20 nmol/L) is also prevalent (77%), and that low serum B6 concentration is associated with poor nutritional status as indicated by reduced body mass index, weight and mid-arm circumference and also with poorer hematologic status. The first study is a randomized placebo-control clinical trial to determine the effect of vitamin A supplementation at the current Recommended Dietary Allowance (RDA) on number of hospitalizations, the number and length of both SCD-related and nonSCD-related disease events, on growth, body composition, hematologic status, rod cell integrity,and immune status in prepubertal children (ages 2.0 to 9.9 years) with SCD. Seventy-five children with SCD will be screened for vitamin A status and 44 subjects with serum retinol levels< 30 mu g/dL at screening will be randomized to receive either the RDA for vitamin A daily or placebo for 12 months. The second study will explore the effect of vitamin B6, supplementation at two doses on growth and nutritional status and hematological indices of SCD disease severity in children and adolescents (ages 6.0 to 17.9 years) with SCD. A total of 100 children and adolescents with SCD and 100 healthy controls, similar in age, gender and ethnic background, will be screened to document the prevalence of vitamin B6 deficiency in children with SCD. Forty children with serum PLP levels < 20 nmol/L will be identified and randomized to receive either 5 mg/day or 25 mg/day vitamin B6 for 12 months. For both supplementation studies, assessments will be made at baseline, 3, 6, 9 and 12 months. These two projects will provide systematic investigations of the roles of both vitamin A and vitamin B6 in improving health outcomes, growth and nutritional status in children with SCD and will potentially result in cost-effective nutritional interventions that can be quickly implemented into the standard of care for these children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NUTRITION, MECHANISMS

CYTOKINES,

AND

ANABOLIC

SIGNALING

Principal Investigator & Institution: Smith, Robert J.; Rhode Island Hospital (Providence, Ri) Providence, Ri 02903 Timing: Fiscal Year 2002; Project Start 01-SEP-1995; Project End 31-MAR-2005 Summary: Patients with severe illnesses resulting from such diverse causes as trauma, infection, burn injury, major surgery, and certain cancers frequently develop a catabolic response that contributes to disease morbidity and complications, delays recovery, and may affect final disease outcome. Intensive nutrition support has significant benefit in catabolic patients, but current methods of nutrition support often do not reverse the catabolic state. In these patients, resistance to the actions of anabolic hormones, including growth hormone, appears to be a significant factor contributing to the catabolic response. The long-term objectives of this project are to define the molecular

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mechanisms that lead to growth hormone resistance during severe illness and, ultimately, use this information to develop more effective strategies for managing critically ill patients. During the previous grant period, specific signaling defects in the growth hormone pathway in the liver were shown to develop in rats in an experimental catabolic state induced by injection of endotoxin. Subsequent studies demonstrated that growth hormone resistance correlated with a marked increase in mRNAs for several of the recently described negative-regulatory SOCS (suppresser of cytokine signaling) genes. This has led to the hypothesis that cytokines elaborated in response to endotoxin activate SOCS genes as part of a negative feedback loop and, through a specificityspillover mechanism, the SOCS proteins then inhibit growth hormone signaling. Additional studies have shown that SOCS mRNAs are increased by fasting or protein malnutrition, consistent with a role for these proteins in malnutrition-induced growth hormone resistance. The specific goals of this project are: (1) to define the extent and mechanisms of nutritional regulation of SOCS genes in rat liver and skeletal muscle, (2) to investigate the functional effects of SOCS proteins on GH signaling in liver tissue in vivo using recombinant adenovirus-mediated gene transfer, (3) to investigate the synergistic effects of malnutrition and endotoxin in the induction of SOCS genes, and (4) to examine the effects of the tyrosine phosphorylation modifying agent vanadyl sulfate as a potential pharmacological approach to decreasing growth hormone resistance. The work will investigate fundamental molecular mechanisms of the catabolic response in pathophysiologically relevant ecperimental models with the ultimate objective of developing new approaches to the use of nutritional, hormonal, and pharmacological interventions in the treatment of catabolic patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NUTRITION, IMMUNOLOGY, AND EPIDEMIOLOGY OF TB Principal Investigator & Institution: Fawzi, Wafaie W.; Associate Professor; Nutrition; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-AUG-1999; Project End 31-JUL-2004 Summary: Tuberculosis (TB) remains the single most common infectious disease cause of mortality. We propose to examine the inter- relationships of nutrition, immunology, and epidemiology with respect to TB in Tanzania. Given that TB is so much linked with HIV immunologically, clinically, and epidemiologically, it is essential to examine how these relationships are modified by HIV infection. Published animal and human studies suggest that vitamin deficiency is associated with poor immune response in TB. By modulating immune function, nutritional supplements may be a useful adjunct to antiTB drugs, and could lead to the development of shorter drug regimens. We propose to enroll 600 patients, half of whom have active TB and are co-infected with HIV, and the other half have TB alone. All patients will be randomized to receive either multivitamins or placebo from the start of their TB therapy, through the 8 months of anti-TB therapy, and for the 12 months following that (i.e. for a total of 20 months). Consenting subjects who present to 2 TB clinics in Dar es Salaam seeking care for respiratory illness will be screened for TB and HIV infection and invited to participate in the study. Patients who are severely debilitated (Karnofsky score of 40 percent or less, basal metabolic index of less than 18 kg/m2, or hemoglobin less than 7 g/dl) will be excluded. All patients will receive standard anti-TB therapy. Follow-up visits will occur every two weeks for the first 2 months and monthly thereafter till the end of the study. The minimum duration of followup is 20 months including 8 months of anti-TB treatment. The endpoints of interest include immune response parameters, bacteriologic cure, and clinical outcomes. Immune parameters (CD4 and CD8 cell counts; ex vivo lymphocyte proliferation; and

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cytokine production, namely IL-2, INF-g, IL-12, and TNF-alpha will be determined at baseline, 2 months, and 6 monthly thereafter. Bacteriologic cure at 1, 2, and 8 months will be determined by ascertaining conversion of sputum culture to negative. Compliance with therapy will be monitored. Surrogate markers are needed to rapidly evaluate the efficacy of anti-TB treatments or vaccines. Hence, we will examine the utility of the above immune response parameters as surrogate markers for treatment efficacy in TB. Using computer simulation modeling and epidemiological data collected during the follow up in this cohort study, we also propose to assess the effectiveness and cost-effectiveness of different treatment strategies for active TB and the use of INH post-TB treatment in Tanzania. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NUTRITIONAL AND METABOLIC MECHANISMS OF AGING Principal Investigator & Institution: Jazwinski, S Michal.; Professor; Biochem and Molecular Biology; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: Nutritional status, alongside physical exercise, is a crucial component in determining functional health in old age. The benefits of caloric restriction (without malnutrition) in prolonging life and postponing functional decline in mammals are wellestablished. Though many physiological changes occur on reduction of caloric intake, it is unclear which of these are responsible for the salutary effect on aging of this regimen. The goal of this research is to identify the mechanisms underlying the life-extending and anti-aging effects of caloric restriction. The yeast Saccharomyces cerevisiae will be used for this purpose. This choice will allow immediate focus on the cellular and molecular mechanisms involved, by eliminating consideration of systemic functions. The rationale behind the choice of model system is the well-known fact that caloric restriction results in a reduction in circulating glucose and insulin and the novel finding that reduction in caloric content of the growth medium by altering glucose concentration markedly extends yeast life span and metabolic potential. The initial signals, signaling pathways, and downstream effectors of this caloric restriction response on yeast life span will be examined. The hypothesis is that caloric restriction exerts its effects by changing the way in which glucose is metabolized and that the changes in cell physiology involve specific signaling pathways. The research will involve an examination of different nutritional protocols coupled to the genetic manipulation of metabolic and signal transduction pathways. If will include a careful biochemical analysis of the metabolic consequences and an evaluation of global changes in gene activity. The results of the proposed research have important implications for aging, diabetes, and cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NUTRITIONAL CONTROL OF ASPARAGINE SYNTHETASE Principal Investigator & Institution: Kilberg, Michael S.; Biochem and Molecular Biology; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 01-JAN-1997; Project End 31-DEC-2005 Summary: Nutrient control of mammalian gene expression is a poorly understood process that is important to general cellular nutrition and the progression of numerous diseases. The proposed research will continue our work on transcriptional control of the human asparagine synthetase (AS) gene following amino acid deprivation. In addition, we have discovered that the AS gene is transcriptionally activated by glucose deprivation, a process mediated by the Unfolded Protein Response (UPR) signal

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transduction pathway. This observation is novel because most UPR activated genes are ER-bound proteins associated with protein processing. We have characterized a human AS genomic clone and shown that the AS proximal promoter has six protein binding sites, at least three of which (I, II, or III, and V, VI) are required for maximal nutrient control. None of these sequences corresponds to the reported mammalian UPR ciselement. Instead, the AS promoter appears to contain two unique cis-elements (sites V and VI) that mediate the regulated response to both amino acid and glucose limitation. These exciting results suggest that there are two independent mechanisms for UPR transcriptional control in mammalian cells, one of which overlaps with amino acid signaling. The global hypothesis is that there is a common set of unique cis-elements within the human AS gene that mediate increased transcription in response to multiple nutrient-sensing pathways. The proposed experiments contain both standard and innovative approaches to further characterize these nutrient-responsive cis-acting elements and to identify the corresponding transcription factors. Yeast one-hybrid screening, TJV cross-linking, and DNA affinity chromatography will be used to identify the proteins that bind to the AS promoter sites V and VI. The Pin point strategy involving transfection of trans-acting factor/FokI nuclease fusion constructs will document in vivo the specific transcription factors that bind to a particular AS promoter site. Mutagenesis, EMSA, Transcription Factor Decoy, and overexpression of likely trans-acting factors will further define these cis-elements and explore their role in nutrient-dependent regulation. The proposed experiments test important hypotheses and will generate valuable new information regarding the mechanisms by which mammalian cells respond to changes in amino acid and glucose availability. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NUTRITIONAL STATUS IN HIV POSITIVE HISPANIC DRUG ABUSERS Principal Investigator & Institution: Forrester, Janet; Family Medicine & Cmty Health; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 01-JAN-1999; Project End 31-DEC-2003 Summary: Progressive weight loss and wasting are common in HIV disease. The causes of wasting in HIV infection included reduced dietary intake, malabsorption and ineffective metabolism of nutrients. It is likely that the causes of wasting differ between drug abusers and non-drug abusers because of differences in diet and metabolism. There is little information on the natural history of HIV infection, including nutritional status and wasting, in HIV-positive drug abusers. This project will study the nutritional status and causes of wasting in HIV-positive drug abusers in the Hispanic community. Emphasis will be placed on the early stages of injection when malnutrition is most amenable to correction. Recruitment of women will receive high priority. Three groups will be studied: Hispanic HIV-positive drug abusers, Hispanic HIV-negative drug abusers and Hispanic HIV-positive non-drug abusers. The three groups will be followed every 6 months for three years during which they will be examined for changes in nutritional, immunological, and clinical status. Periodic measures of dietary intake, body composition, energy expenditure, serum vitamin levels, immunologic status, gastrointestinal function, functional status, and quality of life will be taken as the clinical course of the disease is tracked. Identify the causes of weight loss and wasting at different periods in the course of HIV disease progression will help in the design of targeted nutrition interventions that are appropriate to the drug abusing, HIV-infected population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Malnutrition

Project Title: NUTRITIONAL/INFLAMMATORY EVALUATION OF DIALYSIS PATIENTS Principal Investigator & Institution: Kalantar-Zadeh, Kamyar; Assistant Professor of Medicine and Pedi; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2006 Summary: (adapted from the application) The 250,000 chronic dialysis patients in the US have an increased rate of malnutrition and inflammation, which are felt to be major risk factors for their high morbidity and mortality. The risk of cardiovascular death appears to be especially high among these individuals. To date, there is no uniform, practical tool for assessment of nutritional status, inflammation and food intake in dialysis patients. The goals of this prospective cohort study are to determine whether the nutritional and inflammatory states in dialysis population affect the mortality, morbidity, and other clinical outcomes in a predictable way and to ascertain how the deterioration of these indices over time is associated with poor outcome. To achieve these goals, we will study a cohort of dialysis patients in the San Francisco Bay Area prospectively. Nutritional assessment will be performed periodically. A convenient but reliable nutritional scoring system to predict the mortality and clinical outcome in the dialysis population will be developed and validated. The following specific questions will be answered: 1) Are the dialysis mortality and risk of cardiovascular death associated with malnutrition or inflammation? 2) Do malnutrition and/or inflammation and their deterioration over time have measurable, distinct impact on relevant clinical outcomes in dialysis patients such as hospitalization and erythropoietin resistance? 3) Can a numerical result of a uniform nutritional scoring system be a reliable predictor of dialysis morbidity and mortality? 4) Can a food questionnaire reliably detect deficient nutrient intake in dialysis patients? As a Mentored PatientOriented Research Career Development Award, this proposal also aims to develop the research abilities of the PI, and enables him to be a productive independent researcher. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OPTIMAL CHILD NUTRITION IN HIV-AFFECTED COMMUNITIES Principal Investigator & Institution: Marquis, Grace S.; Food Science & Human Nutrition; Iowa State University of Science & Tech Ames, Ia 500112207 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 31-AUG-2007 Summary: Malnutrition among young children remains high in sub-Saharan Africa where poverty and the HIV epidemic synergistically undermine progress in child health that has been obtained in other regions of the world. HIV may indirectly influence children's nutritional and health status by altering household food security, caregiving practices (such as, breastfeeding), and health-seeking practices. The knowledge gap concerning these mechanisms limits the ability of health professionals to effectively develop and promote services and practical and sustainable recommendations that will support child health, growth, and survival in communities affected with the HIV epidemic. This grant incorporates training and research activities in the area of nutrition and HIV in Ghana. Our long-range goal is to enhance the institutional capacity to provide local training and research opportunities that will lead to policy recommendations and program development for the improvement of the lives of individuals living in communities affected by HIV. The main objectives are: 1) to provide postgraduate training in maternal and child nutrition within the context of HIV through formal US academic programs and intensive short courses in Ghana, and 2) to

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conduct a pilot study on the mechanisms by which HIV infection indirectly influences child health. The central hypothesis is that the presence of HIV infection in the household increases the risk of childhood malnutrition and mortality through increased food insecurity, decreased time for caregiving practices, and modified expectations of normal child health and well-being. Extensive social networks may mitigate this effect by offering alternative resources to children. The central hypothesis will be tested with 302 women and their newborns who will be followed for one year to collect data on feeding, health, growth, household demographic and socioeconomic characteristics, and family's use of social networks. All women will have used a voluntary testing center for HIV; half of the enrolled mothers will be positive for HIV and the other half will be negative. Statistical analyses will provide an estimate of the effect of HIV on outcomes of infants who are infected and not infected with the virus. These results will provide the knowledge needed to develop appropriate, effective programs and recommendations that will improve child health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OVERCOMING NUTRITIONAL BARRIERS IN HEMODIALYSIS PTNTS Principal Investigator & Institution: Sehgal, Ashwini; Associate Professor of Medicine; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 20-FEB-1996; Project End 30-NOV-2006 Summary: (taken from abstract) American hemodialysis patients are frequently malnourished. This contributes to dialysis patient mortality rates that are the highest in the industrialized world at 22% per year. Poor nutritional status probably also contributes to high health care costs (an average of two hospitalizations annually per patient and total Medicare expenditures of $11 billion per year) and diminished quality of life. Our prior work identified five potentially modifiable nutritional barriers (poor appetite, inadequate dialysis dose, poor nutritional knowledge, low fluid intake, and needing help shopping and cooking) and pilot tested a promising approach to overcome these barriers. This proposed community-based randomized controlled trial extends our prior work by targeting specific nutritional barriers with a tailored feedback and education intervention. Thirty dialysis facilities in northeast Ohio will be randomly assigned to intervention and control groups, with 135 malnourished patients enrolled from 15 intervention facilities and 135 from 15 control facilities. Baseline evaluation will include measures of nutritional status, specific barriers, inpatient expenditures, and quality of life. On a monthly basis for 12 months, intervention patients and their dietitians will receive tailored feedback and education on overcoming patient-specific barriers. They will then meet monthly to jointly formulate a care plan addressing these barriers. Control patients will continue to get usual care. Major analyses will compare changes in nutritional parameters, hospitalization-related costs, and quality of life in intervention vs. control patients with adjustment for nesting of patients within facilities. The proposed project will test a novel intervention that targets patients and providers as they together make nutrition-related decisions. Overcoming specific barriers may lead not only to improved nutritional status but also to better patient survival, decreased health care costs, and increased quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PARABRACHIAL NUCLEUS AND FEEDING Principal Investigator & Institution: Trifunovic, Radmila D.; Psychology; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612

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Malnutrition

Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-MAY-2005 Summary: (provided by applicant): Eating disorders represent one the most rapidly growing health problems. Abnormal food intake may, in extreme cases, lead to malnutrition or obesity with their attended medical complications. Thus, research concerning the mechanisms governing the cessation of feeding advances our understanding of, and the development of treatments for, eating disorders. Two drugs that are known to suppress food intake, presumably through different mechanisms, are cholecystokinin (CCK), a gut-brain peptide, and d-fenfluramine (DFEN), a serotonin agonist. Using solid food, data reported in the preliminary studies show that the parabrachial nucleus (PBN) is a critical central site for the action of these anorectic drugs. Specifically, lesions of the lateral PBN (a component of the central visceral system) abolished the anorexia induced with CCK but not DFEN, whereas lesions of the medial PBN (a part of the central gustatory system) enhanced the anorectic action of DFEN but not CCK. The goal of the proposed experiments is to investigate the pharmacological basis of this double dissociation of function within the PBN. Assessing the method of food presentation, Specific Aim 1 will determine if PBN lesions disrupt the anorectic effect of systemic CCK and DFEN on liquid, as well as solid, food intake. If our expectations are realized, liquid food will be used in all subsequent experiments because it affords a more accurate analysis of ingestive behavior. Using centrally administered selective CCK-A or CCK-B receptor antagonists alone or in combination with peripherally or centrally infused CCK, Specific Aim 2 begins our evaluation of the role of lateral PBN CCK receptors in food intake. Finally, using drugs that modulate the release and postsynaptic action of serotonin, the experiments of Specific Aim 3 will further our understanding of the role of the medial PBN in the anorectic action of systemic DFEN. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATHOGENESIS OF PHYSICAL DISABILITY IN AGING WOMEN Principal Investigator & Institution: Fried, Linda P.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Disability in older adults is a frequent, adverse health outcome associated with aging. Population-based and clinical research indicates that disability in older adults is strongly associated with chronic diseases, both singly and in combination, and modified by a host of factors at the individual level. However, there is increasing evidence to suggest that pathogenic factors beyond chronic diseases may play significant roles in the development or progression of disability, as well as being associated with mortality in older adults. This study proposes to evaluate the role of three potential contributors to the pathogenesis of disability: inflammation, hormones, micronutrient deficiencies, singly, in combination, and in relation to existing diseases, impairments and frailty. We propose to evaluate these questions through analysis of already-collected data in the Women's Health and Aging Study (WHAS) I and its ancillary studies, the WHAS II and a study that collected blood, analyzed many measures and stored plasma and serum. WHAS I and II provide data on the 1/3 most disabled and the 2/3's least disabled older women living in the community, respectively. Older women are substantially more likely than older men to live disabled or dependent, and to require long-term care due to this. This study proposes to answer the following research aims using merged data sets that span the full spectrum of function in older women: a) to establish population norms and rates of change for pathogenic biomediators; b) to determine the degree to which these biomarkers explain

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disability status; c) to evaluate longitudinally the independent and interactive contributions of pathogenic biomediators to disability, over and above that of disease, and the potential role of frailty as a modifier of these relationships; d) to develop screening nomograms for clinical identification of those at high risk of severe disability and assess potential impact of interventions needed to meaningfully delay such progression; and e) produce a Monograph based on WHAS results that describes evidence for a causal pathway to disability and its risk factors. This proposed research is one of three studies that comprise an Interactive Research Project Grant designed to conduct next-generation analyses of the Women's Health and Aging Studies. These 3 projects will explore a range of biological, social and environmental risk factors for disability in older women. These 3 levels of evaluation are anticipated, singly and together, to provide substantive new understanding of opportunities for effective prevention and treatment of disability in older women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PET IMAGING AND SEROTONIN LIGANDS IN EATING DISORDERS Principal Investigator & Institution: Kaye, Walter H.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 15-FEB-2001; Project End 31-JAN-2006 Summary: Several lines of indirect evidence suggest that brain serotonin alterations occur in women with anorexia nervosa (AN) and bulimia nervosa (BN) when they are ill and after recovery. In theory, a trait-related increase of 5-HT neurotransmission may contribute to vulnerabilities (restricted feeding, obsessions with order and perfectionism, harm avoidance and negative affect) that contribute to developing AN and BN. In turn, malnutrition may reduce 5-HT neuronal activity, which in turn reduces dysphoric affective states, particularly in AN. New technologies offer the potential of direct characterization of dynamic relations between 5-HT receptor function and human behavior. In the short term (years 1 to 4), funded studies will investigate five groups of women 18 to 45 years old: 1) ill AN and BN women; 2) recovered AN and BN women (greater than 1 year normal menses, no binging and purging, and healthy and stable weight); and 3) healthy control women. In Aim 1, 150 PET imaging and 18-Faltanserin will assess 5-HT-2A postsynaptic receptor binding. Preliminary data support the possibility that recovered AN and BN women will have a reduction of orbitofrontal 5-HT-2A receptor finding associated with evidence of increased extracellular 5-HT. Increased 2A finding and decreased extracellular 5-HT will occur in ill AN and BN subjects. In Aim 2 150 PET imaging and 11-C-WAY100635 studies will assess 5-HT-1A receptor binding. Knockout gene studies in mice support the hypothesis that a malfunction of pre-synaptic raphe autoreceptors could contribute to increased 5-HT activity and behavioral symptoms. Thus, 1A binding may not change with state of the illness. Aim 3 will test whether core AN or BN symptoms or impulse control are related to 5-HT neuronal activity. To fully characterize the 14 or more receptors and other components of the 5-HT neuronal pathways may require multiple ligands. In the long term (years 3 to 5) the candidate seeks to use this K05 to develop a multicenter collaborative study to 1) use PET imaging and radioligands to comprehensively characterize 5-HT and related systems in AN and BN and 2) develop rodent models relating 5-HT to behavior. In addition, this K05 award will support training the candidate, who in turn will train established and young investigators in these new technologies. Understanding whether biologic vulnerabilities, such as a 5-HT disturbance, occurs in AN and BN may contribute to developing a new treatment

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interventions for these often chronic and deadly disorders as well as shed light on the relation of 5-HT neurotransmission and behavior. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHASE II DEVELOPMENTAL STUDY ON FATIGUE IN CANCER Principal Investigator & Institution: Cruciani, Ricardo; Director of Clinical Studies; Beth Israel Medical Ctr (New York) 1St Ave at 16Th St New York, Ny 10003 Timing: Fiscal Year 2002; Project Start 27-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Fatigue is the most frequently reported symptom in patients with cancer. The causes of fatigue are multifactorial and include the disease itself, antineoplastic therapies, anemia, depression, and malnutrition. Our preliminary data suggest that micronutrient deficiencies, specifically carnitine deficiency, may be an important factor in fatigue. Carnitine plays a major role in energy metabolism. Systemic depletion is characterized by weight loss, fatigue, muscle weakness, decreased tolerance to metabolic stress, andcardiomyopathy. We found deficiency of the micronutrient carnitine in 17/27 patients with cancer. Symptoms of fatigue and functional status improved significantly in those patients who received oral L-carnitine supplementation. In addition, we observed similar results in 6/10 patients with end stage AIDS presenting with carnitine deficiency. Objectives: a) To determine the effect of L-carnitine therapy on symptoms of fatigue in patients with terminal cancer and serum carnitine deficiency, and b) to determine the effect of L-carnitine therapy on performance status, cognitive function, mood, quality of life, and motor activity in these patients. Study Design: We propose to conduct a Phase Il developmental randomized double-blind placebocontrolled study to determine the effect of the micronutrient L-carnitine on fatigue and other outcomes in patients with terminal cancer. A sample of 130 patients with terminal cancer, fatigue and serum carnitine deficiency will be recruited into the intervention study. At the first visit, the patients will receive a baseline assessment of fatigue, performance status, cognitive function, mood, and quality of life and motor activity. a) During weeks 1-4, patients will be randomized to receive L-carnitine, 2 g/day, placebo. b) During weeks 5-8, all patients will receive L-carnitine at a dose of 2 g/day, for a period of 4 weeks. Measures will be repeated at 48 hs, 2 weeks, 4 weeks and 8 weeks. The primary endpoint will be change in fatigue at 4 weeks. Analysis will evaluate group differences in the primary endpoint and other outcomes. An interim analysis will be done once 15 patients have been observed in each group at 4 weeks. Paired and unpaired data analyses between groups will be conducted with the assistance of a statistician. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POSTMENOPAUSAL ESTROGEN INFLUENCES ON OLFACTION Principal Investigator & Institution: Doty, Richard L.; Director and Professor; Otorhinolaryngology Head & Neck Surgery; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-AUG-2000; Project End 31-JUL-2005 Summary: (adapted from applicant's abstract): Loss of olfactory function in later life is common, and decreased smell ability appears to be the first sign of Alzheimer's disease (AD). Recent studies suggest that estrogen replacement therapy (ERT) may lessen or retard the development of postmenopausal declines in cognitive function in healthy older women, as well as older women with AD. The question arises as to whether ERT also protects against postmenopausal olfactory loss. Two lines of circumstantial

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evidence suggest this may be the case. First, postmenopausal women presenting to the University of Pennsylvania Smell & Taste Center with complaints of chemosensory dysfunction are less likely to be taking Premarin or other estrogens prior to symptom onset than what would be expected from the population at large. Second, ovariectomized rats receiving estradiol have less olfactory loss, and recover more rapidly, from systemic administration of 3-methylindole, an olfactory system neurotoxin. The proposed study will establish whether ERT mitigates olfactory loss observed in postmenopausal women. Employing a paradigm that has been proved powerful in other contexts (e.g., the Baltimore Longitudinal Study of Aging), the investigators will determine whether associations exist between ERT and well-validated measures of both olfactory and cognitive function in 600 women whose estrogen-taking histories are well-defined. If estrogen use is associated in a systematic manner with olfactory function, as they believe will be the case, this study will be important for several reasons. First, it would lead to improving the quality of life for many aging women, since olfaction plays a key role in eating and drinking. Second, it would lead to the reduction of risks associated with olfactory loss such as malnutrition and accidental gas poisonings. Third, it would lead to testable hypotheses regarding the role of reproductive hormones, and their underlying mechanisms, in the maintenance of normal olfactory function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRE NATAL NUTRITION AND ADULT DISEASE Principal Investigator & Institution: Lumey, L H.; Epidemiology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 10-SEP-2001; Project End 31-AUG-2005 Summary: Decreased birth weight, especially if due to intrauterine growth retardation, is associated with increased risk for cardiovascular disease and increased prevalence of insulin resistance, Type 2 diabetes mellitus, and hypertension. It has been proposed that fetal undernutrition may result in 'programming' of the fetus and thereby increase the risk for selected diseases later in life. The specific exposures, including any potential role of maternal nutrition, have not been determined. To date, no study with adequate bias control has showed that altered maternal nutrition in pregnancy can induce fetal programming. More specifically, any critical time periods in pregnancy during which maternal undernutrition could induce fetal programming have not been well established. It is therefore possible that the reported associations that are seen between size at birth and adult chronic disease risk may reflect confounding by a non-nutritional exposure, by social class, or by other factors. We propose to address these issues in a study of maternal undernutrition in identified trimesters of pregnancy and the subsequent risk of insulin resistance, Type 2 diabetes mellitus, hypertension, obesity and other risk factors for coronary artery disease in adulthood. We will examine whether (1) fetal programming can be induced by maternal undernutrition in pregnancy, (2) programming is limited to specific stages of gestation and (3) any effects are consistent across the examined cardiovascular disease risk factors. We will also evaluate the sensitivity and specificity of selected morphological measures of the hand as markers of the timing of intrauterine exposure. This study is feasible in the unique setting of the Netherlands, where selected men and women who were exposed prenatally to the Dutch famine of 1944-45 and who are now 55-60 years old can be identified, traced, and examined. We will study about 400 probands with prenatal famine exposure at prespecified stages of pregnancy, 200 probands without prenatal famine exposure, and an unexposed same-sex sibling serving as a control for each proband. The total study size

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will be about 1,200 individuals. The unique circumstances of the famine and the novel use of a sib-paired design provide a well controlled assessment of the effect of maternal undernutrition at specific stages in pregnancy on her infant's disease risk later in life. We will establish the degree to which reported associations between birth weight and cardiovascular disease risk could reflect a shared maternal nutritional exposure. Answers to these unresolved issues are essential for further targeted studies into the mechanism of fetal programming in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PUBERTY, IMMUNITY AND MALNUTRITION IN S. JAPONICUM Principal Investigator & Institution: Mc Garvey, Stephen T.; International Health Institute; Brown University Providence, Ri 02912 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 31-MAY-2006 Summary: The overall objective of this proposal is to prospectively investigate the interrelationships among puberty, protective immune responses, and nutritional status in adolescent Philippine residents of Schistosoma japonicum endemic areas Determining immunologic and developmental predictors of resistance in naturally exposed humans is a fundamental component of the ongoing effort to develop vaccines against schistosomiasis japonicum. Development of protective human immune responses to other schistosomes appears to occur during puberty in endemic communities. A recent hypothesis states that the hormonal changes of puberty, e.g., increasing dehydroepiandrosterone (DHEA), not cumulative exposure, initiate and promote the development of protective immune responses to schistosome infections Schistosomiasis is causally linked to malnutrition leading to the hypothesis that chronic infection results in attenuate growth for age and possibly delayed pubertal development. Animal models of chronic parasitemia have identified TNF-alpha and IL-6 as mediators of malnutrition and cachexia. Production of this mediator is significantly attenuated by increasing DHEA levels. These interrelationships suggest that a DHEA-modulated cycle of infection, pubertal delay, and malnutrition may be responsible for the marginal nutritional status of schistosome infected adolescents. This study will employ a longitudinal, treatment-reinfection design of naturally exposed humans to determine the immunologic predictors of resistance to reinfection and their interrelationships with puberty. In addition, the relationships among nutritional status, circulating mediators of inflammation and pubertal hormones will be examined. Information provided by these studies will influence all phases of vaccine development for S. japonicum including the identification of appropriate antigens, protective isotype and cytokine responses and the modulating effects of host pubertal and nutritional development on these responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PULMONARY BENEFITS OF CYSTIC FIBROSIS NEONATAL SCREENING Principal Investigator & Institution: Farrell, Philip M.; Pediatrics; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-AUG-1985; Project End 31-MAR-2006 Summary: Although cystic fibrosis (CF) is the most common, life-threatening autosomal recessive genetic disorder of the white population, there are often delays in diagnosis and hence initiation of treatment. Advances of the past two decades have made CF screening feasible using routinely collected neonatal blood specimens and determining trypsinogen levels and CF mutations by DNA analyses. Our overall goal is to address

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the following hypothesis: Early diagnosis of CF through neonatal screening will be medically beneficial without major risks. "Medically beneficial" refers to better nutritional and/or pulmonary status, whereas "risks" include laboratory errors, potential iatrogenic medical sequelae, miscommunication or misunderstanding and adverse psychosocial consequences. Specific aims include assessment of the benefits, risks, costs, quality of life, and cognitive function associated with CF neonatal screening and delineation of the characteristic epidemiologic features of CF. A comprehensive, randomized clinical trial emphasizing early diagnosis as the key variable has been underway since 1985. Nutritional status has been assessed by anthropometric and biochemical methods, and the results have demonstrated significant benefits in the screened group. Answering the important questions about pulmonary outcome will require five more years of follow-up evaluation focused on lung function measures and quantitative chest radiology, including high resolution computerized tomography. If the questions underlying this study are answered favorably, it is likely that neonatal screening using a combination of trypsinogen and DNA tests will become the routine method for identifying new cases of CF and that diagnosis in early infancy will allow prevention of many clinically-significant problems such as malnutrition. If CF neonatal screening is implemented nationally, however, several epidemiologic gaps must be closed, and this will require more precise data on the course of this disease and determination of risk factors for pulmonary infections with Pseudomonas aeruginosa. This project will generate that important information, as well as essential data on the quality of life and cognitive function of children with CF who experience early or delayed diagnosis. We will also clarify the risks of screening and delineate for the first time the costs of diagnosis and treatment of CF throughout childhood as well as the cost-effectiveness of screening. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RAPID FIELD TEST FOR IODINE IN URINE AND SALT Principal Investigator & Institution: Harper, Robert D.; Portascience, Inc. 337 Tom Brown Rd Moorestown, Nj 08057 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Iodine deficiency disorders (IDD) are a range of health problems, which impact over 2 billion people. IDD covers a wide spectrum of clinical conditions, Goiter is the visible "marker condition" for more severe disorders. Some disorders are the result of compensation mechanisms, such as thyroid enlargement, early abortions, still births, increased infant mortality, mental and growth retardation. Some disorders are associated with permanent brain damage that occurs during the first two trimesters of pregnancy. The resulting clinical condition, cretism is irreversible and is the single most severe and dramatic manifestation of IDD. Iodine supplementation through salt fortification has shown to eliminate all deficient disorders from goiter through cretism. In several countries tremendous social and economic gains have resulted from the control of IDD. The World Bank has concluded that iodine supplementation is one of the interventions "that would have the highest costeffectiveness of any health intervention available in the world today" (World Bank 1993). There is overwhelming evidence to prevent IDD by increasing iodine intake by populations at large. The need for a simple, inexpensive, semi-quantitative iodine test for urinary screen is acute and broadly based throughout the world. PortaScience has proposed the development of a disposable device for the measurement of iodide in salt solutions and urine that can be used in a clinical setting, in the field or at home. The proposed test in Phase II will have a mini column and reagent chambers all built in one

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piece of disposable cassette. The test weighs less than three ounces, can be stored and shipped at ambient temperature, and gives an accurate result. Phase I studies have successfully demonstrated the feasibility of the proposed method by removing interfering compounds in a single step, identifying a suitable membrane material, identifying a sensitive dye, and manually assembling test devices for testing urine that met Phase I precision and accuracy criteria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF ALS AND ITS ROLE IN THE IGF SYSTEM Principal Investigator & Institution: Boisclair, Yves R.; Animal Science; Cornell University Ithaca Office of Sponsored Programs Ithaca, Ny 14853 Timing: Fiscal Year 2003; Project Start 26-SEP-1997; Project End 31-MAR-2007 Summary: (provided by applicant): Gene deletion studies have demonstrated the importance of IGF-I and II (IGFs), particularly during fetal life when local IGFs production predominates. After birth, the liver becomes the most important site of IGFs synthesis, resulting in the development of a substantial plasma reservoir. This reservoir is dependent on the postnatal production of the acid labile subunit (ALS), a protein that recruits IGFs and IGF Binding Protein-3 in long-lived ternary complexes. The significance of this reservoir has been uncertain until we showed that ALS and the plasma IGF-I reservoir are required for early postnatal growth and bone development. We now will extend these studies to normal and diseased states of later postnatal life. This is relevant to malnutrition and catabolic illnesses in which decreased plasma IGF-I is associated with erosion of lean mass. Despite this association, IGF-I-based therapies have had limited success, reflecting the need for their incorporation into ternary complexes for effectiveness. Three specific aims wilt be pursued to address the role of ALS and the circulating IGFs reservoir during diseased states. AIM A: IGF-I is a potent positive regulator of skeletal muscle mass. Null ALS mice will be subjected to challenges known to induce changes in plasma IGF-I and to alter the mass of skeletal muscles (i.e., sudden increase in GH, nutritional deficiency or sepsis). AIM B: Humans have 3 times as much plasma IGF-II than IGF-I. In contrast, mice have little IGF-II and null ALS mice have normal carbohydrate homeostasis. To determine the role of ALS in containing the metabolic effects of IGF-II, we will study null ALS mice over-expressing human IGF-II. AIM C: GH stimulates ALS synthesis by increasing transcription. In vitro, this effect is conveyed by STAT5, but the importance of this mechanism remains to be established in vivo. Using null STAT5 mice and liver cells, we will evaluate the contribution of direct and indirect mechanisms mediating the effects of GH on ALS synthesis. Studying the GH-regulation of ALS transcription will provide clues to mechanisms responsible for development of hepatic GH resistance during catabolic diseases. Overall, these studies will significantly advance our understanding of the roles played by ALS and the circulating IGF reservoir in diseases of postnatal life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF FOOD INTAKE AND BODY WEIGHT BY AMYLIN Principal Investigator & Institution: Reidelberger, Roger D.; Biomedical Sciences; Creighton University 2500 California Plaza Omaha, Ne 68178 Timing: Fiscal Year 2002; Project Start 15-SEP-2001; Project End 31-AUG-2006 Summary: Amylin (also called Islet Amyloid Polypeptide or IAPP) is a 37 amino acid peptide that is co-produced and secreted with insulin from the pancreas in response to a meal. Amylin is also found in gut endocrine cells, visceral sensory neurons, and

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hypothalamus. When administered systemically or into the brain of rats amylin potently reduces food intake, body weight and/or adiposity. In contrast, amylin receptor blockade using AC187 has been reported to increase food intake and adiposity. Mice with targeted destruction of the amylin gene develop a 29 percent larger body weight at 4 months of age. Together, these results suggest that amylin plays an essential role in control of food intake and long-term regulation of energy reserves. Thus, it is reasonable to speculate that insufficient amylin production or amylin-insensitivity may contribute to the development of obesity. Amylin may also play a pathophysiological role in the malnutrition associated with pancreatic cancer, because marked elevation of plasma amylin occurs in association with the early, severe cachexia in pancreatic cancer patients. Studies are designed to test the hypothesis that pancreatic amylin acts as a hormonal signal to the brain to reduce food intake and to regulate adipose energy reserves. Rat and amylin- null mutant mouse models will be used to test this hypothesis. Specific aims are to: 1. Determine whether amylin acts as an essential hormonal signal (via the bloodstream) to decrease food intake, body weight, and adiposity. 2. Determine whether plasma amylin responses to ingestion (or intragastric infusion) of different nutrients are sufficient to decrease food intake and body weight. 3. Determine whether amylin reduces food intake, body weight, and adiposity through a synergistic interaction with CCK and leptin, peptides known to contribute to the production of satiety and the long-term regulation of energy reserves. 4. Determine whether the source and site of endogenous amylin action to reduce food intake, body weight, and adiposity is in the periphery and/or brain. These studies should advance our understanding of the physiological role of amylin in control of food intake and the long-term regulation of energy reserves. They may also provide direction in the search for pathogenic mechanisms of eating and metabolic disorders and strategies for their treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESISTANCE TRAINING DURING MAINTENANCE DIALYSIS Principal Investigator & Institution: Sceppa, Carmen C.; Nutrition Exercise Physiology Sarcopenla (Neps) Lab; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-MAR-2005 Summary: (provided by applicant): There is a rising incidence of kidney failure in the US, with poor outcomes and high cost. End-stage renal disease (ESRD) affects almost 375,000 individuals in the US at a cost of more than $14 billion per year. Despite advances in dialysis and transplantation therapies, kidney failure leads to poor outcomes, poor prognosis and high health care costs. Malnutrition and the underlying systemic inflammatory response developed during the course of chronic kidney disease, worsen during ESRD, and leads to adverse outcomes, increased morbidity and mortality. Muscle wasting, impaired functional capacity and poor quality of life are the most important factors associated with malnutrition and inflammation in renal failure. We have shown in pre-dialysis patients with moderate chronic renal insufficiency that the anabolic effects of resistance exercise training result in significant improvements in protein utilization, nutritional status and functional capacity even in the context of anorexia and prescribed low protein diets. Thus, we propose to develop, test and implement a progressive resistance exercise routine for ESRD patients during the hemodialysis session. Our hypotheses are that the addition of 30-45 min of resistance exercise training during the dialysis session will counteract the burden of renal disease and will result in: 1) A feasible and safe exercise modality for ESRD patients (6-wk feasibility phase tested in 10 patients); 2) Net anabolism as evidenced by: improved nutritional status (i.e. increased protein catabolic rate, muscle mass and muscle

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strength); and reduced systemic inflammatory response (i.e. reduced C-reactive protein and interleukin-6, and increased serum albumin levels) compared to a randomly assigned control group on hemodilaysis but not exercise training (6-mo efficacy phase tested in 20 patients/group); and that 3) Improved self-reported physical function (i.e. increased SF-36 physical component scale) observed with resistance training will be associated with the improvements in nutritional status and inflammatory response. The long-term goal is to implement resistance exercise training routines during hemodialysis to overcome the underlying malnutrition and inflammation of ESRD and to improve disease outcome and prognosis. By implementing such intervention, we hope to offer a therapeutic strategy that can be incorporated to the standard of care of ESRD patients by working in conjunction with the dialysis unit staff. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF PICROLIV IN ANGIOGENESIS AND WOULD HEALING Principal Investigator & Institution: Maheshwari, Radha K.; Professor of Pathology; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2002; Project Start 10-SEP-2001; Project End 31-AUG-2004 Summary: (APPLICANT'S ABSTRACT): Tissue repair and wound healing are complex processes involving clotting, fibrin-fibronectin deposition, inflammation, reepithelialization, neovascularization, fibroplasia, and wound contraction. Interactions of different cell types, extracellular matrix proteins and their receptors are involved in these biological significant processes, which are mediated by cytokines and growth factors. In the normal host, wound healing is usually uncomplicated and proceeds at a rapid rate. In contrast, most healing failures are associated with some form of host impairment, including diabetes, infection, immunosuppression, obesity, or malnutrition. Wound healing studies that focus on models of impaired healing, therefore, have greater clinical relevance. Diabetes probably represents the prototype of impaired healing models since multiple factors contribute towards the impairment, including peripheral vascular disease, sensory and autonomic neuropathy, and lowered immunity against infections. Recently, we have shown that treatment with a novel pharmacological agent picroliv, resulted in enhanced proliferation and migration of endothelial cells in an ex-vivo model of angiogenesis. Picroliv treatment also increased expression of growth factors that regulate the angiogenic process. The objective of this proposal is to understand effectiveness and underlying mechanism of angiogenic agent picroliv for the better management of chronic and diabetic wounds. To accomplish this objective, we plan to study the effect of picroliv on the growth of human vein endothelial cells. Cell viability and cytotoxicity studies will include cell morphology and lactate dehydrogenase (LDH) activity. We will examine whether picroliv enhances angiogenesis in an in-vitro and in vivo model of angiogenesis. We will use genetically diabetic mice models of impaired healing for our study. Additionally, it is well known that the anti-inflammatory and immunosuppressive activities of corticosteroids suppress healing. We will therefore use animal models wherein healing has been impaired by treatment with steroids. Several wound healing parameters such as wound width and gap, vessel formation, collagenization, apoptosis will be studied in tissues obtained from these models. The regulation of growth factors viz. TGFb-1, bFGF, PDGF, IGF-1 and adhesion molecules will be examined in the wound tissue by immunohistochemistry, RT-PCR as well as by in situ hybridization. Further, to understand the molecular mechanism of action of picroliv, we will examine the profile of metalloprotienases such as MMPl, MMP9, MMP2, and their tissue inhibitors (TIMPs) in the wound tissue by gelatinography and PCR. We believe that these studies will

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provide information regarding the mechanism(s) underlying the angiogenic effects of picroliv in better management of chronic wounds. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAME AND FOLATE DEFICIENCY IN ALCOHOLIC MIRCROPIGS Principal Investigator & Institution: Halsted, Charles H.; Professor; Internal Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2007 Summary: (provided by applicant): The overall hypothesis of the proposed research is that the pathogenesis of alcoholic liver disease (ALD) is regulated by changes in intrahepatic methionine metabolism that result from chronic ethanol consumption. Previously, we found that the combination of dietary ethanol and a folate deficient diet both maximized perturbations in methionine metabolism and accelerated the development of ALD in micropigs. The objective of the proposed research is to prove the hypothesis by demonstrating that the biochemical and histopathological features of ALD can be prevented or reversed by provision of supplemental S-adenosylmethionine (SAM) or folic acid to pigs maintained on chronic ethanol feeding with and without folate deficient diet. The first specific aim is to determine the efficacy and metabolic effects of intervention with SAM or folic acid in the prevention and treatment of ALD in micropigs. The second specific aim is to study the effects of abnormal methionine metabolism on known mediators and signal pathways of alcoholic liver injury. Micropigs will be fed diets with ethanol that are either folate sufficient or deficient and with or without supplemental SAM during development of liver injury, and with or without supplemental SAM or folic acid after development of alcoholic liver injury. Data collection will include methionine metabolites in plasma and liver, liver histopathology, markers of inflammation, necrosis, and apoptosis, products of lipid, protein, and DNA oxidation, antioxidant enzymes, and signal pathways of apoptosis. The data will be interpreted to confirm the role and establish potential mechanisms for abnormal methionine metabolism in the pathogenesis of ALD. While furthering understanding of interactions of methionine metabolites on pathways of liver injury, the project may establish novel approaches to the prevention and treatment of ALD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SELENOPROTEINS, NF-KB, AND HIV DISEASE IN IV DRUG USERS Principal Investigator & Institution: Taylor, Ethan W.; Associate Professor; Pharmaceutical & Biomed Scis; University of Georgia 617 Boyd, Gsrc Athens, Ga 306027411 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: At a 1998 NIDA-sponsored workshop, the need for further research on the role of nutritional and metabolic factors in HIV/drug abuse was established. The evidence reviewed included data showing that malnutrition and low levels of the trace mineral selenium (Se) and other antioxidants are commonly evident in IV drug users (IDUs), who also show increased oxidative stress and lipid peroxidation as a consequence of IV drug use. Because a progressive decline in serum Se is well documented in HIV/AIDS, and correlations between Se status and HIV disease progression are firmly established, IDUs as a group are at increased risk for accelerated HIV-related morbidity and mortality. Significantly, some viruses, including a pox virus and HIV-1 (our preliminary data), encode homologues of glutathione peroxidase (GPx), the prototypical mammalian selenoprotein, in which selenocysteine is encoded by the

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UGA codon. This is particularly relevant for HIV- 1, because recent studies have shown that two cellular selenoproteins, GPx and thioredoxin reductase (TDR), are potent regulators of transcription factor NF-kappaB, which in turn regulates HIV-1 gene expression. Our preliminary theoretical and experimental data show that a novel HIV-1 gene, env-fs, is encoded in an overlapping reading frame of the env gene, and that the protein it codes for is a highly truncated Se-dependent GPx module, enzymatically active in in vitro assays. We have also identified several other active -1 frameshift sites and potential UGA suppression sites in HIV-1, in the protease and nef coding regions; the latter site has clear sequence similarities to the redox centers of TDR. This study will assess the hypothesis that these viral selenoproteins are involved in the connection between Se status and HIV-1 disease progression. Using in vitro methods, the specific aims are A1: to show that the relevant HIV-1 gene regions encode functional selenoproteins that have demonstrable biological activity, and that these novel proteins or isoforms (e.g. the extended nef TDR homolog) are actually expressed in infected cells; A2: to study the effects and interactions of the predicted viral selenoproteins (GPx, extended nef, pro-fs) on HIV-1 gene expression and activation by oxidative stress; A3: to show that viral selenoprotein synthesis contributes to the decline in cellular selenoprotein levels that has been previously demonstrated in HIV-1 infected cells, and that Se supplementation of infected cells can partially reverse this effect. The long- term goal is to establish a molecular basis for the use of Se supplements as a chemoprotectant in HIV+ drug users. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SLOWING OF TRANSIT - THE THIRD ENTERIC FUNCTION OF 5HT Principal Investigator & Institution: Lin, Henry C.; Director Gastrointestinal Motility Progr; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, Ca 900481804 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): In order to optimize nutrition, the movement of a meal through the small intestine must be precisely controlled to ensure that there is adequate time to complete the time-demanding steps of digestion and absorption. Abdominal pain, nausea, bloating, diarrhea and malnutrition are the consequences of impaired control of intestinal transit. After a fat-containing meal, inhibitory feedback mechanisms are activated by the proximal and distal small intestine as the jejunal and ileal brake, respectively. In contrast to this focus of the postprandial gut to slow transit, much of the research efforts over the past 100 years have been directed at the peristaltic reflex, which is responsible for the acceleration of intestinal transit and are known to be mediated by 5-HT. Currently, two roles of enteric 5-HT have been established: the triggering of the peristaltic and mucosal secretory reflexes via intrinsic primary afferent neurons and gut-to-CNS and gut-to-pancreas communications via extrinsic sensory nerves. We have recently found a third role of enteric 5-HT. Specifically, 5-HT is also involved in the slowing of transit by fat via a 5-HT3 pathway that is dependent on 5-HT transmission via myenteric neurons. In this proposal, we will test our overall hypothesis that slowing of intestinal transit by fat depends on primary afferent nerves, betaadrenergic pathway and 5-HT transmission via myenteric neurons, which in turn activates opioid neurons, that slow transit. We will test the hypotheses using pharmacologic and physiologic approaches. The results of these studies will help us to refine our hypotheses so that we can test the neuroanatomic components of this pathway using immunohistochemistry. We have developed a collaboration with 2

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leading neuroscientists who will provide this project with additional expertise in immunohistochemistry. In addition, to test the role of a novel beta-adrenergic system in the slowing of intestinal transit by fat, we have developed a multi-disciplinary team approach by including a cardiologist experienced in the 13- adrenergic system. The PI has a track record of success in bench-to-bedside translational research in the area of nutrient control of intestinal transit. His experience includes the discovery of a novel, nutrient-based strategy to slow intestinal transit. This application will bring this new treatment back to basic research so that we can understand the neural pathways that underpin the slowing response to fat. The hypotheses to be tested in this project will expand our understanding of a new role for enteric 5-HT which may explain conditions such as irritable bowel syndrome and provide better understanding of the effects of drugs that are directed at 5-HT pathways. In addition, by investigating the mediators of the control of intestinal transit, we will gain knowledge that can be used to control the movement of a meal through the small intestine and, in turn, reduce symptoms and improve nutrition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUB-OPTIMAL PRE-ESRD CARE AND ITS IMPACT ON OUTCOMES Principal Investigator & Institution: Kausz, Annamaria T.; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-DEC-2004 Summary: (adapted from the application) The prevalence of end-stage renal disease (ESRD) continues to increase, and mortality among ESRD patients remains high. The principal hypothesis of this proposal is that care of patients with chronic renal failure prior to ESRD (pre-ESRD) is sub-optimal, and this adversely influences outcomes after initiation of ESRD therapy, such as morbidity, mortality and cost. The research will include a macro viewpoint using data from large databases such as the United States Renal Data System (USRDS) and Health Care Financing Administration (HCFA), and a micro viewpoint using detailed primary data collection at a single tertiary care hospital-New England Medical Center (NEMC). USRDS and HCFA files will be used to determine the prevalence and predictors of malnutrition, anemia, late initiation of dialysis and delayed referral to the nephrologist, and their impact on subsequent clinical variables. Separate analyses of pediatric and transplant patients will be undertaken, and compared with dialysis patients. NEMC data will be used to study the impact of delayed nephrology referral and delayed vascular access placement on hospitalization and cost. The results of this proposal are expected to provide important information regarding pre-ESRD care, and for the development of strategies to improve ESRD outcomes. The principal investigator has designed a comprehensive series of studies to evaluate the hypotheses enunciated in this proposal, and is well qualified to carry them through to completion. In addition to a combined fellowship in Adult and Pediatric Nephrology, she holds a Master's degree in Epidemiology. She is mentored by investigators with extensive experience in clinical investigation and advised by a panel of world leaders in epidemiology, clinical trials and health services research. Within a limited time, she and her mentor have put together an infrastructure tailored to achieve the goals of this proposal. The practical experience from the research proposed, and the comprehensive education program outlined are expected to build on the candidate's current skills and experience, and facilitate her transition to an independent investigator in Pediatric and Adult Renal epidemiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE EFFECTS OF CAREGIVING ON CHILD MALNUTRITION Principal Investigator & Institution: Digirolamo, Ann M.; International Health; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: (applicant's abstract): The purpose of the application for this award is twofold: 1) to gain additional training in conducting research and primary data collection in developing countries, with a focus on issues related to international nutrition; and 2) to obtain more knowledge on contributors to child malnutrition in developing countries, specifically the influence of psychosocial factors. The candidate wishes to pursue a career in International Health, with the ultimate goal of contributing to the improved health and well-being of mothers and children living in impoverished environments. The candidate's immediate goals are to combine her backgrounds in Child Health Psychology and Public Health to address global health issues such as psychosocial factors influencing child malnutrition, growth, and development. The candidate's long-term goals include embarking on a career of independent research and teaching in international health, conducting field research, and working in an academic environment. This award will allow the candidate to benefit from a period of mentored research in international nutrition and gain necessary experience in conducting field research and primary data collection in a developing country. The candidate plans to spend two years at the National Institute of Public Health in Cuernavaca, Mexico under the guidance of Dr. Juan Rivera and Dr. Reynaldo Martorell, with a third year spent in the Department of International Health at Emory University. During this time, she will attend relevant nutrition and maternal and child health seminars and courses at both institutions, and receive intensive Spanish language training. She plans to conduct a study on the influence of psychosocial factors on child nutrition, growth, and development in Mexico. Specifically, home observations of caregiver-child interactions, and self-report measures of caregiver's depressive symptoms, parenting stress, and perceived social support will be obtained for approximately 360 children during the second year of life and their primary caregivers. The project will be part of a larger collaborative study with the proposed mentors assessing the effects of prenatal and postnatal multiple micronutrient supplementation on child growth and development. These data will be used to test the hypotheses that poorer caregiver-child interactions, greater stress and distress experienced by the caregiver, and less perceived available social support will be associated with poorer outcomes of child growth and development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE ROLE OF INFECTION IN HUMAN NUTRITION Principal Investigator & Institution: Manary, Mark L.; Pediatrics; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2003 Summary: Malnutrition often accompanies chronic illness in childhood in the US. Poor nutritional status is thought to compromise the metabolic response to infection. In the US it is difficult to delineate the metabolic consequences of malnutrition during infection because there are very few children with primary malnutrition. In Malawi, where primary malnutrition is prevalent, the nutritional effects on metabolism during infection can be headily studied. We will study 3 groups of children age 12-60 months, those with marasmus and acute infection, those who are well-nourished with acute infection and those with marasmus without infection. In these 3 groups of children we

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will measure whole-body and splanchnic bed protein kinetics, total energy expenditure, the magnitude of the acute phase response, and the pro-inflammatory cytokine response to characterize and compare the metabolic response to infection. This proposal will also compare nitrogen conservation and the acute phase response in two diets with differing amino acid compositions, milk and egg white-tryptophan. Hypercortisolemia is typically seen in malnutrition, yet the metabolic response to cortisol is blunted from that which occurs in well-nourished children. Thus, we will also explore the glucocorticoid receptor response to endogenous hypercortisolemia by measuring the number, isoform type and cellular location of the glucocorticoid receptors. These studies are essential to developing rational dietary recommendations for the many chronically ill children with protein-energy malnutrition in the US. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE WORK, INCOME, AND MICRONUTRITION PILOT STUDY Principal Investigator & Institution: Friedman, Jed; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): It is widely believed that health influences labor outcomes, particularly in low-income settings where malnutrition and infectious diseases are common and much work requires physical strength and stamina. Most previous studies of health and economic behavior have relied on the analysis of observational data, however, this makes inferences of causation problematic. Not only can health affect income and economic status but also socio-economic status may in turn affect health. In contrast, this pilot will prepare for a study to isolate the causal effect of health on labor by conducting a random assignment treatment-control experiment. Specifically, the larger study will investigate how a micronutrient supplement influences the economic and social productivity of adult and older men in rural Indonesia. The treatment group will receive a multi-vitamin and mineral supplement, including iron, while the control group will receive a placebo. This pilot will prepare for the larger study by: 1) Choosing an appropriate study site; 2) Establishing a representative population profile for numerous micronutritional markers; and 3) Developing a piloting intervention protocols to maximize respondent compliance. We highlight micronutrients because deficiencies in them are endemic in the developing world and because they play a key role in biological processes related to work efficacy. Numerous experimental studies have looked at the effects of micronutrition on health and physical and cognitive functioning, but very few have examined the economic impacts of select micronutrients such as iron, and none has explored the consequences of a general micronutritional supplement for economic productivity and other work outcomes. This is of particular interest since interactions between micronutrients may be important. While our main focus is on the effect of a health intervention on socioeconomic status, the study will shed light on the mechanisms through which nutrition affects work. In addition to contributing to the scientific literature, our results will be of substantial interest to economic and health policy makers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSCRIPTIONAL REGULATION OF A SURFACTANT ENZYME Principal Investigator & Institution: Mallampalli, Rama K.; Professor; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 18-FEB-2002; Project End 31-JAN-2004

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Summary: (provided by applicant): The developing fetal lung critically relies on the availability of maternal lipoproteins to maintain adequate synthesis of surfactant by alveolar type II epithelial cells. Lipoproteins are a rich source of fatty acids, which serve as substrates for synthesis of phosphatidylcholine (PC), the major 1ipid of surfactant. Lipoproteins also serve as potent post-transnational activators of the rate-limiting enzyme required for surfactant PC synthesis, cytidylyltransferase (CT). Although much is known about post-transnational control of CT, transcriptional regulation of this enzyme has not been evaluated. In addition, feedback control mechanisms that exist in the lung to maintain surfactant PC homeostasis under conditions of lipoprotein deficiency remain largely unknown. The revised proposal expands from recent advances made in our laboratory showing that chronic lipoprotein deficiency increases CT activity and surfactant synthesis in fetal type II cells by increasing transcription of the CT gene. These in vitro results suggest that lipoprotein deprivation stimulates CT gene transcription as a novel compensatory mechanism. These preliminary results led us to hypothesize that CT is regulated, in vivo, at the transcriptional level. We propose to test this hypothesis by generating a CT promoter-reporter mouse (AIM 1). This transgenetic mouse will be used to study constitutive and induced CT transcription after lipoprotein deprivation during various phases of fetal lung development (AIM 2). In addition, transgenic mice harboring specific CT promoter segments linked to the betagalactosidase (beta gal) reporter gene will be used to determine the functional relevance of regulatory elements within the 5' flanking region of the CT promoter in vivo. To achieve our Aims, maternal and fetal lungs will be analyzed for reporter expression by tissue immunohistochemical staining, immunoblotting, beta gal activity, and Northern analysis for beta gal. Results will be correlated with endogenous CT expression and surfactant production. These in vivo studies will be supplemented by use of a lipoprotein-sensitive type II line. The unique contributions of this proposal impacting the field of surfactant metabolism include providing a springboard by which investigators can understand for the first time how the CT gene is regulated transcriptionally, in vitro and in vivo. Ultimately, the results from these studies could lead to therapeutic strategies directed at modulating expression of this key surfactant enzyme at the molecular level. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VITAMIN A/ZINC - PREVENTION OF PNEUMONIA (VAZPOP) STUDY Principal Investigator & Institution: Griffiths, Jeffrey K.; Associate Professor; Family Medicine & Cmty Health; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2002; Project Start 18-JAN-2000; Project End 31-DEC-2004 Summary: (Adapted from applicant's description): The Vitamin A and Zinc - Prevention of Pneumonia (VAZPOP) Study. Linking Vitamin A and Zinc Deficiencies, Immunity, Growth, and the Prevention of the Leading Cause of Childhood Death. The objective is to delineate how vitamin A and zinc supplementation interact in improving immunity, fostering growth, and preventing infection, in populations at risk for malnutrition and vitamin A and zinc deficiency. Malnutrition is involved in half of the global deaths in children less than 5. Acute respiratory infection (ARI), especially acute lower respiratory infection (ALRI) or pneumonia, is the leading cause of death in children. The investigators propose to conduct a randomized, placebo controlled, double blind, nutritionally stratified study of low dose vitamin A, 10 mg/day elemental zinc, both, or placebo in 2,400 children in Quito Ecuador. They will test the hypotheses that: a) lowdose vitamin A has paradoxically positive and negative effects on ALRI in underweight

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and well nourished children; b) zinc will protect against ALRI and diarrhea while boosting cell mediated immunity; c) growth will be fostered by zinc (and potentially by vitamin A) in deficient children; and d) misclassification of ALRI cases can mask the benefits or risks of vitamin A. The investigators will use state-of- the-art field techniques to assess body composition and growth, and utilize sophisticated techniques to assess vitamin A and zinc deficiency. In addition, they will use rigorous definitions of ALRI/pneumoma to avoid misclassification and ascertainment bias, which may have affected prior studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WHAT IS THE METABOLIC FUNCTION OF SELENOPROTEIN W? Principal Investigator & Institution: Whanger, Philip D.; Professor; Environ & Molecular Toxicology; Oregon State University Corvallis, or 973391086 Timing: Fiscal Year 2002; Project Start 01-JUN-1999; Project End 31-MAY-2004 Summary: The function of selenoprotein W is unknown but is a selenocysteine containing protein, with highest concentrations in muscle, testes and brain. Selenium deficiency is associated with a failure to incorporate selenium into this protein, suggesting a critical metabolic role for it. Information on the function of selenoprotein W will be sought with knockout mice. Based on the genomic sequence, a knockout vector will be designed for injection into embryonic stem cells. After established procedures have been used to produce chimeric mice, they will be bred to normal mice to obtain heterozygotes. These will be used in selected breeding to obtain homozygotes which should lack the gene for selenoprotein W. Southern blots will be used to determine if the desired animals have been obtained. Experiments are planned to determine if the knockout mice are more subject to peroxidation, using three different compounds to promote this disorder. The effects of selenoprotein W deletion on the expression of other selenoproteins such as the cellular glutathione peroxidase (GPX1) and the phospholipid hydroperoxidase (GPX4) will be examined in these knockout mice. The knockout mice will be given selenium to show that this element will increase the activities of GPX1 and GPX4 but not selenoprotein W. This will be followed by oxidative stress studies with tissue cultures of muscle cells to confirm the results in the whole animal. Glutathione and a smaller adduct are stoichiometrically bound to selenoprotein W from muscle, and the identification and binding of this small adduct to selenoprotein W will be explored as a means of further investigation into its metabolic function. We have access to knockout mice deficient in gamma-glutamyl transpeptidase and these will be used to determine the effects of altered glutathione and cystine levels on selenoprotein W content. These animals will also be supplemented with selenium to determine the effects upon selenoprotein W and GPX1 and GPX4 induction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ZINC DEVELOPMENT

AND

IRON

SUPPLEMENTATION:

IMPACT

ON

Principal Investigator & Institution: Black, Maureen M.; Professor; Pediatrics; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 23-JUN-1999; Project End 31-MAY-2004 Summary: The proposed project builds on an existing trial of micronutrient supplementation on children's growth, immune functioning, and morbidity, administered from birth through 9 months among full-term infants born small-forgestational age in a low-income community in India. The trial had four cells: riboflavin

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with and without zinc, and other micronutrients [riboflavin, calcium, phosphorus, folate, and iron] with and without zinc. In April 1999 the children will range in age from 14 to 32 months, providing a unique opportunity to examine the protective effects of early micronutrient supplementation on children's behavior and development during the second and third years of life when the children are consuming community diets. We will use a cross-lag panel design to follow 600 children who participated in the micronutrient supplementation trial and a comparison group of 225 children, born at term with birth weight appropriate for gestational age. Children will be studied in clinical and home settings at 18, 24, 30, and 36 months of age to determine if differences in behavior and development are related to: (i) the micronutrient supplementation they received during infancy and (2) the timing and duration of their micronutrient deficiency during toddlerhood. The project tests the theory of functional isolation which hypothesizes that the lethargy and social isolation that often accompany nutritional deficiency interfere with reciprocal, stimulating interactions with caregivers, thereby leading to developmental and behavioral delays. The design and analysis are based on an ecological model in which behavior and development are influenced by birth weight, supplementation history, growth, temperament, parent-children interaction, and family environment contribute to children's behavior and development. Analysis will be conducted by longitudinal strategies, including multiple regression and hierarchial linear modeling. The results have important public health implications regarding the timing of micronutrient supplementation and the relationship between micronutrient deficiency and children's behavior and development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ZINC DEFICIENCY AND THL FUNCTIONS: MOLECULAR MECHANISMS Principal Investigator & Institution: Prasad, Ananda S.; Professor; Internal Medicine; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JAN-2007 Summary: Zinc plays an important role in immune functions in humans. Decreased thymulin activity, decreased production of IL- 2, decreased NK cell lytic activity, decreased cytolytic T cells, anergy, decreased CD4/CD8 and decreased CD4+ CD45RA+/CD4+ CD45RO+ ratios, have been observed in zinc deficient humans and these abnormalities are corrected by zinc supplementation. In order to understand the mechanism of zinc action on IL-2 production, we propose to utilize HUT-78, a ThO human malignant lymphoblastoid cell line for our studies. The human IL-2 gene promoter contains one binding site for genuine Rel/NF-kB factors and binding of NFkB to DNA is specifically blocked by a zinc chelator and is reconstituted by addition of zinc. NF-kB also binds to the regulatory gene of IL-2 receptor alpha. We hypothesize that in zinc deficient HUT-78 cells, the activation and translocation of NF-kB to nucleus and the gene expression of NF-kB will be decreased and this will lead to decreased gene expression of IL-2 and IL-2 receptor alpha and decreased production of IL-2, sIL-2 receptor alpha and total sIL-2 receptors. The effect of different concentrations of zinc on NF-kB activation in HUT-78 cells will be determined by i) nuclear binding of NF-kB by gel shift assay and confocal imaging ii) gene transfection of cells with luciferase reporter gene vector containing NF-kB enhancer element and iii) assays of phosphorylated, unphosphorylated and ubiquitinated forms of IkB (the inhibitory molecule of the NF-kB complex) in cellular cytosolic fraction. The functional role of NF-kB on transcriptional activation of IL-2 and IL-2 receptor alpha as affected by zinc will be determined by using antisense p105 expression vector in HUT-78 cells. We are also hypothesizing that NF-kB

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activation, IL-2 production and IL-2 mRNA will be decreased in PHA stimulated zinc deficient human mononuclear cells and that these abnormalities will be corrected by in vivo and in vitro zinc supplementation. For this study we will select appropriate number of healthy ambulatory elderly subjects from a nursing home. Our previous experience indicates that approximately 30 percent of these healthy elderly are zinc deficient. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Clinical nutrition: 1. Protein --energy malnutrition in the inpatient. by Hoffer LJ.; 2001 Nov 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81630

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Different degrees of malnutrition and immunological alterations according to the aetiology of cirrhosis: a prospective and sequential study. by Caly WR, Strauss E, Carrilho FJ, Laudanna AA.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=270012

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Effect of malnutrition in Ecuadorian children on titers of serum antibodies to various microbial antigens. by Brussow H, Sidoti J, Dirren H, Freire WB.; 1995 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170102

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Effect of malnutrition on serum and milk antibodies in Zairian women. by Brussow H, Barclay D, Sidoti J, Rey S, Blondel A, Dirren H, Verwilghen AM, Van Geert C.; 1996 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170244

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Effect of protein malnutrition on salmonellosis and fever. by Bradley SF, Kauffman CA.; 1988 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=259406

3 4

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

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Effects of protein calorie malnutrition on tuberculosis in mice. by Chan J, Tian Y, Tanaka KE, Tsang MS, Yu K, Salgame P, Carroll D, Kress Y, Teitelbaum R, Bloom BR.; 1996 Dec 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26226

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Enhancement of Susceptibility to Shiga Toxin-Producing Escherichia coli O157:H7 by Protein Calorie Malnutrition in Mice. by Kurioka T, Yunou Y, Kita E.; 1998 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108110

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Impact of protein malnutrition on exogenous reinfection with Mycobacterium tuberculosis. by McMurray DN, Bartow RA, Mintzer CL.; 1989 Jun; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=313350

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Inequities in under-five child malnutrition in South Africa. by Zere E, McIntyre D.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=201028

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Malnutrition Alters the Innate Immune Response and Increases Early Visceralization following Leishmania donovani Infection. by Anstead GM, Chandrasekar B, Zhao W, Yang J, Perez LE, Melby PC.; 2001 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=98556

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Malnutrition: a frequent misdiagnosis for hemodialysis patients. by Mitch WE.; 2002 Aug 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150424

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Predisposing factors in Pneumocystis carinii pneumonia: effects of tetracycline, protein malnutrition, and corticosteroids on hosts. by Walzer PD, LaBine M, Redington TJ, Cushion MT.; 1984 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=261608

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Protein malnutrition alters the distribution of Fc gamma R+ (T gamma) and Fc mu R+ (T mu) T lymphocytes in experimental pulmonary tuberculosis. by McMurray DN, Bartow RA, Mintzer CL.; 1990 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=258494

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Response of regional brain glutamate transaminases of rat to aluminum in protein malnutrition. by Nayak P, Chatterjee AK.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=126260

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Sendai virus infection of mice with protein malnutrition. by Pena-Cruz V, Reiss CS, McIntosh K.; 1989 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=250935

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 6

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

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

A consistent and reliable tool for malnutrition screening. Author(s): Malnutrition Advisory Group. Source: Nurs Times. 2003 November 18-24; 99(46): 26-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14666817

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A new approach to classifying malnutrition in the hemodialysis patient. Author(s): O'keefe A, Daigle NW. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002 October; 12(4): 248-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12382218

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A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. I: Mortality and morbidity. Author(s): Makonnen B, Venter A, Joubert G. Source: Journal of Tropical Pediatrics. 2003 December; 49(6): 340-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725411

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A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. II: Special investigations. Author(s): Makonnen B, Venter A, Joubert G. Source: Journal of Tropical Pediatrics. 2003 December; 49(6): 353-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725412

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A study of malnutrition among children aged 6 months to 2 years from a resettlement colony of Delhi. Author(s): Khokhar A, Singh S, Talwar R, Rasania SK, Badhan SR, Mehra M. Source: Indian Journal of Medical Sciences. 2003 July; 57(7): 286-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928554

journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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An analysis of childhood malnutrition in Kerala and Goa. Author(s): Rajaram S, Sunil TS, Zottarelli LK. Source: Journal of Biosocial Science. 2003 July; 35(3): 335-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887217

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Anorexia and malnutrition in patients with obstructive jaundice. Author(s): Padillo FJ, Andicoberry B, Pera-Madrazo C, Sitges-Serra A. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2002 November-December; 18(11-12): 987-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12431722

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Anthropometry and moderate malnutrition in preschool children. Author(s): Lloyd ME, Lederman SA. Source: Indian J Pediatr. 2002 September; 69(9): 771-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12420909

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Approaches to the reversal of malnutrition, inflammation, and atherosclerosis in endstage renal disease. Author(s): Caglar K, Hakim RM, Ikizler TA. Source: Nutrition Reviews. 2002 November; 60(11): 378-87. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12462522

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Appropriate food policies and investments could reduce child malnutrition by 43% in 2020. Author(s): Rosegrant MW, Meijer S. Source: The Journal of Nutrition. 2002 November; 132(11): 3437S-40S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12421865

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Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. Author(s): Liu Y, Coresh J, Eustace JA, Longenecker JC, Jaar B, Fink NE, Tracy RP, Powe NR, Klag MJ. Source: Jama : the Journal of the American Medical Association. 2004 January 28; 291(4): 451-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14747502

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Association of APOE gene with schizophrenia in Chinese: a possible risk factor in times of malnutrition. Author(s): Liu W, Breen G, Zhang J, Li S, Gu N, Feng G, Bai S, Shen T, Yu A, Xue H, St Clair D, He L. Source: Schizophrenia Research. 2003 August 1; 62(3): 225-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12837518

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Association of depression with malnutrition in chronic hemodialysis patients. Author(s): Koo JR, Yoon JW, Kim SG, Lee YK, Oh KH, Kim GH, Kim HJ, Chae DW, Noh JW, Lee SK, Son BK. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 May; 41(5): 1037-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12722038

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Association of household rice expenditure with child nutritional status indicates a role for macroeconomic food policy in combating malnutrition. Author(s): Torlesse H, Kiess L, Bloem MW. Source: The Journal of Nutrition. 2003 May; 133(5): 1320-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12730417

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Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment? Author(s): Barbosa-Silva MC, Barros AJ, Post CL, Waitzberg DL, Heymsfield SB. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2003 May; 19(5): 422-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12714094

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Can the vicious inflammation-malnutrition circle be corrected? Author(s): Brunori G, Guerini S. Source: Contrib Nephrol. 2003; (140): 122-30. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12800352

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Changes in child survival are strongly associated with changes in malnutrition in developing countries. Author(s): Pelletier DL, Frongillo EA. Source: The Journal of Nutrition. 2003 January; 133(1): 107-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12514277

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Charities say southern Sudan faces a health crisis and record malnutrition. Author(s): Moszynski P. Source: Bmj (Clinical Research Ed.). 2003 October 25; 327(7421): 948. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14576233

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Child malnutrition in Vietnam and its transition in an era of economic growth. Author(s): Thang NM, Popkin B. Source: Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association. 2003 August; 16(4): 233-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859705

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Childhood malnutrition and its predictors in rural Malawi. Author(s): Maleta K, Virtanen SM, Espo M, Kulmala T, Ashorn P. Source: Paediatric and Perinatal Epidemiology. 2003 October; 17(4): 384-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14629321

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Childhood nutrition and malnutrition in Nigeria. Author(s): Adelekan DA. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2003 February; 19(2): 179-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12591557

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Children in the Gaza Strip suffer malnutrition. Author(s): Eaton L. Source: Bmj (Clinical Research Ed.). 2002 November 9; 325(7372): 1057. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12428606

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Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola. Author(s): Agadjanian V, Prata N. Source: Social Science & Medicine (1982). 2003 June; 56(12): 2515-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12742614

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Co-morbidity and kidney graft failure-two main causes of malnutrition in kidney transplant patients. Author(s): Djukanovic L, Lezaic V, Blagojevic R, Radivojevic D, Stosovic M, Jovanovic N, Ristic S, Simic-Ogrizovic S. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 July; 18 Suppl 5: V68-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12817076

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Detection of severe protein-energy malnutrition by nurses in The Gambia. Author(s): Hamer C, Kvatum K, Jeffries D, Allen S. Source: Archives of Disease in Childhood. 2004 February; 89(2): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14736639

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Diagnostic potential of serum vitamin E tocopherol and cholesterol levels in children with protein energy malnutrition in western Kenya. Author(s): Kwena AM, Nyandieka HS. Source: East Afr Med J. 2003 August; 80(8): 419-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14601784

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Diarrhea and malnutrition. Author(s): Brown KH. Source: The Journal of Nutrition. 2003 January; 133(1): 328S-332S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12514320

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Do risk factors for childhood infections and malnutrition protect against asthma? A study of Brazilian male adolescents. Author(s): da Costa Lima R, Victora CG, Menezes AM, Barros FC. Source: American Journal of Public Health. 2003 November; 93(11): 1858-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14600053

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Effect of malnutrition and short-term refeeding on peripheral blood mononuclear cell mitochondrial complex I activity in humans. Author(s): Briet F, Twomey C, Jeejeebhoy KN. Source: The American Journal of Clinical Nutrition. 2003 May; 77(5): 1304-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12716686

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Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance. Author(s): Gonzalez-Barranco J, Rios-Torres JM, Castillo-Martinez L, Lopez-Alvarenga JC, Aguilar-Salinas CA, Bouchard C, Depres JP, Tremblay A. Source: Metabolism: Clinical and Experimental. 2003 August; 52(8): 1005-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12898465

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Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Author(s): Kalantar-Zadeh K, McAllister CJ, Lehn RS, Lee GH, Nissenson AR, Kopple JD. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 October; 42(4): 761-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520627

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Effect of supplementary feeding on the prevention of mild-to-moderate wasting in conditions of endemic malnutrition in Guatemala. Author(s): Rivera JA, Habicht JP. Source: Bulletin of the World Health Organization. 2002; 80(12): 926-32. Epub 2003 January 23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12571719

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Effects of malnutrition on child survival in China as estimated by PROFILES. Author(s): Ross J, Chen CM, He W, Fu G, Wang YY, Fu ZY, Chen MX. Source: Biomed Environ Sci. 2003 June; 16(2): 187-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12964793

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Effects of malnutrition on economic productivity in China as estimated by PROFILES. Author(s): Ross J, Chen CM, He W, Fu G, Wang YY, Fu ZY, Chen MX. Source: Biomed Environ Sci. 2003 September; 16(3): 195-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14631824

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Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum. Author(s): Yousafzai AK, Filteau S, Wirz S. Source: The British Journal of Nutrition. 2003 December; 90(6): 1097-106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14641969

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Food-based approaches to prevent and control micronutrient malnutrition: scientific evidence and policy implications. Author(s): Gopalan C, Tamber B. Source: World Review of Nutrition and Dietetics. 2003; 91: 76-131. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12747090

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Food-consumption patterns in central West Africa, 1961 to 2000, and challenges to combating malnutrition. Author(s): Honfoga BG, van den Boom GJ. Source: Food Nutr Bull. 2003 June; 24(2): 167-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891821

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Gastrointestinal and pancreatic function in peritoneal dialysis patients: their relationship with malnutrition and peritoneal membrane abnormalities. Author(s): Aguilera A, Bajo MA, Espinoza M, Olveira A, Paiva AM, Codoceo R, Garca P, Sanchez S, Celadilla O, Castro MJ, Selgas R. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 October; 42(4): 787-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520630

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Genetic approaches in the clinical investigation of complex disorders: malnutrition, inflammation, and atherosclerosis (MIA) as a prototype. Author(s): Pecoits-Filho R, Nordfors L, Lindholm B, Hoff CM, Schalling M, Stenvinkel P. Source: Kidney International. Supplement. 2003 May; (84): S162-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12694336

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Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation. Author(s): Walters BA, Hays RD, Spritzer KL, Fridman M, Carter WB. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 December; 40(6): 1185-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12460037

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Hematology of malnutrition, part one. Author(s): Jacobs P, Wood L. Source: Disease-A-Month : Dm. 2003 October; 49(10): 555-618. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14574317

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Hematology of malnutrition. Part two. Author(s): Jacobs P, Wood L. Source: Disease-A-Month : Dm. 2003 November; 49(11): 624-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14614434

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High transport and malnutrition-inflammation-atherosclerosis (MIA) syndrome. Author(s): Heaf J. Source: Perit Dial Int. 2003 March-April; 23(2): 109-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12713074

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Hospital malnutrition: is a disease or lack of food? Author(s): Jeejeebhoy KN. Source: Clinical Nutrition (Edinburgh, Lothian). 2003 June; 22(3): 219-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765659

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Hyperhomocysteinemia and its relationship to cardiovascular disease in ESRD: influence of hypoalbuminemia, malnutrition, inflammation, and diabetes mellitus. Author(s): Suliman ME, Stenvinkel P, Barany P, Heimburger O, Anderstam B, Lindholm B. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S89-95. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612961

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Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Author(s): Guigoz Y, Lauque S, Vellas BJ. Source: Clinics in Geriatric Medicine. 2002 November; 18(4): 737-57. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12608501

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Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa. Author(s): Deen JL, Funk M, Guevara VC, Saloojee H, Doe JY, Palmer A, Weber MW. Source: Bulletin of the World Health Organization. 2003; 81(4): 237-43. Epub 2003 May 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12764489

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Increased nitric oxide production in acute diarrhoea is associated with abnormal gut permeability, hypokalaemia and malnutrition in tropical Australian aboriginal children. Author(s): Kukuruzovic R, Brewster DR, Gray E, Anstey NM. Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2003 January-February; 97(1): 115-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12886817

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Increased serum concentrations of tumor necrosis factor-alpha are associated with disease progression and malnutrition in hepatocellular carcinoma. Author(s): Wang YY, Lo GH, Lai KH, Cheng JS, Lin CK, Hsu PI. Source: J Chin Med Assoc. 2003 October; 66(10): 593-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14703276

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India sees parallel rise in malnutrition and obesity. Author(s): Chatterjee P. Source: Lancet. 2002 December 14; 360(9349): 1948. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12493270

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Insulin resistance and abdominal adiposity in young men with documented malnutrition during the first year of life. Author(s): Boule NG, Tremblay A, Gonzalez-Barranco J, Aguilar-Salinas CA, LopezAlvarenga JC, Despres JP, Bouchard C, Gomez-Perez FJ, Castillo-Martinez L, RiosTorres JM. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2003 May; 27(5): 598-604. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12704409

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Intraerythrocytic potassium levels and early insulin release in children with moderate malnutrition. Author(s): Karasalihoglu S, Bi M, Oner N, Celtik C, Pala O. Source: Journal of Tropical Pediatrics. 2003 October; 49(5): 305-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604166

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IRIS. I: a FOODlet-based multiple-micronutrient intervention in 6- to 12-month-old infants at high risk of micronutrient malnutrition in four contrasting populations: description of a multicenter field trial. Author(s): Smuts CM, Benade AJ, Berger J, Hop le T, Lopez de Romana G, Untoro J, Karyadi E, Erhardt J, Gross R; International Research on Infant Supplementation Study Group. Source: Food Nutr Bull. 2003 September; 24(3 Suppl): S27-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14564941

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Is malnutrition an independent predictor of mortality in peritoneal dialysis patients? Author(s): Chung SH, Lindholm B, Lee HB. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 October; 18(10): 2134-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13679492

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Lack of adaptation to severe malnutrition in elderly patients. Author(s): Schneider SM, Al-Jaouni R, Pivot X, Braulio VB, Rampal P, Hebuterne X. Source: Clinical Nutrition (Edinburgh, Lothian). 2002 December; 21(6): 499-504. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12468370

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Levels of plasma insulin-like growth factor I (IGF I), IGF II, IGF binding proteins, type 1 IGF receptor and growth hormone binding protein in community-dwelling elderly subjects with no malnutrition and no inflammation. Author(s): Raynaud-Simon A. Source: J Nutr Health Aging. 2003; 7(4): 267-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12917753

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Long-term effects of early-life malnutrition and status epilepticus: assessment by spatial navigation and CREB(Serine-133) phosphorylation. Author(s): Huang LT, Lai MC, Wang CL, Wang CA, Yang CH, Hsieh CS, Liou CW, Yang SN. Source: Brain Research. Developmental Brain Research. 2003 November 12; 145(2): 2138. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604761

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Low serum leptin levels and malnutrition in chronic alcohol misusers hospitalized by somatic complications. Author(s): Santolaria F, Perez-Cejas A, Aleman MR, Gonzalez-Reimers E, Milena A, de la Vega MJ, Martinez-Riera A, Gomez-Rodriguez MA. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 2003 January-February; 38(1): 60-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12554610

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Maldigestion and malabsorption of dietary lipid during severe childhood malnutrition. Author(s): Murphy JL, Badaloo AV, Chambers B, Forrester TE, Wootton SA, Jackson AA. Source: Archives of Disease in Childhood. 2002 December; 87(6): 522-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12456554

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Malnutrition and bad outcomes. Author(s): Covinsky KE. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2002 December; 17(12): 956-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12472933

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Malnutrition and dietary protein: evidence from China and from international comparisons. Author(s): Jamison DT, Leslie J, Musgrove P. Source: Food Nutr Bull. 2003 June; 24(2): 145-54; Discussion 156-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891820

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Malnutrition and gastrointestinal disease. Author(s): Kastin DA, Buchman AL. Source: Current Opinion in Clinical Nutrition and Metabolic Care. 2002 November; 5(6): 699-706. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12394647

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Malnutrition and iron deficiency in lactating women in urban slum communities from Addis Ababa, Ethiopia. Author(s): Haidar J, Muroki NM, Omwega AM, Ayana G. Source: East Afr Med J. 2003 April; 80(4): 191-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12918801

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Malnutrition as the cause of variant Creutzfeldt-Jacob disease. Author(s): Stockdale T. Source: Medical Hypotheses. 2002 December; 59(6): 716-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12445515

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Malnutrition at age 3 years and lower cognitive ability at age 11 years: independence from psychosocial adversity. Author(s): Liu J, Raine A, Venables PH, Dalais C, Mednick SA. Source: Archives of Pediatrics & Adolescent Medicine. 2003 June; 157(6): 593-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796242

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Malnutrition in Civil War armies. Author(s): Bollet AJ. Source: Pharos Alpha Omega Alpha Honor Med Soc. 2003 Fall; 66(4): 18-28. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725189

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Malnutrition in end-stage renal disease: beyond inadequate nutrient intake. Author(s): Pupim LB, Cuppari L. Source: Nephrol News Issues. 2003 June; 17(7): 66-71. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12847964

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'Malnutrition in England' University College Hospital Magazine 1934. Some reflections in 2003 on the 1930s. Author(s): Pemberton J. Source: International Journal of Epidemiology. 2003 August; 32(4): 496-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913014

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Malnutrition in England. 1934. Author(s): Pemberton J. Source: International Journal of Epidemiology. 2003 August; 32(4): 493-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913013

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Malnutrition in institutionalized seniors: the iatrogenic component. Author(s): Wendland BE, Greenwood CE, Weinberg I, Young KW. Source: Journal of the American Geriatrics Society. 2003 January; 51(1): 85-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12534851

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Malnutrition in peritoneal dialysis patients: causes and diagnosis. Author(s): Garibotto G, Saffioti S, Russo R, Verzola D, Cappelli V, Aloisi F, Sofia A. Source: Contrib Nephrol. 2003; (140): 112-21. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12800351

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'Malnutrition' in the aged: the dietary assessment. Author(s): Wahlqvist ML, Wahlqvist ML. Source: Public Health Nutrition. 2002 December; 5(6A): 911-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12633515

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Malnutrition is a risk factor in cirrhotic patients undergoing surgery. Author(s): Merli M, Nicolini G, Angeloni S, Riggio O. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2002 November-December; 18(11-12): 978-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12431721

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Malnutrition leading cause of death in post-war Angola. Author(s): Brown P. Source: Bulletin of the World Health Organization. 2003; 81(11): 849-50. Epub 2004 January 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14758418

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Malnutrition research: high time to change the menu. Author(s): Olde Rikkert MG, Rigaud AS. Source: Age and Ageing. 2003 May; 32(3): 241-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12720605

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Malnutrition, chronic inflammation and atherosclerosis in dialysis patients. Author(s): Phanish MK, Marcora SM, Lemmey AB. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 February; 18(2): 446. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12543910

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Malnutrition, dehydration, and starvation in the midst of plenty: the political impact of qualitative inquiry. Author(s): Kayser-Jones J. Source: Qualitative Health Research. 2002 December; 12(10): 1391-405. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12474910

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Malnutrition, disease, and the developing world. Author(s): Pimentel D, Morse J. Source: Science. 2003 April 11; 300(5617): 251. Erratum In: Science. 2003 Apr 11; 300(5617): 251. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12690174

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Malnutrition, infection, and sepsis in acute and chronic illness. Author(s): Felblinger DM. Source: Critical Care Nursing Clinics of North America. 2003 March; 15(1): 71-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12597042

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Malnutrition, muscle wasting and cachexia in chronic heart failure: the nutritional approach. Author(s): Pasini E, Aquilani R, Gheorghiade M, Dioguardi FS. Source: Ital Heart J. 2003 April; 4(4): 232-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12784775

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Malnutrition: more than the eye can see. Author(s): van Leth FC, Koeleman JM, Manya AS. Source: East Afr Med J. 2000 October; 77(10): 549-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12862123

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Malnutrition-inflammation syndrome is associated with endothelial dysfunction in peritoneal dialysis patients. Author(s): Aguilera A, Sanchez-Tomero JA, Bajo MA, Ruiz-Caravaca ML, Alvarez V, del Peso G, Herranz A, Cuesta MV, Castro MJ, Selgas R. Source: Adv Perit Dial. 2003; 19: 240-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763071

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Management of severe malnutrition: facilitating learning. Author(s): Shah D, Gupta P. Source: Lancet. 2003 June 14; 361(9374): 2088. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12814751

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Measurement of perceived health problems as a means of detecting elderly people at risk of malnutrition. Author(s): Christensson L, Unossons M, Ek AC. Source: J Nutr Health Aging. 2003; 7(4): 257-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12917751

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Mechanisms of malnutrition in uremia. Author(s): Guarnieri G, Antonione R, Biolo G. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 April; 13(2): 153-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12671841

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Milk formulas in acute gastroenteritis and malnutrition: a randomized trial. Author(s): Kukuruzovic RH, Brewster DR. Source: Journal of Paediatrics and Child Health. 2002 December; 38(6): 571-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12410869

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Minister “ashamed” at malnutrition in Argentina. Author(s): Iglesias-Rogers G. Source: Lancet. 2002 December 21-28; 360(9350): 2058. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12504415

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Must metabolic acidosis be associated with malnutrition in haemodialysed patients? Author(s): Lin SH, Lin YF, Chin HM, Wu CC. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 November; 17(11): 2006-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12401862

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Neonatal hypernatraemic dehydration and malnutrition associated with inadequate breastfeeding and elevated breast milk sodium. Author(s): Scott JX, Raghunath, Gnananayagam JE, Simon A. Source: J Indian Med Assoc. 2003 May; 101(5): 318, 321. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14575224

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Nutritional status of drug addicts undergoing detoxification: prevalence of malnutrition and influence of illicit drugs and lifestyle. Author(s): Nazrul Islam SK, Jahangir Hossain K, Ahmed A, Ahsan M. Source: The British Journal of Nutrition. 2002 November; 88(5): 507-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12425731

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Nutritional status of preschool Senegalese children: long-term effects of early severe malnutrition. Author(s): Idohou-Dossou N, Wade S, Guiro AT, Sarr CS, Diaham B, Cisse D, Beau JP, Chappuis P, Hoffman D, Lemonnier D. Source: The British Journal of Nutrition. 2003 December; 90(6): 1123-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14641972

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Nutritionally enhanced rice to combat malnutrition disorders of the poor. Author(s): Potrykus I. Source: Nutrition Reviews. 2003 June; 61(6 Pt 2): S101-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12908739

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Osteoporosis and anorexia nervosa: relative role of endocrine alterations and malnutrition. Author(s): Jacoangeli F, Zoli A, Taranto A, Staar Mezzasalma F, Ficoneri C, Pierangeli S, Menzinger G, Bollea MR. Source: Eat Weight Disord. 2002 September; 7(3): 190-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12452250

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Part I. Malnutrition in the pediatric population. Author(s): Kumar S, Olson DL, Schwenk WF. Source: Disease-A-Month : Dm. 2002 November; 48(11): 703-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12474013

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Plasma electrolytes, total cholesterol, liver enzymes, and selected antioxidant status in protein energy malnutrition. Author(s): Etukudo MH, Agbedana EO, Akinyinka OO, Osifo BO. Source: Afr J Med Med Sci. 1999 March-June; 28(1-2): 81-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12953993

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Plasma ghrelin levels and malnutrition: a comparison of two etiologies. Author(s): Krsek M, Rosicka M, Papezova H, Krizova J, Kotrlikova E, Haluz'k M, Justova V, Lacinova Z, Jarkovska Z. Source: Eat Weight Disord. 2003 September; 8(3): 207-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649784

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Plasma pentosidine is associated with inflammation and malnutrition in end-stage renal disease patients starting on dialysis therapy. Author(s): Suliman ME, Heimburger O, Barany P, Anderstam B, Pecoits-Filho R, Rodriguez Ayala E, Qureshi AR, Fehrman-Ekholm I, Lindholm B, Stenvinkel P. Source: Journal of the American Society of Nephrology : Jasn. 2003 June; 14(6): 1614-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12761263

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Position of the American Dietetic Association: Addressing world hunger, malnutrition, and food insecurity. Author(s): Struble MB, Aomari LL. Source: Journal of the American Dietetic Association. 2003 August; 103(8): 1046-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891157

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Postnatal malnutrition of extremely low birth-weight infants with catch-up growth postdischarge. Author(s): Ernst KD, Radmacher PG, Rafail ST, Adamkin DH. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2003 September; 23(6): 477-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13679935

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Postoperative malnutrition in Duchenne muscular dystrophy. Author(s): Iannaccone ST, Owens H, Scott J, Teitell B. Source: Journal of Child Neurology. 2003 January; 18(1): 17-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12661933

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Prevalence and severity of malnutrition in pre-school children in a rural area of western Kenya. Author(s): Kwena AM, Terlouw DJ, de Vlas SJ, Phillips-Howard PA, Hawley WA, Friedman JF, Vulule JM, Nahlen BL, Sauerwein RW, ter Kuile FO. Source: The American Journal of Tropical Medicine and Hygiene. 2003 April; 68(4 Suppl): 94-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12749491

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Prevalence of hospital malnutrition in Argentina: preliminary results of a populationbased study. Author(s): Wyszynski DF, Perman M, Crivelli A. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2003 February; 19(2): 115-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12591541

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Prevalence of malnutrition in rural Karnataka, South India: a comparison of anthropometric indicators. Author(s): Joseph B, Rebello A, Kullu P, Raj VD. Source: J Health Popul Nutr. 2002 September; 20(3): 239-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12430761

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Prevalence of malnutrition using Z-scores and absolute values in children under five years of age in Utan village, Jos, Plateau State, Nigeria. Author(s): Zoakah AI, Idoko LO, Okoronkwo MO, Adeleke OA. Source: East Afr Med J. 2000 March; 77(3): 123-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12858884

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Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. Author(s): Gazzotti C, Arnaud-Battandier F, Parello M, Farine S, Seidel L, Albert A, Petermans J. Source: Age and Ageing. 2003 May; 32(3): 321-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12720620

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Primary malnutrition. Can we always tell? Author(s): Stephen CA, Thame MM, Gray R, Barker D, Wilks R, Forrester TE, McKenzie CA. Source: The West Indian Medical Journal. 2002 September; 51(3): 148-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12501539

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Programs to improve production and consumption of animal source foods and malnutrition in Vietnam. Author(s): Hop le T. Source: The Journal of Nutrition. 2003 November; 133(11 Suppl 2): 4006S-4009S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14672303

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Pro-inflammatory cytokines in Turkish children with protein-energy malnutrition. Author(s): Dulger H, Arik M, Sekeroglu MR, Tarakcioglu M, Noyan T, Cesur Y, Balahoroglu R. Source: Mediators of Inflammation. 2002 December; 11(6): 363-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12581501

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Protein energy malnutrition and risk of tuberculosis infection. Author(s): Boelaert JR, Gordeuk VR. Source: Lancet. 2002 October 5; 360(9339): 1102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12384022

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Protein status in pancreatitis--transthyretin is a sensitive biomarker of malnutrition in acute and chronic pancreatitis. Author(s): Lasztity N, Biro L, Nemeth E, Pap A, Antal M. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2002 December; 40(12): 1320-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12553437

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Protein-energy malnutrition and involuntary weight loss: nutritional and pharmacological strategies to enhance wound healing. Author(s): Collins N. Source: Expert Opinion on Pharmacotherapy. 2003 July; 4(7): 1121-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12831338

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Reducing the risks of malnutrition by ensuring adequate dietary intake. Author(s): Nazarko L. Source: Prof Nurse. 2002 December; 18(4): 211-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12518615

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Response to “Malnutrition and dietary protein: evidence from China and from international comparisons”. Author(s): Wray J. Source: Food Nutr Bull. 2003 September; 24(3): 291-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14564935

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Risk of mortality in patients with end-stage renal disease: the role of malnutrition and possible therapeutic implications. Author(s): Zeier M. Source: Hormone Research. 2002; 58 Suppl 3: 30-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12435894

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Serum IgE level in malnutrition. Author(s): Forte WC, Santos de Menezes MC, Horta C, Carneiro Leao Bach R. Source: Allergologia Et Immunopathologia. 2003 March-April; 31(2): 83-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12646123

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Severe anaemia in west African children: malaria or malnutrition? Author(s): Muller O, Traore C, Jahn A, Becher H. Source: Lancet. 2003 January 4; 361(9351): 86-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12517511

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Socio-economic risk factors for severe protein energy malnutrition among children in Mulago Hospital, Kampala. Author(s): Owor M, Tumwine JK, Kikafunda JK. Source: East Afr Med J. 2000 September; 77(9): 471-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12862136

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Summary report of the Standards, Options and Recommendations for malnutrition and nutritional assessment in patients with cancer (1999). Author(s): Duguet A, Bachmann P, Lallemand Y, Blanc-Vincent MP; FNCLCC. Source: British Journal of Cancer. 2003 August; 89 Suppl 1: S92-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915908

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Sweat test results in children with primary protein energy malnutrition. Author(s): Yigit H, Selimoglu MA, Altinkaynak S. Source: Journal of Pediatric Gastroenterology and Nutrition. 2003 September; 37(3): 2425. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12960643

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The 1998 flood in Bangladesh: is different targeting needed during emergencies and recovery to tackle malnutrition? Author(s): Hossain SM, Kolsteren P. Source: Disasters. 2003 June; 27(2): 172-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12825439

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The acute-phase protein response to infection in edematous and nonedematous protein-energy malnutrition. Author(s): Reid M, Badaloo A, Forrester T, Morlese JF, Heird WC, Jahoor F. Source: The American Journal of Clinical Nutrition. 2002 December; 76(6): 1409-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12450910

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The Argentinean paradox: the case of contradictory child malnutrition epidemics. Author(s): Mercer R. Source: Journal of Epidemiology and Community Health. 2003 February; 57(2): 83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540678

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The association between protein-energy malnutrition, malaria morbidity and allcause mortality in West African children. Author(s): Muller O, Garenne M, Kouyate B, Becher H. Source: Tropical Medicine & International Health : Tm & Ih. 2003 June; 8(6): 507-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12791055

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The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition. Author(s): Duesberg P, Koehnlein C, Rasnick D. Source: Journal of Biosciences. 2003 June; 28(4): 383-412. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12799487

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The global problems of child malnutrition and mortality in different world regions. Author(s): El-Ghannam AR. Source: Journal of Health & Social Policy. 2003; 16(4): 1-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943330

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The history of nutrition: malnutrition, infection and immunity. Author(s): Keusch GT. Source: The Journal of Nutrition. 2003 January; 133(1): 336S-340S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12514322

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The identification of malnutrition in heart failure patients. Author(s): Nicol SM, Carroll DL, Homeyer CM, Zamagni CM. Source: European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2002 February; 1(2): 13947. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14622767

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The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Author(s): Correia MI, Waitzberg DL. Source: Clinical Nutrition (Edinburgh, Lothian). 2003 June; 22(3): 235-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765661

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The influence of protein-calorie malnutrition on quality of life in nursing homes. Author(s): Crogan NL, Pasvogel A. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2003 February; 58(2): 159-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12586854

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The malnutrition, inflammation, and atherosclerosis (MIA) syndrome -- the heart of the matter. Author(s): Pecoits-Filho R, Lindholm B, Stenvinkel P. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002; 17 Suppl 11: 28-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386254

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The need to update the classification of acute malnutrition. Author(s): Collins S, Yates R. Source: Lancet. 2003 July 19; 362(9379): 249. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885498

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The role of visceral protein markers in protein calorie malnutrition. Author(s): Brugler L, Stankovic A, Bernstein L, Scott F, O'Sullivan-Maillet J. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2002 December; 40(12): 1360-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12553444

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The two-factor method--a new approach to categorizing the clinical stages of malnutrition in geriatric patients. Author(s): Weinrebe W, Graf-Gruss R, Schwabe R, Stippler D, Fusgen I. Source: Journal of the American Geriatrics Society. 2002 December; 50(12): 2105-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12473037

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The use of intradialytic parenteral nutrition to treat malnutrition: a case study. Author(s): Wong P, Smith P, Rodger D. Source: Cannt J. 2003 April-June; 13(2): 31-46; Quiz 37-9,46-8. English, French. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14535227

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The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. Author(s): de Onis M, Blossner M. Source: International Journal of Epidemiology. 2003 August; 32(4): 518-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913022

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Total parenteral nutrition, an ally in the management of patients with intestinal failure and malnutrition: a long-term view. Author(s): Spencer CT, Compher CW. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2003 September-October; 27(5): 374-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12971737

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Translocation model of Candida albicans in DBA-2/J mice with protein calorie malnutrition mimics hematogenous candidiasis in humans. Author(s): Takahashi K, Kita E, Konishi M, Yoshimoto E, Mikasa K, Narita N, Kimura H. Source: Microbial Pathogenesis. 2003 November; 35(5): 179-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14521876

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Transthyretin: its response to malnutrition and stress injury. clinical usefulness and economic implications. Author(s): Bernstein LH, Ingenbleek Y. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2002 December; 40(12): 1344-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12553442

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Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection. Author(s): van Lettow M, Fawzi WW, Semba RD. Source: Nutrition Reviews. 2003 March; 61(3): 81-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12723640

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Uremic malnutrition: new insights into an old problem. Author(s): Pupim LB, Alp Ikizler T. Source: Seminars in Dialysis. 2003 May-June; 16(3): 224-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12753685

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Use of serum retinol-binding protein for prediction of vitamin A deficiency: effects of HIV-1 infection, protein malnutrition, and the acute phase response. Author(s): Baeten JM, Richardson BA, Bankson DD, Wener MH, Kreiss JK, Lavreys L, Mandaliya K, Bwayo JJ, McClelland RS. Source: The American Journal of Clinical Nutrition. 2004 February; 79(2): 218-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14749226

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

Finding Nutrition Studies on Malnutrition The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “malnutrition” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

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

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

A prudent toast to your health. Source: Tufts-University-diet-and-nutrition-letter (USA). (December 1989). volume 7(10) page 3-6.

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Caloric restriction and experimental tumorigenesis. Author(s): Wistar Institute of Anatomy and Biology, Philadelphia Source: Kritchevsky, D. Nutrition-today (USA). (February 1993). volume 28(1) page 2527.

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Diet, nutrition, and cancer research: an overview. Source: Jacobs, M.M. Nutrition-today (USA). (June 1993). volume 28(3) page 19-23.

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Dietary measures to decrease disability in elderly women. Author(s): University of California at Davis School of Medicine, Davis, CA Source: Meredith, C.N. Nutrition-and-the-M.D (USA). (January 1993). volume 19(1) page 1-3.

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Moderate malnutrition in an Egyptian village: associations with pregnancy outcome and infant development. Author(s): Purdue University Source: Kirksey, A. Nutrition-today (USA). (December 1994). volume 29(6) page 30-38.

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Nutrition screening among rural older persons: a managed care model for a regional approach. Author(s): Geisinger Medical Center. Source: Beyer, K. Thomas, P. Fish, J. Jensen, G.L. Nutrition-today (USA). (February 1996). volume 31(1) page 24-28.

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Nutritional status of the elderly: office evaluation. Author(s): Presbyterian and Mercy Hospitals, Charlotte, NC Source: Blank, R.C. Nutrition-and-the-M.D (USA). (June 1992). volume 18(6) page 1-3.

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On behalf of the United Nations. Source: Nutrition-today (USA). (Sep-October 1985). volume 20(5) page 11-13.

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President of the International Union of Nutrition Societies. Source: Nutrition-today (USA). (Sep-October 1985). volume 20(5) page 8-11.

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Strategies to detect and prevent malnutrition in the elderly: the nutrition screening initiative. Author(s): New England Medical Center Hospitals, Boston, MA. Source: Dwyer, J. Nutrition-today (USA). (October 1994). volume 29(5) page 14-24.

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The fetal origins of adult disease. Author(s): University of Southampton, Southampton, England. Source: Barker, D.J.P. Nutrition-today (USA). (June 1996). volume 31(3) page 108-114.

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The folly of restricting fat in the diet of children. Author(s): USE, Tampa, FL. Source: Olson, R.E. Nutrition-today (USA). (December 1995). volume 30(6) page 234-245.

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Additional consumer oriented references include: •

A study of prevalence of protein energy malnutrition among 0-5 years in rural Benue State, Nigeria. Author(s): Department of Community Health, College of Medicine, University of Lagos, Nigeria. Source: Abidoye, R O Sikabofori Nutr-Health. 2000; 13(4): 235-47 0260-1060

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Approaches to the reversal of malnutrition, inflammation, and atherosclerosis in endstage renal disease. Author(s): Department of Medicine, Division of Nephrology, Gulhane Military Medical School, Ankara, Turkey. Source: Caglar, K Hakim, R M Ikizler, T A Nutr-Revolume 2002 November; 60(11): 37887 0029-6643

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CINI's approaches to intervention: an innovative strategy to combat malnutrition in India. Author(s): Child in Need Institute, Calcutta, West Bengal, India. Source: Chaudhuri, S N Nutr-Revolume 2002 May; 60(5 Pt 2): S102-8 0029-6643

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Contribution of Joaquin Cravioto to the research on malnutrition and mental development. Source: Mandujano, M. Sanchez Perez, C. Nutr-rev. Washington, D.C.: International Life Sciences Institute--ILSI Press. August 2001. volume 59 (8,pt.2) page s2-s6. 0029-6643

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Drug-induced malnutrition in the geriatric patient. Source: Forbes, G.B. Nutr-M.D. Van Nuys, Calif. : Nutrition & the M.D. August 1987. volume 13 (8) page 1-3. 0732-0167

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Fetal malnutrition and adult chronic disease. Author(s): National Institute of Nutrition, Hyderabad, AP, India. Source: Krishnaswamy, K Naidu, A N Prasad, M P R Reddy, G A Nutr-Revolume 2002 May; 60(5 Pt 2): S35-9 0029-6643

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Is protein-calorie malnutrition a problem in alcoholic hepatitis. Source: Nutr-Rev. Washington, D.C. : Nutrition Foundation. April 1985. volume 43 (4) page 108-109. charts. 0029-6643

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Is tropical pancreatic diabetes malnutrition related? Author(s): University of Pittsburgh School of Medicine, Department of Endocrinology, Montefiore Hospital, PA 15213. Source: Rao, R H Diabetes-Care. 1993 June; 16(6): 941-5 0149-5992

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Life expectancy, infant mortality and malnutrition in preindustrial Europe: a contemporary explanation. Author(s): Department of History, Potsdam College, State University of New York, USA. Source: Knapp, V J Nutr-Health. 1998; 12(2): 89-95 0260-1060

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Malnutrition and excess mortality in Shangri-La. Author(s): Scientific Director of the Center for Studies of Sensory Impairment, Aging, and Metabolism (CeSSIAM), Guatemala City, Guatemala. Source: Solomons, Noel W Nutr-Revolume 2002 February; 60(2): 59-62 0029-6643

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Malnutrition and weight loss in patients with AIDS. Source: Nutr-Rev. New York, N.Y. : Springer-Verlag New York Inc. November 1989. volume 47 (11) page 354-356. 0029-6643

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Malnutrition in cancer. Source: D'Amico, S. Nutr-M-D. Van Nuys, Calif. : The Journal. July 1989. volume 15 (7) page 1-3. charts. 0732-0167

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Malnutrition in hospital. Source: Arens, U. BNF-nutr-bull. London : The British Nutrition Foundation. Autumn 1999. volume 24 (88) page 131-136. 0141-9684

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Malnutrition in Iraqi children following the Gulf War: results of a national survey. Author(s): Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115. Source: Smith, M C Zaidi, S Nutr-Revolume 1993 March; 51(3): 74-8 0029-6643

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Malnutrition in patients with AIDS. Source: Nutr-Rev. New York, N.Y. : Springer-Verlag New York Inc. November 1990. volume 48 (11) page 393-401. 0029-6643

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Malnutrition in the rehabilitation setting. Source: Arego, D.E. Koch, S. Nutrition-today (USA). (Jul-August 1986). volume 21(4) page 28-32. malnutrition digestive disorders appetite nervous system diseases 0029666X

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Malnutrition-related diabetes mellitus (MRDM), not diabetes-related malnutrition. A report on genuine MRDM. Source: Chattopadhyay, P S Gupta, S K Chattopadhyay, R Kundu, P K Chakraborti, R Diabetes-Care. 1995 February; 18(2): 276-7 0149-5992

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Micronutrient malnutrition, infection, and immunity: an overview. Author(s): National Institute of Nutrition (Indian Council of Medical Research), Hyderabad, Andhra Pradedsh, India. Source: Bhaskaram, Padbidri Nutr-Revolume 2002 May; 60(5 Pt 2): S40-5 0029-6643

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Nutrition and malnutrition in neonates and immature infants. Source: Doyle, Wendy. Crawford, M.A. Nutr-Health. Berkhamstead : A B Academic Publishers. 1983. volume 1 (3/4) page 213-218. charts. 0260-1060

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Plasma levels of zinc in protein-calorie malnutrition and after nutritional rehabilitation. Source: Prasad, Ananda S. Nutr-Rev. Washington, D.C. : Nutrition Foundation. July 1983. volume 41 (7) page 209-211. 0029-6643

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Prevalence of malnutrition and vitamin A deficiency in Nigerian preschool children subsisting on high intakes of carotenes. Author(s): Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. Source: Adelekan, D A Fatusi, A O Fakunle, J B Olotu, C T Olukoga, I A Jinadu, M K Ojofeitimi, E O Nutr-Health. 1997; 12(1): 17-24 0260-1060

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Prevalence of micronutrient deficiency based on results obtained from the national pilot program on control of micronutrient malnutrition. Author(s): Department of Biochemistry & Nutrition (Government of India), All India Institute of Hygiene and Public Health, Calcutta. Source: Chakravarty, Indira Sinha, R K Nutr-Revolume 2002 May; 60(5 Pt 2): S53-8 00296643

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Protein malnutrition and leukocyte endogenous mediator. Source: Nutr-Rev. Washington, D.C. : Nutrition Foundation. August 1983. volume 41 (8) page 242-244. 0029-6643

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Refeeding in the setting of chronic protein-calorie malnutrition. Source: Nutr-M-D. Van Nuys, Calif. : PM, Inc. March 1991. volume 17 (3) page 1-3. 07320167

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Report from the United Nations: Malnutrition and disability. Source: Norman, Ruth E. Environ-Nutr-Newsl. New York : Environmental Nutrition, Inc. July 1983. volume 6 (7) page S-1--S-2. 0195-4024

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Sociocultural factors of malnutrition among under-fives in Adamawa state, Nigeria. Author(s): Tropical Health and Disease Control Programme, Department of Biological Sciences, Federal University of Technology, PMB 2076, Yola (Nigeria) Source: Madusolumuo, M.A. Akogun, O.B. Nutrition-and-Health (United Kingdom). (1998). volume 12(4) page 257-262. malnutrition nigeria children nutritional status weaning infant feeding mankind

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The contribution of weaning foods to protein-energy malnutrition. Source: Simeon, D.T. Grantham McGregor, S.M. Nutr-Res-Rev. Cambridge [England] : Cambridge University Press. 1990. volume 3 page 25-47. 0954-4224

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The potentiating effects of malnutrition on child mortality: epidemiologic evidence and policy implications. Author(s): Division of Nutritional Sciences, Cornell University, Ithaca, NY. Source: Pelletier, D L Nutr-Revolume 1994 December; 52(12): 409-15 0029-6643

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World wide malnutrition. Source: Hilton, Patricia Anne. Nutr-Food-Sci. London, Eng. : Forbes Publications. Nov/December 1983. volume (85) page 18-19. ill. 0034-6659

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

Dietary recommendations for replacement heifers. Source: Socha, M.T. Johnson, A.B. Kraftfutter (Germany). (2000). (no. 4) page 156-160.

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Metabolic changes during the perinatal period in dairy sheep in relation to level of nutrition and breed, 2: Early lactation. Source: Bizelis, J.A. Charismiadou, M.A. Rogdakis, E. Journal-of-Animal-Physiologyand-Animal-Nutrition (Germany). (2000). volume 84(3-4) page 73-84.

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Preventing and controlling micronutrient malnutrition through food-based actions in South Asian countries. Source: Hussain, A. Food,-Nutrition-and-Agriculture (FAO)Alimentation, Nutrition et Agriculture (FAO)Alimentacion, Nutricion y Agricultura (FAO). (1998). (no.22) page 6368.

Additional physician-oriented references include: •

A class lesson in alcoholic malnutrition. The poor get sicker than the affluent. Source: Moore, D.T. Alcohol-Health-Res-World-Natl-Inst-Alcohol-Abuse-Alcohol. [Rockville, Md.] : U.S. Department of Health, Education, and Welfare. Summer 1987. volume 11 (4) page 58-59, 73. ill. 0090-838X

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A concept analysis of malnutrition in the elderly. Author(s): Yale University School of Nursing, New Haven, Connecticut 06536-0740, USA. [email protected]

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Source: Chen, C C Schilling, L S Lyder, C H J-Adv-Nurs. 2001 October; 36(1): 131-42 0309-2402 •

Birthdates and number of neurons in the serotonergic raphe nuclei in the rat with prenatal protein malnutrition. Author(s): Department of Anatomy and Neurobiology, Boston University School of Medicine, 80 E, Concord Street, Boston, MA 02118, USA. [email protected] Source: King, R S Kemper, T L DeBassio, W A Ramzan, M Blatt, G J Rosene, D L Galler, J R Nutr-Neurosci. 2002 December; 5(6): 391-7 1028-415X

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Chronic disease from early malnutrition. Author(s): Department of Pediatrics, University of South Florida College of Medicine, Tampa 33606, USA. Source: Barness, L A Pediatr-Pathol-Mol-Med. 2002 Mar-April; 21(2): 87-92 1522-7952

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Dietary advice for illness-related malnutrition in adults. Author(s): Systematic Reviews Training Unit, Department of Epidemiology and Public Health, Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH. [email protected] Source: Baldwin, C Parsons, T Logan, S Cochrane-Database-Syst-Revolume 2001; (2): CD002008 1469-493X

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Effect of malnutrition and of changes in protein intake on renal function. Source: Klahr, S. Nutritional management of renal disease /. Baltimore, Md. : Williams & Wilkins, c1997. page 229-244. ISBN: 068304740X

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Effect of ovariectomy, malnutrition and glucocorticoid application on bone properties in sheep: a pilot study. Author(s): AO Research Institute Davos, Davos, Switzerland. [email protected] Source: Lill, C A Fluegel, A K Schneider, E Osteoporos-Int. 2002; 13(6): 480-6 0937-941X

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Effects of cysteine on the pharmacokinetics of intravenous chlorzoxazone in rats with protein-calorie malnutrition. Author(s): College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Kwanak-Gu, Republic of Korea. Source: Kim, Y G Cho, M K Kwon, J W Kim, S G Chung, S J Shim, C K Le Myung, G Biopharm-Drug-Dispos. 2002 April; 23(3): 121-9 0142-2782

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Effects of prenatal protein malnutrition and neonatal stress on CNS responsiveness. Author(s): Neuroscience Program and Department of Engineering, Trinity College, Hartford, CT, USA Source: Kehoe, P Mallinson, K Bronzino, J McCormick, C M Brain-Res-Dev-Brain-Res. 2001 December 14; 132(1): 23-31 0165-3806

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Immunological effects of yogurt addition to a re-nutrition diet in a malnutrition experimental model. Author(s): Centro de Referencia para Lactobacilos, CERELA, Tucuman, Argentina. Source: Cano, P G Aguero, G Perdigon, G J-Dairy-Res. 2002 May; 69(2): 303-16 0022-0299

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Impact of protein energy malnutrition on Trichuris suis infection in pigs concomitantly infected with Ascaris suum. Author(s): Danish Centre for Experimental Parasitology, The Royal Veterinary and Agricultural University, Copenhagen. [email protected] Source: Pedersen, S Saeed, I Michaelsen, K F Friis, H Murrell, K D Parasitology. 2002 May; 124(Pt 5): 561-8 0031-1820

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Individually adjusted meals for older people with protein-energy malnutrition: a single-case study. Author(s): Department of Medicine and Care, Faculty of Health Sciences, Linkoping University, Sweden. [email protected] Source: Christensson, L Ek, A C Unosson, M J-Clin-Nurs. 2001 July; 10(4): 491-502 09621067

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Inflammation and malnutrition as predictors of mortality in patients on hemodialysis. Author(s): Servicio de Nefrologia, H. General, Segovia, Spain. [email protected] Source: Fernandez Reyes, M J Alvarez Ude, F Sanchez, R Mon, C Iglesias, P Diez, J J Vazquez, A J-Nephrol. 2002 Mar-April; 15(2): 136-43 1120-3625

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Influence of protein-caloric supplements and malnutrition in patients suffering from femoral neck fractures. Influence d'un supplement proteocalorique et malnutrition chez les patients victimes de fracture du col du femur. Source: Bruyere, A. Rapin, C.H. Dirren, H. Proceedings of the Xth International Congress of Dietetics / held under the auspices of the I.C.D.A. (the International Committee of Dietetic Associations); edited by M.F. Moyal. London : Libbey Eurotext, c1988. volume 1 page 253-256.

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Is this the way to solve malnutrition? Source: Lorch, A. Biotechnology-and-Development-Monitor (Netherlands). (March 2001). (no.44-45) page 18-22. vitamin a deficiency biotechnology rice malnutrition health intellectual property rights beta carotene modification patents 0924-9877

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Long-term effects of malnutrition during lactation on the thyroid function of offspring. Author(s): Department of Applied Nutrition, Nutrition Institute, State University of Rio de Janeiro, Av. 28 de setembro, 87, Rio de Janeiro, RJ 20550-030, Brazil. Source: Passos, M C da Fonte Ramos, C Dutra, S C P Mouco, T de Moura, E G HormMetab-Res. 2002 January; 34(1): 40-3 0018-5043

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Malabsorption and malnutrition. Author(s): Section of Gastroenterology, Department of Medicine, Bridgeport Hospital, Bridgeport, Connecticut 06610, USA. Source: Tabrez, S Roberts, I M Prim-Care. 2001 September; 28(3): 505-22, v 0095-4543

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Malnutrition and environmental stimulation in rats: interpeak intervals of the brainstem auditory evoked potentials. Author(s): Department of the Psychology and Education, FFCLRP, University of the Sao Paulo, Ribeirao Preto, Brazil. [email protected] Source: Rocinhol, L F Oliveira, L M Colafemina, J F Nutr-Neurosci. 2001; 4(3): 189-98 1028-415X

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Malnutrition in chronic obstructive pulmonary disease: adding insult to injury. Author(s): University of Illinois at Chicago, College of Nursing M/C802, Chicago, IL 60612, USA. [email protected] Source: Berry, J K Baum, C L AACN-Clin-Issues. 2001 May; 12(2): 210-9 1079-0713

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Malnutrition in patients suffering from chronic heart failure; the nurse's care. Author(s): Department of Medicine, Cardiac Care Unit, Halmstad Central Hospital, 301 85 Halmstad, Sweden. Source: Jacobsson, A Pihl Lindgren, E Fridlund, B Eur-J-Heart-Fail. 2001 August; 3(4): 449-56 1388-9842

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Malnutrition in surgical patients. Source: Cohen, I. Wilson, S.E. Pediatric nutrition : theory and practice / edited by Richard J. Grand, James L. Sutphen, William H. Dietz. Boston : Butterworths, c1987. page 651-661. charts. ISBN: 0409951110

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Maternal malnutrition in the UK and low birthweight. Author(s): Institute of Brain Chemistry and Human Nutrition, University of North London, UK. Source: Doyle, W Rees, G Nutr-Health. 2001; 15(3-4): 213-8 0260-1060

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Mental development and malnutrition. Source: Cravioto, J. Cravioto, P. Long-term consequences of early feeding /. Philadelphia : Lippincott-Raven, c1996. page 35-56. ISBN: 0397517289

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Pepsins in protein-energy malnutrition. Source: Adamson, I. Esangbedo, A. Abiodun, P. Enzyme. Basel : S. Karger. 1988. volume 39 (1) page 44-49. 0013-9432

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Platelet functions in patients with protein-energy malnutrition. Author(s): Department of Pediatrics, Yuzuncu Yil University, Van, Turkey. Source: Uner, A Caliskan, U Oner, A F Koc, H Kasap, A F Clin-Appl-Thromb-Hemost. 2001 October; 7(4): 286-8 1076-0296

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Prevalence of protein malnutrition in children maintained on peritoneal dialysis. Author(s): Division of Pediatric Nephrology, Rhode Island Hospital APC-942, 593 Eddy Street, Providence 02903, USA. [email protected] Source: Brem, A S Lambert, C Hill, C Kitsen, J Shemin, D G Pediatr-Nephrol. 2002 July; 17(7): 527-30 0931-041X

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Protein and energy supplementation in elderly people at risk from malnutrition. Author(s): Health Services Research Unit (Foresterhill Lea), University of Aberdeen, Foresterhill, Aberdeen, Aberdeenshire, Scotland, UK, AB25 2ZD. [email protected] Source: Milne, A C Potter, J Avenell, A Cochrane-Database-Syst-Revolume 2002; (3): CD003288 1469-493X

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Protein-energy malnutrition. Source: MacLean, W.C. Jr. Pediatric nutrition : theory and practice / edited by Richard J. Grand, James L. Sutphen, William H. Dietz. Boston : Butterworths, c1987. page 421-431. charts. ISBN: 0409951110

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Relationship between protein-energy malnutrition, vitamin A, and parasitoses in living in Brasilia. Author(s): Laboratorio de Imunologia Celular, Area de Patologia, Faculdade de Medicina, Universidade de Brasilia, Brasilia, DF, Brasil. [email protected] Source: Muniz Junqueira, M I Queiroz, E F Rev-Soc-Bras-Med-Tropage 2002 Mar-April; 35(2): 133-41 0037-8682

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Seeds for a better future: 'low phytate' grains help to overcome malnutrition and reduce pollution. Author(s): US Department of Agriculture, Agricultural Research Service, 1691 So. 2700 W, PO Box 307, Aberdeen, ID 83210, USA. [email protected] Source: Raboy, V Trends-Plant-Sci. 2001 October; 6(10): 458-62 1360-1385

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Selenium status during recovery from malnutrition: effect of selenium supplementation. Source: Murphy, C. Golden, B. Ramdath, D. Golden, M. Trace elements in man and animals 6 / edited by Lucille S. Hurley,. [et al.]. New York : Plenum Press, c1988. page 11-12. ISBN: 0306430045

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Serum ascorbic acid and protein calorie malnutrition in continuous ambulatory peritoneal dialysis patients. Author(s): Division of Nephrology, Department of Medicine, National University Hospital, Singapore. Source: Lee, E J Myint, C C Tay, M E Yusuf, N Ong, C N Adv-Perit-Dial. 2001; 17: 219-22 1197-8554

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The GAbAergic and cholinergic systems in the retina are differentially affected by postnatal malnutrition during the suckling period. Author(s): Laboratorio de Neurobiologia da Retina, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Ilha do Fundao, Brazil. Source: Almeida, M F Yamasak, E N Silveira, A C Guedes, R C Hokoc, J N NutrNeurosci. 2001; 4(3): 223-38 1028-415X

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The minimum data set: predicting malnutrition in newly admitted nursing home residents. Author(s): College of Nursing, University of Arizona Health Sciences Center, USA. Source: Crogan, N L Corbett, C F Short, R A Clin-Nurs-Res. 2002 August; 11(3): 341-53 1054-7738

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The potential of extruded chickpea, corn and bovine lung for malnutrition programs. Source: Cardoso Santiago, R.A. Moreira Araujo, R.S.R. Pinto e Silva, M.E.M. Areas, J.A.G. Innov-food-sci-emerg-technol. New York, NY : Elsevier Science, c2000-. Sept 2001. volume 2 (3) page 203-209. 1466-8564

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Ultrastructural changes and glutathione depletion in the skeletal muscle induced by protein malnutrition. Author(s): Department of Anatomy and Nutrition Morphology, Graduate School of Health and Nutrition Sciences, Nakamura Gakuen University, Fukuoka, Japan. [email protected] Source: Oumi, M Miyoshi, M Yamamoto, T Ultrastruct-Pathol. 2001 Nov-December; 25(6): 431-6 0191-3123

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Zinc, sodium and potassium losses in the diarrhoeas of malnutrition and zinc deficiency. Source: Golden, B.E. Golden, M.H.N. Trace elements in man and animals : TEMA 5 : proceedings of the fifth International Symposium on Trace Elements in Man and Animals / editors C.F. Mills, I. Bremner, & J.K. Chesters. Farnham Royal, Slough : Commonwealth Agricultural Bureaux, c1985. page 228-232. ISBN: 085198553X

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vitamins Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com

Nutrition

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

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CHAPTER 3. DISSERTATIONS ON MALNUTRITION Overview In this chapter, we will give you a bibliography on recent dissertations relating to malnutrition. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “malnutrition” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on malnutrition, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Malnutrition ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to malnutrition. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

An Economic Analysis of Malnutrition among Young Children in Rural Thailand: Determinants and Implications by Chutikul, Sirilaksana, PhD from University of Hawaii, 1982 http://wwwlib.umi.com/dissertations/fullcit/f66806

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An Economic Analysis of the Determinants of Malnutrition among Young Children in Rural India by Levinson, Franklin James, PhD from Cornell University, 1972, 135 pages http://wwwlib.umi.com/dissertations/fullcit/7310126

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Children's Malnutrition in Rural Guatemala: A Multilevel Statistical Analysis by Gragnolati, Michele, PhD from Princeton University, 1999, 125 pages http://wwwlib.umi.com/dissertations/fullcit/9927803

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Colonial Capitalism and Malnutrition: Nigeria, Kenya and Jamaica. by Oculi, Okello, PhD from The University of Wisconsin - Madison, 1977, 215 pages http://wwwlib.umi.com/dissertations/fullcit/7717846

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Cortical Bone Growth and Relationships with Body Size in Guatemalan Preschool Age Children with Mild to Moderate Protein-Calorie Malnutrition. by Himes, John Harter, PhD from The University of Texas at Austin, 1975, 187 pages http://wwwlib.umi.com/dissertations/fullcit/7524889

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Development of Protein-Calorie Malnutrition in the Male Weanling Rat by Philbrick, Diana-Jane; PhD from University of Guelph (Canada), 1976 http://wwwlib.umi.com/dissertations/fullcit/NK31107

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Development Problems in Rural Ghana: The Case of Wamfie (Rural Development, Poverty, Disease, Malnutrition) by Gyamfi-Kumanini, Nana, PhD from Walden University, 1994, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9526503

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Dimensions of Malnutrition and Hunger among Children in an Andean Community by Graham, Margaret Anne, PhD from Michigan State University, 1991, 265 pages http://wwwlib.umi.com/dissertations/fullcit/9216307

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Estimation of Health Demand and Health Production Functions for Children in Brazil (Nutrition Economics, Malnutrition) by Kassouf, Ana Lucia, PhD from University of Minnesota, 1993, 145 pages http://wwwlib.umi.com/dissertations/fullcit/9328353

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Influence of Protein-Calorie Malnutrition on the Anti-inflammaTory Activity of Salicylate in Rats by Yue, Tian Li; PhD from McGill University (Canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK66580

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Kwashiorkor on Kilimanjaro: The Social Handling of Malnutrition by Howard, Mary Theresa, PhD from Michigan State University, 1980, 269 pages http://wwwlib.umi.com/dissertations/fullcit/8106387

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Malnutrition in Urban Jamaica. Culture, Health, and Well-Being: The God Factor by Tafari, Ida Vintes, PhD from State University of New York at Buffalo, 1993, 157 pages http://wwwlib.umi.com/dissertations/fullcit/9330118

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Malnutrition, Gender, and Development in Ifugao, an Upland Community in the Philippines by Kwiatkowski, Lynn Mary, PhD from University of California, Berkeley with San Francisco State Univ., 1994, 497 pages http://wwwlib.umi.com/dissertations/fullcit/9529712

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'Native Development' and Chronic Malnutrition in Sukumaland, Tanganyika, 1925 1945 (Tanzania) by Little, Marilyn, PhD from University of Minnesota, 1987, 293 pages http://wwwlib.umi.com/dissertations/fullcit/8713086

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Patterns of Protein-Energy Malnutrition among Preschoolers in Belize by Jenkins, Carol Lynn, PhD from The University of Tennessee, 1980, 217 pages http://wwwlib.umi.com/dissertations/fullcit/8104595

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Positioned Perspectives: Understanding Childhood Malnutrition in Niger by Rothenberg, Debra Ann; PhD from Michigan State University, 2001, 440 pages http://wwwlib.umi.com/dissertations/fullcit/3021838

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Relationship of Malnutrition and Mental Functioning. by Rushing, William David, PhD from Southern Illinois University at Carbondale, 1975, 95 pages http://wwwlib.umi.com/dissertations/fullcit/7626962

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Relationships between Marginal Malnutrition, Seasonal Food Intake, Socioeconomic Factors, and Work Performance in Rural Honduras by Grieb, Bettina Christiane, PhD from Kansas State University, 1989, 157 pages http://wwwlib.umi.com/dissertations/fullcit/9005057

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Rural and Urban Food Behavior in Bangladesh: An Anthropological Perspective to the Problem of Malnutrition. by Rizvi, Najma, PhD from University of California, Los Angeles, 1979, 337 pages http://wwwlib.umi.com/dissertations/fullcit/7921450

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Segmentation Research in the Marketing of a Social Cause: Malnutrition in Developing Countries. by Fine, Seymour Howard, PhD from Columbia University, 1978, 263 pages http://wwwlib.umi.com/dissertations/fullcit/7819336

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Social, Cultural and Historical Determinants of Childhood Malnutrition in Urban Communities of Managua and San Jose (Nicaragua, Costa Rica) by McGarrity, Gayle Lynett, PhD from University of California, Berkeley, 1993, 552 pages http://wwwlib.umi.com/dissertations/fullcit/9430603

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Sociocultural Factors Contributing to Protein-Calorie Malnutrition among Preschool Children in Accra, Ghana. by Gershon, Jack, PhD from Univ. of Calif., San Francisco with the Univ. of Calif., Berkeley, 1978, 248 pages http://wwwlib.umi.com/dissertations/fullcit/7904666

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The Correlation of Socioeconomic and Educational Levels, Cultural Factors and Malnutrition among the Banyankole Tribesmen of Uganda by Chipadza, Emedia Evelyn, PhD from United States International University, 1982, 125 pages http://wwwlib.umi.com/dissertations/fullcit/8216480

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The Crisis of Child Malnutrition in Rural North India: Evidence from the Bimaru States by Satyavada, Aravinda; PhD from Kansas State University, 2002, 180 pages http://wwwlib.umi.com/dissertations/fullcit/3059644

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The Dimensions and Causes of Child Malnutrition in a Balinese Village by Cerf, Barry John, PhD from Columbia University, 1982, 229 pages http://wwwlib.umi.com/dissertations/fullcit/8427362

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The Geographic Dimensions of Malnutrition in Haryana, India by Aggarwal, Surinder Kumar, PhD from Kent State University, 1982, 217 pages http://wwwlib.umi.com/dissertations/fullcit/8216936

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The Magnitude of the Incidence of Kwashiorkor (Protein-Calorie Malnutrition) and the Development of Educational Programs to Decrease Its Occurrence in Ashanti Region of Ghana by Baffour-Senkyire, Joseph K., PhD from Purdue University, 1971, 162 pages http://wwwlib.umi.com/dissertations/fullcit/7201820

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The Pattern of Childhood Malnutrition in San Jose Poaquil, Guatemala (Beliefs, Economics, Infection) by Burleigh, Elizabeth, PhD from University of California, Los Angeles, 1986, 274 pages http://wwwlib.umi.com/dissertations/fullcit/8621032

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The Relationship between Reading Achievement and School-Sponsored Breakfast Programs (Nutrition, Relationship, Learning, Protein, Malnutrition, Mississippi) by Brumfield, George Rogers, EdD from The University of Southern Mississippi, 1985, 115 pages http://wwwlib.umi.com/dissertations/fullcit/8611208

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Transforming Social, Gendered Practices Affecting Malnutrition: Action Research in Malawi by Drost, Nancy Marie; EdD from University of Toronto (Canada), 1999, 331 pages http://wwwlib.umi.com/dissertations/fullcit/NQ41065

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Urban Malnutrition: Maternal Activities and Child Nutrition in Kigali, Rwanda by Ogden, Cynthia Louise, PhD from Cornell University, 1993, 278 pages http://wwwlib.umi.com/dissertations/fullcit/9325316

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Will Viet Nam Grow Out of Malnutrition? The Impact of Market Transition on Child Growth by Ponce, Ninez Alafriz, PhD from University of California, Los Angeles, 1998, 126 pages http://wwwlib.umi.com/dissertations/fullcit/9905499

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 4. CLINICAL TRIALS AND MALNUTRITION Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning malnutrition.

Recent Trials on Malnutrition The following is a list of recent trials dedicated to malnutrition.8 Further information on a trial is available at the Web site indicated. •

Study of antioxidants and oxidants in malnourished children Condition(s): Protein-Energy Malnutrition; Kwashiorkor; Marasmus Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: It is believed that the organs of severely malnourished children malfunction because harmful compounds called oxidants injure the tissues in these organs. In a healthy person oxidants are made harmless because another compound called glutathione neutralizes them. Glutathione is made from three amino acids that we get from the protein we eat in our food. We found that malnourished children were not making enough glutathione because they lacked one of these amino acids called cysteine. In this study we determine why malnourished children do not have sufficient cysteine, and we will feed malnourished children a whey-based diet which is rich in cysteine during their treatment to determine whether they will make more glutathione. This in turn may make their organs recover faster. These findings will let us know whether malnourished children can recover faster if they are given more cysteine during the early phase of treatment. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00069134

8

These are listed at www.ClinicalTrials.gov.

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A Study of Different Doses of Megestrol Acetate in Patients with AIDS Who Have Anorexia and Malnutrition Condition(s): Anorexia; Cachexia; HIV Infections Study Status: This study is no longer recruiting patients. Sponsor(s): Bristol-Myers Squibb Purpose - Excerpt: To compare the effects of megestrol acetate and placebo on body weight, anorexia, cachexia, calorie intake, and nutritional parameters of patients with a confirmed diagnosis of AIDS. To characterize dose response in relation to weight gain. To determine whether megestrol acetate relative to placebo improves the perception of well-being among AIDS patients with cachexia. To evaluate megestrol acetate's effect on immune function via skin test reactivity, T4/T8 ratio, and total lymphocytes. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002300

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 “malnutrition” (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/

•

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 5. PATENTS ON MALNUTRITION 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 “malnutrition” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on malnutrition, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Malnutrition By performing a patent search focusing on malnutrition, 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 malnutrition: •

Amino acid solutions for treatment of peritoneal dialysis patients Inventor(s): Jones; Michael R. (Hawthorne Woods, IL), Martis; Leo (Long Grove, IL) Assignee(s): Baxter International Inc. (deerfield, Il) Patent Number: 5,670,176 Date filed: April 4, 1995 Abstract: The present invention provides a dialysis solution that contains amino acids for treating and/or preventing malnutrition in a peritoneal dialysis patient. The amino acid composition is optimized to minimize metabolic acidosis while normalizing amino acid plasma profiles. Excerpt(s): The present invention relates generally to peritoneal dialysis and solutions for same. More specifically, the present invention relates to providing nutrition to peritoneal dialysis patients. Dialysis provides a method for supplementing or replacing renal function in certain patients. Principally, hemodialysis and peritoneal dialysis are utilized. Although dialysis provides in many cases life saving therapy, there are health issues that must be addressed in such patients. In hemodialysis, the patient's blood is passed through an artificial kidney dialysis machine. A membrane in the machine acts as an artificial kidney for cleansing the blood. Because it is an extracorporeal treatment that requires special machinery, there are certain inherent disadvantages with hemodialysis. Web site: http://www.delphion.com/details?pn=US05670176__

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Bird's nest Inventor(s): Oh; Jung C. (107-607, Hyundai, Apt. Ung Bong-Dong, Sungdong-Ku, Seoul, KR) Assignee(s): None Reported Patent Number: 5,134,970 Date filed: November 26, 1991 Abstract: A bird's nests comprising a box-shaped body having a roof, a hole provided at each corner of said roof, a first entrance and a second entrance provided at an upper part and at a lower part of a front side of the body, side plates fitted to both sides of the body, a slit formed under the first entrance, and a pair of guide rail rearwardly extending from both ends of the slit; a panel which has at least one divided feed bucket slidably inserted into the slit; an inner wall vertically extending from a rear surface of the front side of the body; a bottom plate mounted at a lower portion of the body; a hanging bracket provided at a rear side of the body; means for slidably fitting both sides of the body with the side plates; and a hanger for hanging the nest on trees. The bird's nest according to the invention has advantages in that parent birds, during the laying and brooding on eggs period, can access to the feed buckets easily thereby preventing the birds from malnutrition, and that the nest is capable of installing both in a cage and on the trees of the fields.

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Excerpt(s): The present invention relates to a bird's nest, and more particularly to a bird's nest capable of preventing malnutrition in case of bird's nests installed in cages or on trees, birds can not easily eat food, thereby protecting the birds from malnutrition during the laying and brooding on eggs period. Conventionally, known bird's nests are designed to have at their inner bottom a cavity formed therein which is a depressed portion for restraining an injurious animal from looking or invading the nest so that parent birds can comfortably brood on eggs gathered in the center of the inner bottom. However, the known bird's nest are not provided with a feed bucket so that the parent birds can not easily eat feed due to brooding on the eggs during the laying and brooding on the eggs period. Thus, the known nest has a disadvantage in that it causes the parent birds in brooding on the eggs to sometimes suffer from malnutrition or become even starved to death. Web site: http://www.delphion.com/details?pn=US05134970__ •

Food composition comprising urea Inventor(s): Anderson; Kent L. (Crete, NE), Anderson; Philip C. (Crete, NE) Assignee(s): Foodsmith Corporation (crete, Ne) Patent Number: 5,098,719 Date filed: August 14, 1990 Abstract: The present invention provides food compositions comprising urea, sorbitol and a quantity of an edible anti-urease component effective to prevent substantial exocellular degradation of urea, and methods of using such compositions to alleviate protein malnutrition and to suppress the appetite in humans for ethanol specifically or for food generally. Excerpt(s): The present invention relates generally to human dietary supplements and more specifically to dietary supplements which are useful as a source of dietary nitrogen. Daily acquisition of sufficient dietary protein of adequate quality is an essential task of all living things. Nitrogen is a critical element required for the synthesis of protein, and a tremendous amount of human work is devoted to the effort to support the biological nitrogen economy of the species. At all stages in the existence of humans, there is a continuing process of acquisition and loss of nitrogen with nitrogen balance being the difference between intake and loss of nitrogen. Growth during infancy and childhood is characterized by a strong positive nitrogen balance in which intake substantially exceeds output. Maximal negative nitrogen balance is elicited by starvation and implies loss of lean body mass through breakdown of endogenous protein. In all mammals, maintenance of appropriate nitrogen balance equilibrium is a basic biological requirement which is ultimately dependent on timely consumption of sufficient amounts of foods of suitable nutritional quality. In humans as in other mammals, a reserve of non-protein nitrogen is provided by urea, a compound ubiquitous in the blood of mammals. Blood urea nitrogen (BUN) is routinely measured as a critical indicator in human medicine. There is a direct relationship between BUN and the total nitrogen balance in humans when BUN is less than about 14 mg/100 ml of blood serum. Web site: http://www.delphion.com/details?pn=US05098719__

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Formulations containing growth hormone and nutritional supplements, and methods of treating malnutrition in chronic lung disease Inventor(s): Rothkopf; Michael (North Caldwell, NJ) Assignee(s): Clinical Homecare, Corp. (fairfield, Nj) Patent Number: 5,179,080 Date filed: August 31, 1989 Abstract: Methods of treating malnutrition associated with chronic lung diseases comprising the administration of metabolically active peptides in an amount sufficient to increase circulating somatomedin C levels more than 0.8 U/ml plasma above the patient's baseline SmC level, along with nutritional supplementation providing a daily caloric intake of between 100% and 200% of the patient's baseline resting energy expenditure; and formulations utilized therein. Excerpt(s): This invention relates to formulations of metabolically active peptides and nutritional supplements, and to methods of treatment of malnutrition in chronic lung diseases therewith. The present invention is directed to formulations and methods of treating malnutrition associated with chronic lung diseases. Chronic lung diseases include diseases such as chronic obstructive pulmonary disease (COPD), cystic fibrosis and interstitial lung disease. A common characteristic of these diseases is the decreased capacity of lungs to exchange oxygen and carbon dioxide. This causes the patient to breathe faster which increases the energy the patient must expend in order to obtain enough oxygen. Malnutrition is a common complication in these patients resulting from the increased energy needed to breathe as well as the reduced oral intake of food. This often results in weight loss which leads to a decline in pulmonary function. Severe weight loss is associated with a poor prognosis and increased mortality. Sukumalchantra, et al. Am. J Med, 39:941-945 (1965); Vandenbergh, et al., Am Rev Respir Dis, 95:556-566 (1967); Burrows, et al., Am Rev Respir Dis. 91:665-678 (1963); and Tiech, S., Chest. 85:635-665(1984). Web site: http://www.delphion.com/details?pn=US05179080__

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High-caloric, high-fat dietary formula Inventor(s): Simko; Vlado (Staten Island, NY) Assignee(s): The State University of New York (albany, Ny) Patent Number: 4,690,820 Date filed: June 7, 1985 Abstract: A high caloric, high fat dietary composition having greater than 2.5 Kcals/ml. is utilizable for enteral hyperalimentation in severe malnutrition. The composition has an increased proportion of fat which gives it a higher caloric density and enables a patient to be fed up to 6000 Kcals/24 hour period. Excerpt(s): Critically ill patients often lose their ability to ingest normal amounts of food necessary to maintain adequate nutritional levels. Typical of such patients are those having various oroesophageal cancers, strokes, neuromuscular dystrophy and Parkinson's Disease. Many cancer therapy routines require periods of abstinence. Other cancer therapies often cause nausea and vomiting which result in the interruption of a patient's normal eating habits. Obviously, such patients become malnourished and resort must be had to some form of hyperalimentation in order to sustain the patient.

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Enteral hyperalimentation is usually the treatment of choice since it produces fewer side effects than the introduction of nutrients directly into a vein. The compositions presently marketed as complete therapeutic diets for enteral hyperalimentation all contain 2 Kcal/ml or less. These products have a low fat and high carbohydrate content. Carbohydrates are osmotically more active than fats. Low fat diets have a higher osmolality which frequently leads to diarrhea. This reduces the feeding load of such products to less than 3500 Kcal/24 hours. Also, the lower caloric density of low fat diets precludes higher intake because of the volume limitations. Although central vein hyperalimentation can provide more energy and nutrients, this mode of feeding has frequent serious side effects which limit the intake to below 4000 Kcal/24 hours. Compositions which would provide a higher caloric intake via enteral hyperalimentation without side effects would obviously be desirable. Heretofore, such compositions have been unknown. Low fat content of the presently available diets is based on the observation of increased stool fat in malabsorption. (See Davis-Christopher Textbook of Surgery, Ed. D. C. Sabiston, Jr., W. B. Saunders Co., Philadelphia, Pa., (1977) p. 1021; Clinics In Gastroenterology, 8, 373 (1979); Gastrointestinal Disease, II, 2nd. Ed., W. B. Saunders Co., Philadelphia, Pa., (1978), "The Short Bowel Syndrome", Trier, 1137). This accepted clinical judgment completely neglects that with increasing intake of dietary fat there is a linear increase in the absorption of fat. A great example from the nature the very high fat content of breast milk provided for the first weeks of life has not been conceptually considered in the development of routinely available diets. Web site: http://www.delphion.com/details?pn=US04690820__ •

Immunoassay for thymopoietin Inventor(s): Goldstein; Gideon (Riverdale, NY) Assignee(s): Sloan Kettering Institute for Cancer Research (new York, Ny) Patent Number: 4,124,700 Date filed: June 27, 1977 Abstract: An immunoassay for the polypeptide thymic hormone thymopoietin is described. Determination of thymopoietin levels in biological fluids provides a useful diagnostic test for myasthenia gravis (elevated levels), immune deficiency diseases (reduced levels), (immunologically mediated diseases such as rheumatoid arthritis, systemic lupus erythematosus and allergy (reduced levels), cancer (reduced levels), malnutrition (reduced levels) and infections (reduced levels). The present assay is also useful as a monitor of the effectiveness of therapy in each of the aforementioned types of disease states. Excerpt(s): Thymopoietin is a polypeptide hormone of the thymus that induces differentiation of prothymocytes to thymocytes and also has secondary effects on neuromuscular transmission. Two forms of bovine thymopoietin, designated thymopoietin I and II have been isolated and shown to be immunologically cross reactive. (Thymopoietin is now used in preference to the original name Thymin). See G. Goldstein, Nature 247, 11 (1974). Although thymopoietin can be detected by bioassay using either its effects on T cell differentiation or neuromuscular transmission, these assays are complex, timeconsuming, and difficult to standardize. Moreover, unlike immunoassay, and particularly radioimmunoassay, bioassays are not readily automated and thus could not be routinely employed by clinical laboratories or other diagnostic facilities to screen large numbers of samples in an economic fashion. The present invention relates to an immunoassay for thymopoietin. A preferred immunoassay can

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give sensitivities down to about 0.1 ng/ml. of the hormone in biological fluid samples such as plasma or serum. Thus the instant assay can be employed as a diagnostic test for disease states which exhibit either elevated (myasthenia gravis) or reduced (aging, immune deficiency or immunologically mediated diseases, cancer, malnutrition, infections and the like) levels of thymopoietin. The two forms of thymopoietin are indistinguishable in immunoassay procedures. Web site: http://www.delphion.com/details?pn=US04124700__ •

Method of predicting body cell mass using bioimpedance analysis Inventor(s): Kotler; Donald P. (New Rochelle, NY) Assignee(s): St. Luke's-roosevelt Hospital (new York, Ny) Patent Number: 5,615,689 Date filed: December 12, 1994 Abstract: The inability to precisely estimate body composition using simple, inexpensive and easily applied techniques is an impediment to clinical investigations in nutrition. In this study, predictive equations for body cell mass (BCM), fat free mass (FFM), and total body water (TBW), were derived, using single frequency bioimpedance analysis (BIA), in 332 subjects, including white, black and hispanic men and women, both normal healthy controls and patients infected with the human immunodeficiency virus (HIV). Preliminary studies demonstrated more accurate predictions of BCM when using parallel transformed values of reactance than the values reported by the bioimpedance analyzer. Modeling equations derived after logarithmic transformation of height, reactance and impedance were more accurate predictors than equations using height.sup.2 /resistance, and the use of gender-specific equations further impoved accuracy. The addition of weight to the modeling equation also improved accuracy but was less important than the impedance measurements. The resulting equations were internally validated, and race, disease (HIV infection) and malnutrition were shown not to affect the predictions. The equation for FFM also was validated externally against results derived from hydrodensitometry measurements in a group of 440 healthy individuals, with a standard error of the estimate of under 5%. These results indicate that body composition can be estimated accurately using simple, inexpensive, and easily applied techniques, and that the estimates are sufficiently precise for use in clinical investigation and clinical practice. Excerpt(s): Recent developments in the field of body composition analysis have increased the accuracy of estimation of the different body compartments in normal individuals (1-3). However, the ability to assess body composition in the clinical arena has lagged behind scientific and technological developments. Research techniques such as whole body counting, isotope dilution, dual photon absorptiometry, total body electrical conductivity, in vivo neutron activation analysis, and others have limited availability, are expensive to develop and maintain, and are technologically difficult to perform, thus limiting their applicability in field studies. Bioimpedance analysis (BIA) has shown great potential in its ability to estimate body composition. The method is based upon assuming the body to be a cylindrical-shaped ionic conductor, with the extracellular and intracellular, non-adipose tissue compartments acting as resistors and capacitors, respectively (4). Initial studies indicated that total body water (TBW) volume was more closely related to height.sup.2 /resistance than to height/resistance, as predicted from the theoretical model (5,6). Those studies also showed that reactance (capacitance) did not add to the accuracy of predicting TBW (5,6). Many investigators

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have developed empiric equations for predicting TBW, extracellular and intracellular water volumes, lean body mass, body cell mass, and body fat content utilizing weight, age, gender, race, or other variables in addition to height and resistance (7-16). However, the body is not shaped as a simple cylinder. In addition, the lack of effect of reactance in predicting TBW does not negate its potential use in predicting other body composition parameters. Furthermore, few studies have compared the predictability of BIA as a function of race, gender or disease. The purpose of this study was to derive predictive equations for the estimation of body cell mass (BCM), fat free mass (FFM), and TBW using single frequency BIA. Studies were performed in a large, diverse group of study subjects, including white, black and hispanic men and women, and in healthy subjects as well as subjects infected with the human immunodeficiency virus. Predictive equations were derived from direct measurements; BCM by determination of total body potassium (TBK), FFM and fat content by dual X ray absorptiometry, and TBW by.sup.2 H.sub.2 O dilution. The usefulness of using reactance in the predictive models for BCM, FFM, and TBW was determined. The precise relationship between height and the impedance values, resistance and reactance, was evaluated using an exponential approach to regression analysis. The resulting predictive models were internally validated and their relative accuracy in men and women, whites, blacks and hispanics, and in healthy people versus those infected with the human immunodeficiency virus (HIV) were determined. In addition, the predictive model derived from the current data set for FFM was compared to calculations based upon studies performed in a large group of healthy controls, in whom fat free mass was determined by hydrodensitometry. Web site: http://www.delphion.com/details?pn=US05615689__ •

Mixed salts of essential or semi-essential amino acids and nitrogen-free analogs thereof Inventor(s): Walser; Mackenzie (Ruxton, MD) Assignee(s): The Johns Hopkins University (baltimore, Md) Patent Number: 4,296,127 Date filed: April 18, 1979 Abstract: Novel compounds are prepared by reacting essential or semi-essential amino acids with nitrogen-free analogues thereof, particularly alpha-keto and/or alphahydroxy analogues. The mixed salt reaction products are precursors of essential and semi-essential amino acids in the body, and mixtures of the salts are useful in the treatment of renal and hepatic disorders characterized by protein intolerance leading to deficiencies of various essential and semi-essential amino acids in the body. They may also be useful in the treatment of nitrogen wasting disorders and protein malnutrition. The novel compounds are generally far more palatable and soluble in aqueous solutions than the individual essential or semi-essential amino acids, nitrogen-free analogues thereof, or simple mixtures of these. Excerpt(s): The present invention is directed to mixed salts of essential or semi-essential amino acids and nitrogen-free analogues thereof, and to the use of these novel salts in the treatment of renal and hepatic disorders. More particularly, the invention is directed to the novel compounds per se, compositions containing mixtures of the novel compounds, and methods of treatment using the compounds. The essential amino acids in man are L-isoleucine, L-leucine, L-valine, L-methionine, L-phenylalanine, L-histidine, L-lysine, L-tryptophan and L-threonine. The semi-essential amino acids for man include

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L-tyrosine, L-cystine, and L-cysteine, which are believed to be required for optimal growth in infants. Arginine is essential in children who have defects of one of the enzymes of the urea cycle, but is not generally considered essential or semi-essential in normal man, although it may have nutritional value. Ornithine is also not generally considered essential or semi-essential in man, but will substitute for arginine. Nevertheless, for ease of reference in the present disclosure arginine and ornithine will be grouped with and referred to as semi-essential amino acids, unless otherwise indicated. Renal disorders (such as uremia), hepatic diseases (such as hyperammonemia and portal-systemic encephalopathy), and other protein or nitrogen wasting diseases of man result in severe deficiencies of essential and/or semi-essential amino acids which are needed for building protein in the body. Thus, individuals suffering from renal and hepatic disorders must either be restricted in their ingestion of dietary protein due to the inability of the kidneys to excrete nitrogenous wastes, or they are intolerant of dietary protein due to the vomiting, agitation, lethargy and impaired mental and physical processes which occur following protein ingestion. Web site: http://www.delphion.com/details?pn=US04296127__ •

Nutritional assessment by measuring mitochondrial complex activity Inventor(s): Jeejeebhoy; Kursheed (69 Boulton Drive, Toronto, Ontario, CA) Assignee(s): None Reported Patent Number: 6,455,243 Date filed: February 16, 2001 Abstract: According to a first aspect of the invention, a method of detecting malnutrition in a mammal is provided. The method includes the steps of: (a) measuring the activity in the mammal of one of more complexes selected from the group consisting of Complex I, Complex II, and Complex III; and (b) determining if the level of activity is below the level of activity of the complexes in a normal control sample. According to a second aspect of the invention, the use of Complex I is disclose for nutritional assessment of a mammal. According to a third aspect of the invention, the use of Complex II is disclosed for nutritional assessment of a mammal. According to a fourth aspect of the invention, the use of Complex III is disclosed for nutritional assessment of a mammal. According to a fifth aspect of the invention, a kit for nutritional assessment of a mammal is provided, comprising one or more reagents for measuring the activity in the mammal of one or more complexes selected from the group consisting of Complex I, Complex II, and Complex III. Excerpt(s): This invention relates to nutritional assessment, and in particular to a method of nutritional assessment by measuring Complex I, II, and III activity, as well as use of these compounds for nutritional assessment. It is known in the prior art that lack of or excess intake of nutrients results in a change in the amount of body fat, lean tissue.sup.1 and plasma proteins Accordingly, prior art methods of nutritional assessment have been based on changes in both body composition and plasma proteins. However, these prior art methods are not able to differentiate whether the loss of body fat and leant tissue results from lack of intake of nutrients, or from some other cause not related to nutrition, such as disease. Accordingly, there is a need for a nutritional assessment which is capable not only of determining malnutrition, but also whether the cause of the malnutrition is a lack of intake of nutrients. Web site: http://www.delphion.com/details?pn=US06455243__

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Pinitol and derivatives thereof for the treatment of metabolic disorders Inventor(s): Ostlund; Richard E. (39 Fair Oaks, Ladue, MO 63124), Sherman; William R. (8126 Teasdale Ave., University City, MO 63130) Assignee(s): None Reported Patent Number: 5,550,166 Date filed: March 17, 1995 Abstract: Pinitol and derivatives and metabolites thereof are useful in nutritional and medicinal compositions for treating conditions associated with insulin resistance, such as diabetes mellitus and its chronic complications; obesity; hyperlipidemias and dyslipidemias atherosclerosis; hypertension; cardiovascular disease; AIDS; cancer; wasting/cachexia; sepsis; trauma associated with burns, malnutrition, and stress; aging; lupus and other autoimmune diseases; endocrine disease; hyperuricemia, polycystic ovary syndrome and complications arising from athletic activity or inactivity. Excerpt(s): The invention relates to pinitol and derivatives and metabolites thereof and compositions containing same for treating conditions associated with insulin resistance. These include disorders such as diabetes mellitus and its chronic complications; obesity; hyperlipidemias and dyslipidemias; atherosclerosis; hypertension; cardiovascular disease; AIDS; cancer; wasting/cachexia; sepsis; trauma associated with burns, malnutrition, and stress; aging; lupus and other autoimmune diseases; endocrine disease; hyperuricemia, polycystic ovary syndrome and complications arising from athletic activity or inactivity. The compositions of the invention are preferably in a dosage form providing from 0.1 milligram to 1.0 grams per day of the pinitol, derivative or metabolite thereof per kilogram body weight of a mammal. The compositions can be administered orally, enterally, or intravenously and are effective in lowering plasma glucose, insulin and lipid levels. A method is also provided for obtaining pinitol from soy fractions. Insulin is the major anabolic hormone in the body and has multiple effects on a variety of tissues. The actions which are most familiar are its ability to stimulate the uptake of glucose into insulin-sensitive tissues such as muscle and fat and to inhibit the release of glucose from the liver. In addition, insulin regulates both plasma and tissue lipid metabolism, protein turnover, cell growth and electrolyte balance. Insulin acts by binding to a specific receptor on the cell membrane, which is a glycoprotein consisting of two alpha and two beta subunits. Binding of insulin to the alpha subunit activates autophosphorylation of the beta subunit, which then becomes an active tyrosine kinase. By phosphorylating tyrosine residues of other proteins the activated insulin receptor initiates a cascade of biochemical effects. A complete understanding of insulin actions and identification of mediators has yet to be elucidated. Web site: http://www.delphion.com/details?pn=US05550166__

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Stable glutamine derivatives for oral and intravenous rehydration and nutrition therapy Inventor(s): Guerrant; Richard L. (Charlottesville, VA), Lima; Aldo A. M. (Fortaleza, BR), MacDonald; Timothy L. (Charlottesville, VA), Miller; Thomas (Charlottesville, VA), Thielman; Nathan M. (Charlottesville, VA) Assignee(s): The University of Virginia Patent Foundation (charlottesville, Va) Patent Number: 5,561,111 Date filed: December 23, 1994

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Abstract: A method for the treatment of dehydration or nitrogen deficiency-based malnutrition is provided which involves administering to a patient in need thereof an effective amount of a compound selected from oligopeptides formed from the coupling of one or more amino acids with glutamine, the product of coupling glucose with glutamine, the product of coupling glucose and one or more amino acids with glutamine, or the product from acylating glutamine with a carboxylic acid having from 2 to 6 carbon atoms. Excerpt(s): The present invention relates to stable glutamine derivatives and their use in rehydration and nutrition therapy. Glutamine, the chief metabolic fuel of the small intestine, is an amino acid which cotransports Na.sup.+ across the enterocyte brush border membrane. It is known to be the major bowel nutrient and energy source and has been used in intravenous solutions to improve nitrogen balance, inhibit protein breakdown, stimulate the growth of epithelial cells, and reduce intestinal villous atrophy. Additionally, various researchers have shown that glutamine stimulates the absorption of sodium and chloride and has been tried in oral rehydration solutions to reduce cholera diarrhea. Web site: http://www.delphion.com/details?pn=US05561111__ •

Substituted quinazolines and analogs and use thereof Inventor(s): Cai; Sui X. (San Diego, CA), Fick; David B. (Newport Beach, CA), Field; George (Danville, CA), Lan; Nancy C. (S. Pasadena, CA), Upasani; Ravi (San Jose, CA), Wang; Yan (San Diego, CA) Assignee(s): Euro-celtique S.a. (luxembourg, Lu) Patent Number: 6,465,472 Date filed: September 1, 2000 Abstract: The invention relates to novel quinazolines and heterocycles which are antagonists or positive modulators of AMPA receptors, and the use thereof for treating, preventing or ameliorating neuronal loss associated with stroke, global and focal ischemia, CNS trauma, hypoglycemia and surgery, as well as treating or ameliorating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease, Parkinson's disease and Down's syndrome, treating, preventing or ameliorating the adverse consequences of the overstimulation of the excitatory amino acids, treating, preventing or ameliorating anxiety, psychosis, convulsions, chronic pain, glaucoma, retinitis, urinary incontinence, muscular spasm and inducing anesthesia, as well as for treating or ameliorating the adverse consequences of excitatory amino acid deficiency such as schizophrenia, myoclonus. Alzheimer's disease and malnutrition and neural maldevelopment, and as cognition and learning enhancers. Excerpt(s): This invention is in the field of medicinal chemistry. In particular, the invention is related to novel substituted quinazolines and analogs thereof. These compounds are antagonists of.alpha.-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) ionotropic receptors. Certain of these compounds are positive modulators of AMPA receptors. The invention also is directed to the use of novel substituted quinazolines and analogs thereof for the treatment of neuronal damage following global and focal ischemia, and for the treatment or prevention of neurodegenerative conditions as anticonlvulsants, as cognitive enhancers, and for the treatment of schizophrenia, Parkinson's disease and myoclonus. The compounds of the invention are also useful for treatment or prevention of pain, including acute and chronic pain. The invention also is

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directed to a process for the preparation of the substituted quinazolines and analogs thereof. Excitatory amino acid receptors are classified into two general types. Receptors that are directly coupled to the opening of cation channels in the cell membrane of the neurons are termed "ionotropic." This type of receptor has been subdivided into at least three subtypes, which are defined by the depolarizing actions of the selective agonist Nmethyl-D-aspartate (NMDA),.alpha.-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA), and kainic acid (KA). The second general type is the G-protein or second messenger-linked "metabotropic" excitatory amino acid receptor. This second type, when activated by the agonists quisqualate, ibotenate, or trans-1-aminocyclopentane1,3-dicarboxylic acid, leads to enhanced phosphoinositide hydrolysis in the postsynaptic cell. Both types of receptors appear not only to mediate normal synaptic connections during development, but also change in the efficiency of synaptic transmission throughout life. (Schoepp, Bockaert, and Sladeczek, Trends Pharm. Sci. 11:508 (1990); McDonald and Johnson, Brain Res. Rev. 15:41 (1990)). The excessive or inappropriate stimulation of excitatory amino acid receptors leads to neuronal cell damage or loss by a mechanism known as excitotoxicity. The medical consequences of such neuronal degeneration makes the abatement of these degenerative neurological processes an important therapeutic goal. (See U.S. Pat. No. 5,284,957). Antagonists of the AMPA receptor are considered useful in treating, preventing and ameliorating a number of neurologic disorders which are due to overstimulation by the excitatory amino acids. These include acute neurologic disorders such as domoic acid poisoning; cerebral ischemia, global ischemia associated with cardiac arrest; stroke; spinal cord trauma; hypoxia; anoxia; poisoning be carbon monoxide, manganese or cyanide; hypoglycemia; mechanical trauma to the nervous system; epileptic seizures; and chronic neurologic disorders such as Huntington's disease, neuronal injury associated with HIV and AIDS, AIDS dementia, neuropathic pain syndrome, olivopontocerebral atrophy, Parkinson's disease, amyotrophic lateral sclerosis, mitochondrial abnormalities, Alzheimer's disease, hepatic encephalopathy, Tourette's syndrome, drug addiction and urinary incontinence (see Lipton and Rosenberg, N. Engl. J. Med. 330: 613-622 (1994)) and treatment or amelioration of a number of chronic neurologic disorders such as schizophrenia. AMPA receptor antagonists are also useful in treating, preventing and ameliorating acute and chronic pain, pain associated with post-therapeutic neurolgia, insterstital cystitis, osteoarthritis, spinal cord injury, cancer and diabetic neuropathy. Web site: http://www.delphion.com/details?pn=US06465472__ •

Therapeutic dietary composition containing amaranth Inventor(s): Howman; Karen (733 Cedar Run, Waldorf, MD 20603) Assignee(s): None Reported Patent Number: 5,186,963 Date filed: January 7, 1992 Abstract: A high potency dietary composition for treating patients suffering from malnutrition and other related disorders. The dietary compositions comprise sufficient protein, fat, carbohydrate, vitamins, minerals and trace elements to meet the nutritional requirements of the patient, wherein the protein ingredient is derived from amaranth. The amaranth content and proportions of other nutrients of the compositions can be varied, depending on the particular condition to be treated, to provide better patient tolerance and a lower incidence of side effects. The amaranth-containing dietary

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compositions are suitable for use by low birthrate infants, malnourished children suffering from a nutrient deficiency, as well as by adult patients having a chronic illness. Excerpt(s): The present invention relates to a high potency dietary composition for the treatment of malnutrition and other related diseases. More particularly, this invention pertains to nutritionally complete dietary compositions containing amaranth which are suitable for use by low birthrate infants, malnourished children suffering from a nutrient deficiency, as well as by adult patients having a gastrointestinal disease or chronic illness. A deficiency of protein causes the malnutrition disease kwashiorkor which is usually seen in children in the postweaning years, ages 1 to 4. The classic syndrome of kwashiorkor is one of retarded growth and development with mental apathy, edema and muscular wasting. Marasmus is another such disease that occurs mainly in children and is caused by chronic dietary undernutrition, both of protein and kilocalories. This disease is most common in infants 6 to 18 months of age and is characterized by gross underweight. There is atrophy of both muscle mass and subcutaneous fat, giving its victims an almost cadaverous appearance. Growth rate declines progressively in marasmus victims, emotional impairment is also present, and diarrhea is common. Treatment for these nutritional deficiency diseases usually involves immediate therapy and follow-up care during the first 24 hours of therapy. Correction of water and potassium depletion takes priority, especially if diarrhea and consequent dehydration have been severe. Diuresis occurring after about 7 days of treatment indicates a favorable response to initial therapy. Thereafter, the kilocalorie content of the diet is increased by the addition of mixed foods that supply sufficient vitamins and minerals. However, kwashiorkor and marasmus usually occur in underdeveloped regions of the world where socioeconomic factors combine to make nutritious food products unavailable to the child. Web site: http://www.delphion.com/details?pn=US05186963__ •

Use of gut-trophic growth factors to improve oxidative status Inventor(s): Jones; Dean P. (Decatur, GA), Ziegler; Thomas R. (Lilburn, GA) Assignee(s): Emory University (atlanta, Ga) Patent Number: 6,335,317 Date filed: April 9, 1999 Abstract: The present disclosure describes methods for minimizing oxidative damage in an animal or human during or after malnutrition, underfeeding or fasting, especially during refeeding after undernutrition or malnutrition, and for minimizing oxidant damage during or after toxicity resulting from chemotherapy, alcoholism, irradiation therapy or chemical or environmental exposure to a toxic compound. Administration of an effective amount of a gut trophic growth factor (GTGF) effective for improving gut and/or systemic antioxidant status results in improved clinical condition and/or outcome for the patient or animal to which the GTGF has been administered. In the context of the present disclosure, GTGF includes fibroblast growth factors, keratinocyte growth factor, hepatocyte growth factor, insulin-like growth factor I, glucagon, glicentin, and glucagon-like peptide. Excerpt(s): Growth of the gastrointestinal mucosa is markedly influenced by nutritional status and enteral nutrient availability. This is evidenced by the disproportionate loss of gut mucosal mass relative to body weight during starvation and other states of malnutrition (1-2). Fasting or severe protein-calorie restriction result in mucosal cell

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atrophy, decreased digestive enzyme activity and absorptive capacity, and impaired intestinal barrier function (3-4). Malnutrition is also associated with reduced antioxidant capacity in the intestinal mucosa (5). Enteral refeeding after a period of malnutrition rapidly regenerates intestinal cellularity and mucosal mass (3-5). The tripeptide glutathione (L-glutamyl-L-cysteinyl-glycine, GSH) is the most abundant low molecular weight thiol in mammalian cells and plays a key role in the detoxification of cellular free radicals, chemical toxins, and carcinogens (16). GSH deactivates potentially harmful oxidants by serving as a hydrogen donor to reduce reactive molecules with concomitant conversion to its oxidized disulfide form, GSSG (6). GSH is synthesized endogenously in mucosal cells utilizing specific amino acid substrates, can be derived exogenously from dietary sources, or may enter the gut lumen via bile and by direct secretion from mucosal cells (7-8). GSH present in the gut lumen and within enterocytes appears to be required for normal intestinal function, in part, by protecting intestinal epithelial cells from damage by dietary electrophiles and fatty acid hydroperoxides (911). GSH also appears to play a role in maintaining the proper sulfhydryl/disulfide balance of gut luminal proteins, potentially modulating activity of thiol-containing enzymes on the brush border (12-13). Previous studies demonstrate that malnutrition reduces tissue GSH content (5, 15-16). In animal models, fasting or an insufficient dietary supply of amino acids that may serve as GSH substrates (e.g., glutamine and cysteine) depletes GSH levels in both small intestine and colon (5, 16, 17). Therefore, malnutrition-associated depletion of cellular GSH in gut epithelial cells may increase their susceptibility to oxidative injury and exacerbate the degeneration of the intestinal mucosa (17). Also, there is evidence to suggest that GSH is involved in regulation of cell growth (18). Web site: http://www.delphion.com/details?pn=US06335317__

Patent Applications on Malnutrition 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 malnutrition: •

Formulation and method for treating skeletal muscle degeneration caused by malnutrition and disease Inventor(s): Bababunmi, Enitan Ablsogun; (Norcross, GA) Correspondence: Epstein, Edell, Shapiro, Finnan & Lytle, Llc; 1901 Research Boulevard; Suite 400; Rockville; MD; 20850; US Patent Application Number: 20020006911 Date filed: May 22, 2001 Abstract: A formulation is provided for the treatment of the adverse affects of skeletal muscle degenerative diseases prevalent in humans in developing countries. The formulation typically includes jasmone and at least one of an antioxidant and carnitine. Additionally, soy milk may be utilized as a delivery vehicle for the formulation for oral ingestion by a subject. The formulation is designed to replenish energy levels in disease infected muscle cells, reinstate calcium homeostasis within the muscle cells, and reduce

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

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the activity of oxidizing free radical reactions typically caused by muscle degenerative diseases. Excerpt(s): The present invention relates to formulations for counteracting skeletal muscle cell damage and degeneration due to the effects of malnutrition and various muscle degenerative diseases. The devastating effect of malnutrition on worldwide child mortality rates has been well documented. Indeed, statistical studies of worldwide mortality data indicates that approximately 70% of the millions of deaths occurring annually among children less than 5 years old in developing countries is associated with malnutrition singly, or in combination with diseases such as malaria, diarrhea, measles, or acute respiratory infections. Two forms of malnutrition prevalent in developing African and Asian countries are kwashiorkor and marasmus. Both are forms of proteinenergy malnutrition characterized by growth retardation in children and wasting of subcutaneous fat and muscle. Many factors add to and promote the deleterious effects of malnutrition including ingestion of toxins and viral infection. Chronic ingestion of fungal mycotoxins by humans, particularly cyclopiazonic acid (CPA) and aflatoxin (AFL), contribute significantly to the development of malnutrition and liver cancer, respectively. CPA, an indolic fungal metabolite, coexists with AFL, a liver carcinogen, in nature. Assays of both CPA and AFL indicate that the two mycotoxins elicit their toxic effects by independent modes of action. The mechanism of the toxicity of CPA in mammals and its role as a very common toxic food contaminant is now well established. CPA is a specific inhibitor of Ca-ATPase in the skeletal muscle (sarcoplasmic reticulum) of mammals. See Goeger et al., Biochemical Pharmacology, 37, 978-981 (1988). CaATPase controls the pumping of calcium within the sarcoplasmic reticulum to effect muscle contraction or relaxation. Inhibition of Ca-ATPase by CPA prevents the pumping of calcium in the muscle cell that would otherwise be used for maintaining overall health of the cell, thus resulting in a wasting and degeneration of muscle cell tissue. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Nutritional preparation comprising ribose and medical use thereof Inventor(s): Hageman, Robert Johan Joseph; (Waddinxveen, NL), Smeets, Rudolf Leonardus Lodewijk; (Waddinxveen, NL), Verlaan, George; (Wageningen, NL) Correspondence: Young & Thompson; 745 South 23rd Street 2nd Floor; Arlington; VA; 22202 Patent Application Number: 20020183263 Date filed: June 25, 2002 Abstract: Trauma, surgery, inflammation, subfertility, pregnancy, lactation problems, gut disorders, infant nutrition, cancer, arthritis and other joint problems, vascular problems and cardio-or cerebro-vascular problems, ischaemia, aging, impaired immune function, burns, sepsis, malnutrition, problems with liver, pancreas or kidneys, malaria, cystic fibrosis, migraine, neurological problems, respiratory infections, improvement of sports results, muscle soreness, drug intoxication and pain can be treated with a nutritional composition containing effective amounts of ribose and folic acid, optionally combined with other components such as niacin, histidine, glutamine, orotate, vitamin B6 and other components. Excerpt(s): The invention is related to nutritional, pharmaceutical, or dietetic preparations that comprise ribose or folic acid or functional analogs thereof and the use

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of these compositions in the prevention or treatment of specific diseases that are related to disorders or insufficient of total nucleotide metabolism. Nucleotides are heterocyclic compounds that occur in all mammals. Nucleotides consist of a purine or pyrimidine base, a sugar unit and one to three phosphate groups. The major purine bases that occur in the human body are adenine (6-aminopurine), guanine (2-amino-6-hydroxypurine), hypoxanthine (6-hydroxypurine) and xanthine (2,6-dihydroxypurine); the major pyrimidines are uracil (2,4-dihydroxypyrimidine), cytosine (2,4-dihydroxy-5methylpyrimidine) and thymine (4-amino-2-hydroxypyrimidi- ne). The sugar moiety can be ribose (in ribonucleosides) or 2-deoxyribose. The sugar moiety is connected to the base through a.beta.-N-glycosidic bond at N9 of the base; the phosphate groups are connected to the sugar moiety through the 3' or 5' position. When the phosphate groups are split from nucleotides compounds called nucleosides are formed. For the purpose of this document, total nucleotide metabolism (TNM) is defined as the combination of all biochemical pathways in which nucleotides, their precursors and metabolites are directly involved as main ingredients and that occur in the body of mammals. The pathways include the synthetic routes for purines and pyrimidines, both de novo and salvage pathways, starting from carbamoyl phosphate and 5-phosphoribosyl-1pyrophosphate (PRPP), respectively. They also include the interconversions of the various nucleotides into each other, the phosphorylation and dephosphorylation reactions of respectively nucleosides and nucleotides and the catabolic pathways of nucleotides to the compounds that are cleared from the body. They do not include the further reactions of phosphoric groups thus split off from the phosphorylated nucleotides. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Substituted quinazolines and analogs and the use thereof Inventor(s): Cai, Sui X.; (San Diego, CA), Lan, Nancy C.; (Altadena, CA), Upasani, Ravi; (Sunnyvale, CA) Correspondence: Sterne, Kessler, Goldstein & Fox Pllc; 1100 New York Avenue, N.W., Suite 600; Washington; DC; 20005-3934; US Patent Application Number: 20030033089 Date filed: August 16, 2002 Abstract: The invention relates to novel quinazolines and heterocycles which are antagonists or positive modulators of AMPA receptors, and the use thereof for treating, preventing or ameliorating neuronal loss associated with stroke, global and focal ischemia, CNS trauma, hypoglycemia and surgery, as well as treating or ameliorating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease, Parkinson's disease and Down's syndrome, treating, preventing or ameliorating the adverse consequences of the overstimulation of the excitatory amino acids, treating, preventing or ameliorating anxiety, psychosis, convulsions, chronic pain, glaucoma, retinitis, urinary incontinence, muscular spasm and inducing anesthesia, as well as for treating or ameliorating the adverse consequences of excitatory amino acid deficiency such as schizophrenia, myoclonus, Alzheimer's disease and malnutrition and neural maldevelopment, and as cognition and learning enhancers. Excerpt(s): This invention is in the field of medicinal chemistry. In particular, the invention is related to novel substituted quinazolines and analogs thereof. These compounds are antagonists of x-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) ionotropic receptors. Certain of these compounds are positive modulators of

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AMPA receptors. The invention also is directed to the use of novel substituted quinazolines and analogs thereof for the treatment of neuronal damage following global and focal ischemia, and for the treatment or prevention of neurodegenerative conditions, as anticonvulsants, as cognitive enhancers, and for the treatment of schizophrenia, Parkinson's disease and myoclonus. The compounds of the invention are also useful for treatment or prevention of pain, including acute and chronic pain. The invention also is directed to a process for the preparation of the substituted quinazolines and analogs thereof. Excitatory amino acid receptors are classified into two general types. Receptors that are directly coupled to the opening of cation channels in the cell membrane of the neurons are termed "ionotropic." This type of receptor has been subdivided into at least three subtypes, which are defined by the depolarizing actions of the selective agonist N-methyl-D-aspartate (NMDA),.alpha.-amino-3-hydroxy-5methylisoxazole-4-- propionic acid (AMPA), and kainic acid (KA). The second general type is the G-protein or second messenger-linked "metabotropic" excitatory amino acid receptor. This second type, when activated by the agonists quisqualate, ibotenate, or trans-1-aminocyclopentane-1,3-dicarboxylic acid, leads to enhanced phosphoinositide hydrolysis in the postsynaptic cell. Both types of receptors appear not only to mediate normal synaptic connections during development, but also change in the efficiency of synaptic transmission throughout life. (Schoepp, Bockaert, and Sladeczek, Trends Pharm. Sci. 11:508 (1990); McDonald and Johnson, Brain Res. Rev. 15:41 (1990)). The excessive or inappropriate stimulation of excitatory amino acid receptors leads to neuronal cell damage or loss by a mechanism known as excitotoxicity. The medical consequences of such neuronal degeneration makes the abatement of these degenerative neurological processes an important therapeutic goal. (See U.S. Pat. No. 5,284,957). Antagonists of the AMPA receptor are considered useful in treating, preventing and ameliorating a number of neurologic disorders which are due to overstimulation by the excitatory amino acids. These include acute neurologic disorders such as domoic acid poisoning; cerebral ischemia, global ischemia associated with cardiac arrest; stroke; spinal cord trauma; hypoxia; anoxia; poisoning by carbon monoxide, manganese or cyanide; hypoglycemia; mechanical trauma to the nervous system; epileptic seizures; and chronic neurologic disorders such as Huntington's disease, neuronal injury associated with HIV and AIDS, AIDS dementia, neuropathic pain syndrome, olivopontocerebral atrophy, Parkinson's disease, amyotrophic lateral sclerosis, mitochondrial abnormalities, Alzheimer's disease, hepatic encephalopathy, Tourette's syndrome, drug addiction and urinary incontinence (see Lipton and Rosenberg, N. Engl. J. Med. 330: 613-622 (1994)) and treatment or amelioration of a number of chronic neurologic disorders such as schizophrenia. AMPA receptor antagonists are also useful in treating, preventing and ameliorating acute and chronic pain, pain associated with post-therapeutic neurolgia, insterstital cystitis, osteoarthritis, spinal cord injury, cancer and diabetic neuropathy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Use of glutamate and/or a glutamate precursor for the preparation of a nutritional or pharmaceutical preparation for the treatment or prevention of hyperpermeability or undesired permeability of the intestinal wall Inventor(s): Glas, Cornelis; (Tietjerk, NL), Houdijk, Alexander Petrus Johannes; (Amstelveen, NL), Van Leeuwen, Paulus Aluisius Marie; (Amstelveen, NL) Correspondence: Fitch Even Tabin And Flannery; 120 South LA Salle Street; Suite 1600; Chicago; IL; 60603-3406; US Patent Application Number: 20030138476 Date filed: November 20, 2002 Abstract: The present invention relates to the use of glutamic acid for the preparation of a nutritional preparation that is intended for use for the treatment or prevention of excess or undesired permeability of the intestinal wall. In particular, according to the invention the glutamic acid is used in a nutritional preparation, such as a baby food or an enteral food. Examples of conditions where glutamic acid is used are: food allergy, internal drug allergy, sepsis, low blood flow through the intestines, ICU patients, surgical interventions, malnutrition or intestinal maturation of newborn babies. Excerpt(s): The invention relates to the preparation of a nutritional preparation that is suitable for use in the case of conditions associated with an increased permeability of the intestinal wall. The intestinal epithelium acts as a selective barrier which allows the absorption of nutrients but restricts the passage of microorganisms and undesired macromolecules. Maintaining this barrier is considered to be important in order to protect the host against the migration of pathogenic microorganisms from the intestines to the bloodstream. It is assumed that the increase in the permeability of the intestines is associated with damage to the paracellular transport system of the intestinal mucosa, as a result of which translocation of endotoxins and (pathogenic) bacteria can occur. As a result of the damage to the intestinal mucosa it is also possible for absorption of macromolecules to occur, which are then able to initiate allergic reactions. An increase in the permeability of the intestinal wall has been detected in clinical conditions associated with damage to the intestinal mucosa barrier, such as endotoxaemia, sepsis, multiple trauma, malnutrition, major surgical interventions, parenteral nutrition and burns. An increase in the permeability to larger molecules, such as proteins, has been found in the newborn, but also occurs in healthy people if they are allergic to food products. 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 malnutrition, 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 “malnutrition” (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 malnutrition.

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You can also use this procedure to view pending patent applications concerning malnutrition. 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 6. BOOKS ON MALNUTRITION Overview This chapter provides bibliographic book references relating to malnutrition. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on malnutrition 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 “malnutrition” (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 malnutrition: •

Uninvited Guests: The Inside Story on Intestinal Parasites and How to Protect Yourself from Them Source: New Canaan, CT: Keats Publishing, Inc. 1996. 48 p. Contact: Available from Keats Publishing, Inc. 27 Pine Street, Box 876, New Canaan, CT 06840-0876. (800) 540-9440. Fax (800) 998-3103. PRICE: $3.95 plus shipping and handling. ISBN: 0879837365. Summary: Human bodies are perfect homes for parasites, providing food and housing for any number of these uninvited guests. Relatively few patients and doctors realize that parasites cause some of the most common intestinal infections in the U.S. This booklet describes common parasites, from the water poisoning Cryptosporidium to the 15 foot fish tapeworm. The protozoan family of parasites, single celled organisms like Giardia intestinalis (formerly known as Giardia lamblia) and Cryptosporidium parvum are the ones most frequently found in Americans. Diarrhea, nausea, fevers, and

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abdominal pain may be some of the initial symptoms of infections. Bowel disorders, muscle and joint pain, fibromyalgia, fatigue, malnutrition, and allergic reactions may develop when parasites take up long term, undetected residence in a human body. The author discusses sources of contamination, definitions and symptoms, parasitic infections, the parasites themselves, treatment options, and prevention strategies. Sources of contamination include water, food, pets, day care centers, sexual practices, and widespread global travel. Parasites are discussed in four basic categories: Protozoa (microscopic, single celled organisms), Trematodes (flukes), Cestoda (tapeworms), and Nematoda (round, pin, and hook worms). The author reviews the incidence, symptoms, and transmission of each of these parasitic infections. A questionnaire that can be useful in diagnosis is included in the booklet. Treatment options discussed include chemotherapeutic agents, herbal alternatives, and diet and other supportive measures. The author stresses that the best prevention strategy is to build a strong, healthy immune system. 1 figure. 33 references. •

Malnourished Child Source: New York, NY: Raven Press. 1990. 431 p. Contact: Available from Raven Press. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9541. PRICE: $56.50; plus $4.50 shipping and handling. ISBN: 088167592X. Summary: The bulk of this volume about the malnourished child analyzes and discusses the effect of malnutrition on various organs and functions, such as the central nervous system, mental function and development, and the digestive system. Various nutrients are presented separately, including amino acids, lipids, carbohydrates, electrolytes, trace minerals, and vitamins. Finally, prevention and treatment are discussed, based on cases from South America and the Far East. A separate chapter considers problems of secondary malnutrition linked to diseases such as uremia, liver insufficienicy, and malabsorption, and also malnutrition related to cancer and its therapy. Each of 22 chapters includes extensive references, charts and illustrations where appropriate, and discussion and commentary by colleagues in the field. A subject index concludes the volume.

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Disorders of Taste and Smell. 2nd ed Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery, Inc. 1996. 62 p. Contact: Available from American Academy of Head and Neck Surgery, Inc. (AAOHNS). One Prince Street, Alexandria, VA 22314. (703) 836-4444. Fax (703) 683-5100. Website: www.entnet.org. PRICE: $20.00 for members; $30.00 for non-members, plus shipping and handling. ISBN: 1567720242. Summary: The special senses of smell and taste, collectively known as chemosensation, are now amenable to identification, classification, and in certain instances, treatment. This self instruction packet is designed to serve as an up to date clinical reference on disorders of taste and smell. Topics include the anatomy of the olfaction (smell) system, including primary olfactory neuroepithelium, olfactory nerve fibers, vomeronasal system, trigeminal system, central olfactory pathway, and embryology; the physiology of the olfactory system, including odorant access to the receptor site, receptor cell neurophysiology, and neurotransmitters; the pathology of the olfactory system, including age, upper respiratory tract infection, rhinosinusitis, head trauma, surgery, chemical injury, endocrine metabolic abnormalities, neurodegenerative disorders,

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neoplasia (growth of new cells, including cancers), and congenital anosmia (lack of smell); determination of olfactory function; medical evaluation of the patient with an olfactory disorder; treatment of olfactory dysfunction; the anatomy of gustation (taste), including peripheral gustatory receptors, innervation of the taste buds, and central gustatory pathways; development of the gustatory apparatus; gustatory physiology, including chemosensory transduction and the role of saliva; pathology of the gustatory system, including drug effects, trauma, metabolic disturbances, infections, electrochemical taste, malnutrition, age, and cancer; the interaction of tastes among themselves and olfaction (smell); clinical assessment of gustatory function; evaluation of the patient with a taste complaint; and treatment of gustatory dysfunction. The information packet includes a pretest and posttest, interim quizzes for self evaluation, a list of references, and a form with which readers can qualify for continuing education credits. 5 figures. 3 tables. 82 references. •

Nutrition, health, and child development: Research advances and policy recommendations. Source: Washington, DC: Pan American Health Organization. Contact: Available from Pan American Health Organization, Sales and Distribution Center, P.O. Box 27, Annapolis Junction, MD 20701. Telephone: (301) 617-7806 / fax: (301) 206-9789 / e-mail: [email protected] / Web site: http://www.paho.org. $32.40 plus $8.00 shipping and handling; payment can be made online. Summary: This book examines the role of nutritional and other health problems on child development in the Americas. The book reports research conducted in supplementing the diet of school children in several countries, breastfeeding, mild malnutrition, the effects of infection, parasites, iron deficiency, and iodine deficiency. This book is an outgrowth of a workshop in Jamaica in 1995 to examine how nutrition, health, and stimulation affect the development of young children.

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Principles and Practice of Dialysis Source: Baltimore, MD: Williams and Wilkins. 1994. 478 p. Contact: Available from Williams and Wilkins. 428 East Preston Street, Baltimore, MD 21202. (800) 638-0672. PRICE: $129; plus shipping and handling. ISBN: 06830399733. Summary: This book provides dialysis practitioners, trainees, and students with current information about the most pressing issues confronting the practice of dialysis. Thirtyone chapters are presented in two sections: technical and procedural considerations in dialysis therapy and clinical considerations in the evaluation of dialysis patients. Topics in the first section include the choice of the hemodialysis membrane; dialysate composition; hemodialysis vascular access; hemodialysis urea modeling; high-flux, high-efficiency procedures; prescribing drugs for dialysis patients; continuous therapeutic techniques; and the causes, diagnosis, and treatment of peritoneal membrane failure. Topics discussed in the second section include hypertension in dialysis patients; left ventricular dysfunction; coronary artery disease in end-stage renal disease (ESRD); autonomic function and hemodynamic stability; infection and immunity in ESRD; amyloidosis; renal osteodystrophy; dsylipidemias of ESRD; malnutrition and intradialytic parenteral nutrition in ESRD patients; disorders of hemostasis in dialysis patients; treatment of anemia; acquired cystic kidney disease; geriatric dialysis patients; dialysis patients with diabetes; hemodialysis and hemoperfusion for poisoning; dialysis in children; infections in patients on continuous

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ambulatory peritoneal dialysis; and balancing outcomes in dialysis with economic realities. •

Tasty, Tender Temptations: Recipes for Soft, High-Fiber, Low-Salt Meals for Folks with Kidney Disease Source: Roanoke, TX: Niche Pharmaceuticals, Inc. 1997. 19 p. Contact: Available from Niche Pharmaceuticals, Inc. 200 North Oak Street, Roanoke, TX 76262. (800) 677-0355. Fax (817) 491-3533. PRICE: Single copy free to health professionals; bulk copies available. Summary: This cookbook features recipes that are acceptable for a person following a renal diet and that combine high fiber and low salt foods in an easy to ingest and easy to digest form. The recipes are designed to help kidney disease patients who have trouble chewing or swallowing and who may be at increased risk of malnutrition as they try to follow the recommended renal diet. The introductory material discusses the importance of dietary fiber (including the use of supplements), the role of caloric intake, and the individual recommendations for protein foods, starches, vegetables, and fruits. The recipes begin with three basic sauces: a white sauce, a brown sauce, and a tomato sauce; the nutritional values (calories, protein, sodium, potassium, and phosphorus) are provided for each. The cookbook then provides recipes for lasagna, chicken pot pie, beef burgundy, beef stroganoff, shrimp creole, mock stuffed crab, Garden-roni, curried egg, and Dialyzing potatoes. All of the recipes include the supplemental fiber product, Unifiber, manufactured by the company that created the cookbook. All of the recipes include a nutrient analysis that notes calories, protein, sodium, potassium, and phosphorus amounts. The cookbook is spiral bound for ease of use.

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Patients with Hepatic Disease Source: Chicago, IL: American Dental Association (ADA). 1996. 13 p. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174-0776. (800) 947-4746. Fax (888) 476-1880 or (630) 443-9970. Website: www.ada.org. PRICE: $12.00 for members; $18.00 for nonmembers, plus shipping and handling. Summary: This document has been developed by the American Dental Association to offer guidelines that alert physicians and dentists to the need for consultation and cooperation in the management of patients with hepatic (liver) disease. Advanced liver disease may be associated with impaired metabolic capacities, significant malnutrition, bleeding problems, portal hypertension (high blood pressure in the liver venous system), fluid and electrolyte disturbances, an immunocompromised state, central nervous system dysfunctions, and altered metabolism of drugs. Although hepatitis A is transmissible only during the acute stage of the diseaes, hepatitis B, C, and other rarer types of hepatitis may be associated with a chronic carrier state and thereby transmissible for the patient's lifetime. This represents a serious health risk to dental health care workers and a risk to other patients, if proper infection control measures and immunization (for hepatitis B) are not employed. The document reviews dental management considerations in patients with viral hepatitis, and for patients with alcohol related liver disease. Dental care in patients with acute liver disease should be restricted to emergency care only. Patients with chronic or advanced liver diseases may receive emergency dental care, but elective dental treatment will depend on the degree of liver dysfunction and the type and extent of dental care needed. Chronic alcoholics and patients with advanced chronic liver disease should have more frequent followup

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dental appointments because of the known deleterious effects these diseases have on the oral tissues. 3 tables. 15 references. •

Practical Handbook of Nutrition in Clinical Practice Source: Boca Raton, FL: CRC Press. 1994. 300 p. Contact: Available from CRC Press. 2000 Corporate Boulevard NW., Boca Raton, FL 33431. (800) 272-7737 or (561) 994-0555. Fax (800) 374-3401. E-mail: [email protected]. Website: http://www.crcpress.com. PRICE: $89.95. ISBN: 0849378478. Summary: This medical text on clinical nutrition is designed to supplement traditional nutrition textbooks. Chapters include a comprehensive review of nutritional assessment techniques and the judicious application of information derived from metabolic charts. The body's physiological adaptation to malnutrition and the problems sometimes encountered in initiating refeeding regimens is also examined. Overnutrition, a major national health problem, is discussed, and the surgical and nonsurgical options available for its management are presented. Additional chapters cover enteral and parenteral nutrition, including many new techniques and applications. Several chapters explore nutrition and cancer, nutritional fraud, the future of food products, and ethical issues in nutritional support. Each chapter concludes with references; a subject index concludes the volume. (AA-M).

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Nutritional Management of Renal Disease Source: Baltimore, MD: Williams and Wilkins. 1997. 929 p. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This medical textbook is a compendium of information concerning nutrition and metabolism of individuals with renal disease or renal failure. The text features 30 chapters, written by 53 experts from the U.S. and Europe. Several chapters are devoted to scholarly reviews of the scientific literature concerning the nutritional and metabolic state of individuals with renal disease. These topics include protein, amino acid, carbohydrate, lipid, mineral, trace element, vitamin, and carnitine metabolism; uremic toxicity; the causes of protein-calorie malnutrition in renal disease; the effects of this malnutrition on renal function; methods of assessment of nutritional status; and the effect of nutritional and non-nutritional factors on the progression of chronic renal failure. These chapters emphasize the integral relationships between nutrition and the metabolic and clinical status of patients with renal disease or renal failure. Other contributions focus on nutritional disorders and treatment of specific clinical conditions such as hypertension, chronic renal insufficiency, nephrotic syndrome, chronic dialysis, renal transplantation, and acute renal failure. The book also contains chapters that review treatment with growth factors, exercise training, drug-nutrient reactions, the nutritional management of children with chronic renal failure or renal transplantation, and such practical issues as continuous renal replacement therapy, attaining compliance to dietary prescription, and available food supplements and enteral nutrition preparations. A detailed subject index concludes the volume. (AA-M).

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Prisoners With HIV/AIDS : A Guide to Help Caregivers Understand, Care for and Counsel Infected Inmates Contact: Labor Relations Press Publications, PO Box 980, Horsham, PA, 19044-0980, (215) 784-0860, http://www.lrp.com. Summary: This monograph serves as a guide for caregivers of prisoners with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The chapter titles are (1) Introduction; (2) HIV and the Immune System: The Basics; (3) Nutrition; (4) Communication Skills; (5) Coping With Fears; (6) Confronting Dementia; (7) How to Prevent Caregivers, Volunteers From Burning Out; (8) How to Make Sick Inmates Comfortable; (9) Tips for Starting a Peer Education Program for Inmates; (10) Discharge Planning; and (11) Resources. Specific topics include disease progression, the immune system's lines of defense, HIV transmission, HIV testing, malnutrition and wasting, listening skills, counseling basics, and cultural differences and similarities to consider in communication. Other topics include common coping patterns, emotional responses to terminal illness, managing people with dementia, environmental comfort measures, universal precautions, general hygiene, disability benefits, and legal issues and confidentiality.

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Foods That Harm, Foods That Heal: An A-Z Guide to Safe and Healthy Eating Source: Pleasantville, NY: Reader's Digest. 1997. 400 p. Contact: Available from Customer Service, Reader's Digest. Pleasantville, NY 10570. (800) 846-2100. PRICE: $30.00. ISBN: 0895779129. Summary: This nutrition reference book features more than 400 photographs and illustrations with more than 400 A to Z entries on a vast range of foods and health concerns, include caffeine, cancer, diabetes, fast food, garlic, heart disease, influenza, osteoporosis, pregnancy, sexually transmitted diseases, and vegetarianism. The book is designed to provide families with information to help understand the close links between foods and wellness. Each food entry provides at-a-glance information on its nutrients (or lack of) and its benefits and drawbacks. Each ailment is accompanied by a list of foods and beverages that are considered safe, and what foods or beverages should be cut down or avoided altogether. Personalized case studies help to illustrate various topics. There are special features on eating during different life stages, from infancy to old age, as well as such issues as genetically altered foods, irradiation, pesticides, and pollution. Other topics include how to cook foods to achieve maximum nutritional benefits; which dietary supplements really work; tips on exercising, storing food, and reading food labels; an instructive analysis of the most popular diet regimens; and controversial foods and additives such as eggs, nitrites, bran, cheese, milk, fat, wine, and alcohol. A glossary defines unfamiliar or technical terms; there is also a listing of organizations that can provide further information and resources. Topics specifically related to digestive diseases include allergic reactions to food, anorexia nervosa, antioxidants, appetite loss, basic food groups, carbohydrates, celiac disease, childhood and adolescent nutrition, cholesterol, constipation, convenience foods, Crohn's disease, diarrhea, dieting and weight control, digestive and malabsorption disorders, diverticulitis, fats, fiber, food poisoning, gastritis, gastroenteritis, gout, hiatal hernia, indigestion and heartburn, intolerance to milk and other foods, irritable bowel syndrome, malnutrition, medicine-food interactions, minerals, obesity, organic and health foods, preparation and storage of food, restaurants and eating out, smoking and diet, sports nutrition, supplements, traveler's health, ulcers, vitamins, and worms and other parasites.

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Textbook of Diabetes. 2nd ed Source: Oxford, England: Blackwell Science Ltd. 1997. 2 v., [1900 p.]. Contact: Available from Blackwell Science, Inc. 238 Main Street, Cambridge, MA 02142. (800) 215-1000 or (617) 876-7000. Fax (617) 492-5263. PRICE: $295.00. ISBN: 0632038020. Summary: This two-volume textbook, the second edition, examines key clinical and scientific topics related to diabetes. The book first examines diabetes in its historical and social context, focusing on diagnosis, classification, and epidemiology, as well as public health problems associated with diabetes and its occurrence in developing countries. After pancreatic structure and function and insulin structure and secretion are explained, an overview of type 1 and type 2 diabetes, including the role of genetic and other factors in the pathogenesis, is presented. Other types of diabetes, such as diabetes caused by pancreatic disease, malnutrition, hereditary and acquired syndromes of severe insulin resistance, insulopathies, and genetic syndromes are then discussed, as are metabolic disturbances. The book also explores the management of type 1 and type 2 diabetes, including insulin therapy and diet and lifestyle modification for both types and other drug treatments for type 2. The focus then shifts to acute metabolic complications and the mechanisms of chronic diabetes complications, such as diabetic eye disease, diabetic neuropathy, diabetic nephropathy, microvascular disease, hypertension, cardiovascular disease, and other complications. After a discussion of exercise, drug interference with glucose homeostasis, infection, and surgery, the book examines diabetes in special populations, including pregnant women, children, adolescents, and the elderly, as well as the issues of living with diabetes, diabetes care, and future directions in research and care. Each volume concludes with an index. 1 appendix. Numerous figures. Numerous tables. Numerous references.

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

2 Faces of Malnutrition by Eckholm; ISBN: 0916468089; http://www.amazon.com/exec/obidos/ASIN/0916468089/icongroupinterna

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A bibliography of psycho-social studies of malnutrition in southern Africa by R. D. Griesel; ISBN: 0869815342; http://www.amazon.com/exec/obidos/ASIN/0869815342/icongroupinterna

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A practical guide to combating malnutrition in the preschool child; nutritional rehabilitation through maternal education, report; ISBN: 0390733466; http://www.amazon.com/exec/obidos/ASIN/0390733466/icongroupinterna

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A study of malnutrition in the Nqutu district of Kwazulu by Lawrence Schlemmer; ISBN: 0869800620; http://www.amazon.com/exec/obidos/ASIN/0869800620/icongroupinterna

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Addressing Malnutrition in Africa: Low-Cost Program Possibilities for Government Agencies and Donors (Social Dimensions of Adjustment in Sub-Saharan) by F. James Levinson; ISBN: 0821318977; http://www.amazon.com/exec/obidos/ASIN/0821318977/icongroupinterna

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Apartheid, Poverty and Malnutrition; ISBN: 9251012032; http://www.amazon.com/exec/obidos/ASIN/9251012032/icongroupinterna

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Attacking the Double Burden of Malnutrition in Asia and the Pacific by Stuart Gillespie, et al; ISBN: 9715613667; http://www.amazon.com/exec/obidos/ASIN/9715613667/icongroupinterna

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Bangladesh, breaking the malnutrition barrier key to development by A. F. M. Iqbal Kabir; ISBN: 984051573X; http://www.amazon.com/exec/obidos/ASIN/984051573X/icongroupinterna

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Brain function and malnutrition : neuropsychological methods of assessment; ISBN: 0471696730; http://www.amazon.com/exec/obidos/ASIN/0471696730/icongroupinterna

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Children of the Urban Poor: The Sociocultural Environment of Growth, Development and Malnutrition in Guatemala City by Francis E. Johnston, Setha M. Low; ISBN: 0813386330; http://www.amazon.com/exec/obidos/ASIN/0813386330/icongroupinterna

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Cities of hunger : urban malnutrition in developing countries by Jane Pryer; ISBN: 0855980842; http://www.amazon.com/exec/obidos/ASIN/0855980842/icongroupinterna

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Combating Malnutrition: Time to Act (Human Development Network: Health, Nutrition, and Population Series) by Stuart Gillespie (Editor), et al; ISBN: 0821354450; http://www.amazon.com/exec/obidos/ASIN/0821354450/icongroupinterna

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Completing the Food Chain: Strategies for Combating Hunger and Malnutrition: Papers and Proceedings of a Colloquium Organized by the Smithsonian Ins by Neil G. Kotler (Editor), Paula M. Hirschoff; ISBN: 0874745616; http://www.amazon.com/exec/obidos/ASIN/0874745616/icongroupinterna

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Confronting Urban Malnutrition: The Design of Nutrition Programs by James E. Austin; ISBN: 0801822610; http://www.amazon.com/exec/obidos/ASIN/0801822610/icongroupinterna

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Contemporary Issues in Childhood Diarrhoea and Malnutrition by Zulfigar Ahmed Bhutta (Editor), Zulfiqar Ahmed Bhutta; ISBN: 0195791495; http://www.amazon.com/exec/obidos/ASIN/0195791495/icongroupinterna

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Control of Feeding Behavior and Biology of the Brain in Protein-Calorie Malnutrition (Nutrition and the Brain : V. 2) by Richard and Judith Wurtman; ISBN: 089004046X; http://www.amazon.com/exec/obidos/ASIN/089004046X/icongroupinterna

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Delayed Primary School Enrollment and Childhood Malnutrition in Ghana: An Economic Analysis (Lsms Working Paper, No. 98) by Paul Glewwe, Hanan Jacoby; ISBN: 0821326651; http://www.amazon.com/exec/obidos/ASIN/0821326651/icongroupinterna

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133

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Determinants of action against malnutrition in under five children : Kasama District, northern Zambia; ISBN: 9982020633; http://www.amazon.com/exec/obidos/ASIN/9982020633/icongroupinterna

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Development, Reform, and Malnutrition in Chile by Peter Hakim (Author), Giorgio Solimano (Author); ISBN: 0262191725; http://www.amazon.com/exec/obidos/ASIN/0262191725/icongroupinterna

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Diarrhea and Malnutrition in Childhood by J.A. Walker-Smith, A.S. McNeish; ISBN: 0407004017; http://www.amazon.com/exec/obidos/ASIN/0407004017/icongroupinterna

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Diarrhea and Malnutrition: Interactions, Mechanisms and Interventions by Lincoln C. and Scrimshaw, Nevin S. Chen (Editor); ISBN: 030641046X; http://www.amazon.com/exec/obidos/ASIN/030641046X/icongroupinterna

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Diarrheal Disease and Malnutrition: A Clinical Update by Michael Gracey (Editor); ISBN: 0443028923; http://www.amazon.com/exec/obidos/ASIN/0443028923/icongroupinterna

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Disease-Related Malnutrition: An Evidence-Based Approach to Treatment by Stratton (Editor), et al; ISBN: 0851996485; http://www.amazon.com/exec/obidos/ASIN/0851996485/icongroupinterna

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Drought and Man: The 1972 Case History: Constant Catastrophe: Malnutrition, Famines and Drought by Rolando V. Garcia (Editor); ISBN: 0080258247; http://www.amazon.com/exec/obidos/ASIN/0080258247/icongroupinterna

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Ecology of Malnutrition in Central and Southern Europe, Austria, Hungary, Romania, Bulgaria, and Czechoslovakia by J. May; ISBN: 0028490002; http://www.amazon.com/exec/obidos/ASIN/0028490002/icongroupinterna

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Ecology of Malnutrition in Five Countries of Eastern and Central Europe by Jacques M. May, Donna L. Mc Lellan (Editor); ISBN: 0028489705; http://www.amazon.com/exec/obidos/ASIN/0028489705/icongroupinterna

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Ecology of Malnutrition in the Far and Near East by Jacques M. May, Donna L. McLellan (Editor); ISBN: 002849010X; http://www.amazon.com/exec/obidos/ASIN/002849010X/icongroupinterna

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Ecology of Malnutrition in the French-Speaking Countries of West Africa by Jacques M. May (Editor); ISBN: 0028489608; http://www.amazon.com/exec/obidos/ASIN/0028489608/icongroupinterna

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Enriching Lives: Overcoming Vitamin and Mineral Malnutrition in Developing Countries by International Bank for Reconstruction an; ISBN: 0821330969; http://www.amazon.com/exec/obidos/ASIN/0821330969/icongroupinterna

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Enriching Lives: Overcoming Vitamin and Mineral Malnutrition in Developing Countries (Development in Practice) by World Bank; ISBN: 0821329871; http://www.amazon.com/exec/obidos/ASIN/0821329871/icongroupinterna

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Explaining Child Malnutrition in Developing Countries: A Cross-Country Analysis (Research Report (International Food Policy Research Institute), 111.) by Lisa C. Smith, Lawrence Haddad; ISBN: 0896291146; http://www.amazon.com/exec/obidos/ASIN/0896291146/icongroupinterna

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Fighting Malnutrition: An Evaluation of Brazilian Food and Nutrition Programs (World Bank Discussion Papers, 60) by Philip Musgrove; ISBN: 0821312936; http://www.amazon.com/exec/obidos/ASIN/0821312936/icongroupinterna

134

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Finding and fighting malnutrition in the elderly : hearing before the Subcommittee on Aging of the Committee on Labor and Human Resources, United States Senate, One Hundred Second Congress, second session, examining the nutritional status of older Americans, focusing on nutrition screening services, February 20, 1992 (SuDoc Y 4.L 11/4:S.hrg.102-613); ISBN: 0160386306; http://www.amazon.com/exec/obidos/ASIN/0160386306/icongroupinterna

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Fish Protein Concentrate : Panacea for Protein Malnutrition? by E. R. Pariser (Author), et al; ISBN: 0262160692; http://www.amazon.com/exec/obidos/ASIN/0262160692/icongroupinterna

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Fish, Food, and Hunger: The Potential of Fisheries for Alleviating Malnutrition (Westview Special Studies in Ocean Science and Policy) by George Kent; ISBN: 081337409X; http://www.amazon.com/exec/obidos/ASIN/081337409X/icongroupinterna

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Fisheries and malnutrition : a bibliography by George Kent; ISBN: 1555903355; http://www.amazon.com/exec/obidos/ASIN/1555903355/icongroupinterna

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Food Fortification in Canada: Experiences and Issues in Controlling Micronutrient Malnutrition by Mahshid Lotfi; ISBN: 1894217160; http://www.amazon.com/exec/obidos/ASIN/1894217160/icongroupinterna

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Food Fortification to End Micronutrient Malnutrition: State of the Art by Micronutrient Initiative (Editor); ISBN: 1894217047; http://www.amazon.com/exec/obidos/ASIN/1894217047/icongroupinterna

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Geo-Ecology of Malnutrition: A Study of the Haryana Children by Surinder K. Aggarwal; ISBN: 8121000742; http://www.amazon.com/exec/obidos/ASIN/8121000742/icongroupinterna

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Global malnutrition and cereal fortification; ISBN: 0884103668; http://www.amazon.com/exec/obidos/ASIN/0884103668/icongroupinterna

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Global, Regional and Country Assessment of Child Malnutrition (UNICEF Staff Working Papers, No. 7/Sales No. 90.20.Usa.1) by Beverley A. Carlson, Tessa M. Wardlaw; ISBN: 9280600273; http://www.amazon.com/exec/obidos/ASIN/9280600273/icongroupinterna

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Hospital-related Malnutrition (NT Clinical Monographs) by Susan Holmes; ISBN: 1902499441; http://www.amazon.com/exec/obidos/ASIN/1902499441/icongroupinterna

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Hunger and Malnutrition in America (An Impact Book) by Gerald Leinwand; ISBN: 0531100634; http://www.amazon.com/exec/obidos/ASIN/0531100634/icongroupinterna

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Hunger and Shame: Child Malnutrition and Poverty on Mt. Kilimanjaro by Mary Theresa Howard, Ann Millard (Contributor); ISBN: 0415916143; http://www.amazon.com/exec/obidos/ASIN/0415916143/icongroupinterna

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Identification of Malnutrition: Report on the Identification of Malnutrition Within 5 Surgical Wards (Audit Symposium 1994: 60) by Fiona Struthers; ISBN: 0748030476; http://www.amazon.com/exec/obidos/ASIN/0748030476/icongroupinterna

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Malnutrition by J. C. Waterlow; ISBN: 0340501278; http://www.amazon.com/exec/obidos/ASIN/0340501278/icongroupinterna

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Malnutrition and achievement : the assessment of nutritional status and school achievement of rural primary school children in Northern Peninsular Malaysia by

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135

Wan Abdul Manan bin Wan Muda; ISBN: 9839970410; http://www.amazon.com/exec/obidos/ASIN/9839970410/icongroupinterna •

Malnutrition and Brain Development by Myron Winick; ISBN: 0195019830; http://www.amazon.com/exec/obidos/ASIN/0195019830/icongroupinterna

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Malnutrition and Human Behavior: Experimental, Clinical, and Community Studies by Josef Brozek (Editor); ISBN: 0442211082; http://www.amazon.com/exec/obidos/ASIN/0442211082/icongroupinterna

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Malnutrition and Infection in the Classroom by Ernesto Pollitt; ISBN: 9231026623; http://www.amazon.com/exec/obidos/ASIN/9231026623/icongroupinterna

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Malnutrition and intellectual development; ISBN: 0884161811; http://www.amazon.com/exec/obidos/ASIN/0884161811/icongroupinterna

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Malnutrition and Poverty: Magnitude and Policy Options by Shlomo Reutlinger; ISBN: 0801818680; http://www.amazon.com/exec/obidos/ASIN/0801818680/icongroupinterna

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Malnutrition and Retarded Human Development by Sohan L. Manocha; ISBN: 0398025487; http://www.amazon.com/exec/obidos/ASIN/0398025487/icongroupinterna

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Malnutrition and the Immune Response by Suskind; ISBN: 0890040605; http://www.amazon.com/exec/obidos/ASIN/0890040605/icongroupinterna

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Malnutrition and the Infant Brain by Nico Van Gelder, Van Gelder Nico M; ISBN: 0471568236; http://www.amazon.com/exec/obidos/ASIN/0471568236/icongroupinterna

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Malnutrition and the infantile brain by Irene Sjögren; ISBN: 9171060561; http://www.amazon.com/exec/obidos/ASIN/9171060561/icongroupinterna

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Malnutrition in Chronic Diet-Associated Infantile Diarrhea: Diagnosis and Management (Bristol-Myers Squibb/Mead Johnson Nutrition Symposia, Vol. 8) by Carlos H. Lifschitz, Buford L. Nichols (Editor); ISBN: 012450020X; http://www.amazon.com/exec/obidos/ASIN/012450020X/icongroupinterna

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Malnutrition in Cote d Ivoire Prevalence and Determinants (Social Dimensions of Adjustment in Sub-Saharan Africa, Working Paper No. 4) by David E. Sahn; ISBN: 0821315560; http://www.amazon.com/exec/obidos/ASIN/0821315560/icongroupinterna

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Malnutrition in southern Africa : proceedings of a colloquium held at the Institute for Behavioural Sciences, University of South Africa, Pretoria, July 30 and 31, 1979; ISBN: 0869812106; http://www.amazon.com/exec/obidos/ASIN/0869812106/icongroupinterna

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Malnutrition in the Elderly by O. Seiler (Editor), et al; ISBN: 3798511667; http://www.amazon.com/exec/obidos/ASIN/3798511667/icongroupinterna

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Malnutrition in the elderly : a national crisis (SuDoc HE 20.3852:M 29) by Kathy Cope; ISBN: B00010QF6M; http://www.amazon.com/exec/obidos/ASIN/B00010QF6M/icongroupinterna

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Malnutrition, a Problem of Industrial Societies: Fehlernahrung--Ein Problem Der Industriegesellschaft (Biblioteca Nurtritio Et Dieta, No 42) by Symposium on "Malnutrition--A Problem of Industrial Societies? : Diete, et al; ISBN: 3805548117; http://www.amazon.com/exec/obidos/ASIN/3805548117/icongroupinterna

136

Malnutrition

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Malnutrition, behavior, and social organization; ISBN: 0122980506; http://www.amazon.com/exec/obidos/ASIN/0122980506/icongroupinterna

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Malnutrition, determinants and consequences : proceedings of the Western Hemisphere Nutrition Congress VII held in Miami Beach, Florida, August 7-11, 1983; ISBN: 0845116096; http://www.amazon.com/exec/obidos/ASIN/0845116096/icongroupinterna

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Malnutrition, Environment, and Behavior: New Perspectives by David A. Levitsky; ISBN: 0801410452; http://www.amazon.com/exec/obidos/ASIN/0801410452/icongroupinterna

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Malnutrition, Learning, and Behavior by Nevin S. Scrimshaw (Author), John E. Gordon (Author); ISBN: 0262190494; http://www.amazon.com/exec/obidos/ASIN/0262190494/icongroupinterna

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Malnutrition: Determinants and Consequences by Philip L. White, Nancy Selvey (Editor); ISBN: 0471834378; http://www.amazon.com/exec/obidos/ASIN/0471834378/icongroupinterna

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Malnutrition: Its Causation and Control (With Special Reference to Protein Calorie Malnutrition) by John R. K. Robson; ISBN: 0677031408; http://www.amazon.com/exec/obidos/ASIN/0677031408/icongroupinterna

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Malnutrition: What Can Be Done: Lessons from World Bank Experience by Alan Berg, World Bank; ISBN: 0801835534; http://www.amazon.com/exec/obidos/ASIN/0801835534/icongroupinterna

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Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers; ISBN: 9241545119; http://www.amazon.com/exec/obidos/ASIN/9241545119/icongroupinterna

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Management of the Child with a Serious Infection or Severe Malnutrition: Guidelines for Care at the First-referal Level in Developing Countries; ISBN: 9241545313; http://www.amazon.com/exec/obidos/ASIN/9241545313/icongroupinterna

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Maternal and Child Health in Kenya: A Study of Poverty, Disease and Malnutrition in Samia (Monographs of the Finnish Society for Development Studies) by Richard N.O. K'okul; ISBN: 917106320X; http://www.amazon.com/exec/obidos/ASIN/917106320X/icongroupinterna

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Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition by Thomas H., Md. Brewer; ISBN: 0879833084; http://www.amazon.com/exec/obidos/ASIN/0879833084/icongroupinterna

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National Malnutrition by D.T. Quigley; ISBN: 0686767438; http://www.amazon.com/exec/obidos/ASIN/0686767438/icongroupinterna

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Nature and extent of malnutrition in Bangladesh : Bangladesh national nutrition survey, 1995-96 by Khursheed Jahan; ISBN: 9843104447; http://www.amazon.com/exec/obidos/ASIN/9843104447/icongroupinterna

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Nutrition and Malnutrition: Identification and Measurement: Proceedings (Advances in Experimental Medicine and Biology, V. 49) by Burg Wartenstein Conference on Physical Anthropology and Nutritional S, et al; ISBN: 0306390493; http://www.amazon.com/exec/obidos/ASIN/0306390493/icongroupinterna

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137

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Nutrition in the Gulf Countries: Malnutrition and Minerals (World Review of Nutrition and Dietetics, Vol 54) by Geoffrey H. Bourne (Editor); ISBN: 3805546823; http://www.amazon.com/exec/obidos/ASIN/3805546823/icongroupinterna

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Nutritional Metabolism and Malnutrition (Series in Nutrition) by Prakesh Shetty (Editor); ISBN: 1854632094; http://www.amazon.com/exec/obidos/ASIN/1854632094/icongroupinterna

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Objectif : Malnutrition by J. Dupire (Author); ISBN: 2842510194; http://www.amazon.com/exec/obidos/ASIN/2842510194/icongroupinterna

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Physiology, Stress, and Malnutrition: Functional Correlates, Nutritional Intervention by John M. Kinney (Editor), et al; ISBN: 0397587635; http://www.amazon.com/exec/obidos/ASIN/0397587635/icongroupinterna

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Pointers to the Common Remedies: Dentition, Rickets, Malnutrition, Tuberculosis, Disease of Glands and Bones by M.L. Tyler; ISBN: 0946717362; http://www.amazon.com/exec/obidos/ASIN/0946717362/icongroupinterna

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Political economy of malnutrition by Okello Oculi; ISBN: 9781250321; http://www.amazon.com/exec/obidos/ASIN/9781250321/icongroupinterna

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Poverty and Malnutrition in Latin America: Early Childhood Intervention Programs: A Report to the Ford Foundation by Ernesto Pollitt; ISBN: 0030580315; http://www.amazon.com/exec/obidos/ASIN/0030580315/icongroupinterna

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Preventing Malnutrition (Injury Prevention for the Elderly) by Bonnie L. Walker; ISBN: 083420830X; http://www.amazon.com/exec/obidos/ASIN/083420830X/icongroupinterna

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Preventing Micronutrient Malnutrition: A Guide to Food-Based Approaches by International Life Sciences Institute; ISBN: 0944398898; http://www.amazon.com/exec/obidos/ASIN/0944398898/icongroupinterna

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Protein-calorie malnutrition; ISBN: 0125261500; http://www.amazon.com/exec/obidos/ASIN/0125261500/icongroupinterna

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Protein-energy malnutrition; ISBN: 0713142855; http://www.amazon.com/exec/obidos/ASIN/0713142855/icongroupinterna

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Protein-energy malnutrition and intellectual abilities : a study of teen-age Ugandan children by Jan Hoorweg; ISBN: 9027977526; http://www.amazon.com/exec/obidos/ASIN/9027977526/icongroupinterna

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Protein-energy malnutrition and the home environment : a study among children in Coast Province, Kenya by Caroline Peters; ISBN: 907011058X; http://www.amazon.com/exec/obidos/ASIN/907011058X/icongroupinterna

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Protein-energy malnutrition in Barbados : the role of continuity of care in management by Frank C. Ramsey; ISBN: 0914362283; http://www.amazon.com/exec/obidos/ASIN/0914362283/icongroupinterna

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Raingan kanwichai r½ang s½ksa ha nµothang lµ withi kankµpanha phawa thupphochakan [i.e. thupphotchanakan] dek °ayu 0-5 pi khong 3 muban nai Changwat Kalasin Malnutrition in 0-5 years old children of 3 villages in Kalasin Province : a problem solving model; ISBN: 9745556432; http://www.amazon.com/exec/obidos/ASIN/9745556432/icongroupinterna

138

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Rural India and Malnutrition: Implications, Problems and Prospects by S. Zaidi; ISBN: 0391027204; http://www.amazon.com/exec/obidos/ASIN/0391027204/icongroupinterna

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Scaling Up, Scaling Down: Overcoming Malnutrition in Developing Countries by Thomas J. Marchione (Editor); ISBN: 9057005476; http://www.amazon.com/exec/obidos/ASIN/9057005476/icongroupinterna

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Selected Vitamins, Minerals, and Functional Consequences of Maternal Malnutrition (World Review of Nutrition and Dietetics, Vol 64) by A. P. Simopoulos (Editor); ISBN: 3805551681; http://www.amazon.com/exec/obidos/ASIN/3805551681/icongroupinterna

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Struggle for Health: A Case Study of Malnutrition and Ill-Health Among South Indian Tribals by Stuart Gillespie; ISBN: 8170224632; http://www.amazon.com/exec/obidos/ASIN/8170224632/icongroupinterna

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The begging bowl : hunger, starvation, malnutrition & Muslims by Achmad Cassiem; ISBN: 0958321957; http://www.amazon.com/exec/obidos/ASIN/0958321957/icongroupinterna

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The Double Burden of Malnutrition in Asia : Causes, Consequences, and Solutions by Stuart Gillespie (Author), Lawrence Haddad (Author); ISBN: 0761997571; http://www.amazon.com/exec/obidos/ASIN/0761997571/icongroupinterna

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The Ecology of Malnutrition in Seven Countries of Southern Africa and in Portuguese Guinea: The Republic of South Africa, South West Africa (Namibia), by Jacques M. May (Editor), Donna L. McLellan (Editor); ISBN: 0028489403; http://www.amazon.com/exec/obidos/ASIN/0028489403/icongroupinterna

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The Ecology of Malnutrition in Western South America: Colombia, Ecuador, Peru, Bolivia, and Chile, by Jacques Meyer May; ISBN: 0028490703; http://www.amazon.com/exec/obidos/ASIN/0028490703/icongroupinterna

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The Making of Modern Malnutrition by Suzi Leather; ISBN: 1897820054; http://www.amazon.com/exec/obidos/ASIN/1897820054/icongroupinterna

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The risk of malnutrition in nursing homes : forum before the Special Committee on Aging, United States Senate, One Hundred Fifth Congress, first session, Washington, DC, October 22, 1997 (SuDoc Y 4.AG 4:S.HRG.105-323); ISBN: 0160561167; http://www.amazon.com/exec/obidos/ASIN/0160561167/icongroupinterna

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The treatment and management of severe protein-energy malnutrition; ISBN: 9241541598; http://www.amazon.com/exec/obidos/ASIN/9241541598/icongroupinterna

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The Vulnerable Brain and Environmental Risks: Malnutrition and Hazard Assessment by Robert L. Isaacson, Karl F. Jensen (Editor); ISBN: 0306441489; http://www.amazon.com/exec/obidos/ASIN/0306441489/icongroupinterna

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The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition (Contemporary Neurology, No. 30) by Maurice Victor, et al; ISBN: 0803689217; http://www.amazon.com/exec/obidos/ASIN/0803689217/icongroupinterna

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Tropical Diseases: Including Aspects of Hygiene, Malnutrition and Injuries (Tropical Health Concise Notes) by Christine Hoverd, Rosemary Brown; ISBN: 0333423461; http://www.amazon.com/exec/obidos/ASIN/0333423461/icongroupinterna

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Underfed and Overfed: The Global Epidemic of Malnutrition (World Watch Paper 150, March 2000) by Gary T. Gardner, et al; ISBN: 1878071521; http://www.amazon.com/exec/obidos/ASIN/1878071521/icongroupinterna

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Urban Food Insecurity and Malnutrition by Johshin Von Braun; ISBN: 0896293262; http://www.amazon.com/exec/obidos/ASIN/0896293262/icongroupinterna

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Wasting Away: The Crisis of Malnutrition in India (Directions in Development (Washington, D.C.).) by Anthony R. Measham, Meera Chatterjee; ISBN: 0821344358; http://www.amazon.com/exec/obidos/ASIN/0821344358/icongroupinterna

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WHO Global Database on Child Growth and Malnutrition by Monika Onis; ISBN: 0119518112; http://www.amazon.com/exec/obidos/ASIN/0119518112/icongroupinterna

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Worldwide Health Sourcebook: Basic Information About Global Health Issues, Including Malnutrition, Reproductive Health, Disease Dispersion and Prevention, Emerging (Health Reference Series) by Joyce Brennfleck Shannon (Editor); ISBN: 0780803302; http://www.amazon.com/exec/obidos/ASIN/0780803302/icongroupinterna

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

Failure to Thrive, Malnutrition, and Anorexia Source: in Kleiman, R.E., ed. Pediatric Nutrition Handbook. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics. 1998. p. 325-336. Contact: Available from American Academy of Pediatrics. P.O. Box 927, 141 Northwest Point Boulevard, Elk Grove Village, IL 60009-0927. (800) 433-9016. PRICE: $47.95 (members) plus $6.25 shipping and handling; $52.95 for nonmembers; plus $8.95 shipping and handling. ISBN: 1581100051. Summary: Assessment of nutritional status and providing dietary advice and nutritional support are important and increasingly prominent components of the practice of those who provide health care for infants, children, and adolescents. This chapter on failure to thrive (FTT), malnutrition, and anorexia (lack of appetite) is from a handbook that serves as a ready desk reference on the nutritional requirements and impact of nutritional status on the health of infants, children, and adolescents. Topics include the measurement and determination of FTT, etiologic factors (causes), diagnostic evaluation of FTT, management and treatment strategies, and specific conditions, including infant malnutrition, developmental delay, and anorexia nervosa and bulimia (eating disorders). The diagnostic evaluation begins with a thorough history, assessment of nutrient intake, and a complete physical examination. Management strategies begin with a 4 to 6 week course of supervised nutritional intervention; failure to respond to

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this treatment should lead to more customized investigations (diagnostic testing) of digestion, absorption, and caloric utilization. Once growth is achieved, the child should be followed up closely to document catch-up growth and to monitor the response to disease-specific therapies. 1 table. 14 references. •

Malnutrition as a Risk Factor for Morbidity and Mortality in Maintenance Dialysis Patients Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 257-276. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on malnutrition as a risk factor for morbidity and mortality in maintenance dialysis patients is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The authors note that protein energy malnutrition is distressingly common among patients with end-stage renal disease (ESRD) and is often multifactorial. Contributing causes include reduced nutrient intake due to anorexia, depression, financial obstacles, or prescribed dietary restrictions; increased nutrient loss due to phlebotomy and amino acid dialysance; and hypercatabolism due to intercurrent infection and surgical procedures; as well as the dialysis procedure itself. The author concludes that the prevalence and severity of malnutrition remain extraordinarily high, despite recent improvements in dialytic technology and the recognition of malnutrition as a life-threatening clinical syndrome in dialysis patients. Potential interventions should not be limited to enteral and parenteral nutrition sources but should include counseling and social services (e.g., nursing, home care, meals-on-wheels) for needy, elderly, or disabled patients. Lastly, it is imperative to explore the effects of nutritional status not only on mortality and convenient measures of morbidity, such as hospitalization, but also on patient-centered outcomes, such as rehabilitation potential, functional status, vitality, and health-related quality of life. 2 tables. 54 references. (AA-M).

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Causes, Manifestations, and Assessment of Malnutrition in Chronic Renal Failure Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 245-256. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on the causes, manifestations, and assessment of malnutrition in chronic renal failure (CRF) is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The author notes that patients with chronic renal insufficiency and those with end-stage renal disease (ESRD) often manifest signs of wasting and malnutrition. The initiation of dialysis therapy in the malnourished patient often fails to improve nutritional status. The author describes the causes of malnutrition in patients with renal failure and those treated with maintenance dialysis. Renal disease is associated with anorexia and alterations in taste; these symptoms may lead to decreased dietary intake and subsequent malnutrition. CAPD is also associated with abnormal patterns of dietary intake, due to the large amount of fluid in the peritoneal cavity and the effect of glucose absorption on appetite. Patients undergoing maintenance hemodialysis have reduced gastric emptying, and the frequent

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coexistence of diabetes mellitus may also be associated with gastroparesis, further suppressing intake. Frequent intercurrent illness may increase catabolism and further impair nutritional status. Inadequate dialysis is another possible cause of malnutrition in maintenance dialysis patients. The author also outlines the methods available to assess nutritional status in these patients. 1 figure. 2 tables. 52 references. (AA-M). •

Effect of Malnutrition and of Changes in Protein Intake on Renal Function Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 229-244. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on the effect of malnutrition and of changes in protein intake on renal function is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The author notes that protein is an important modulator of renal hemodynamics. A prolonged change from a low to a high protein diet increases renal blood flow and glomerular filtration rate (GFR) by as much as 30 to 60 percent. The author discusses the mechanisms, which may not be mutually exclusive, that have been proposed to explain this increase in renal blood flow and GFR observed after a protein meal or during chronic protein administration. First, humoral factors, either circulating or local, are released in response to elevation in plasma amino acid levels and subsequently stimulate renal vasodilation. An increase in protein intake stimulates the secretion of growth hormone, glucagon, dopamine, eicosanoids, and renin. Second, a role for amino acids as metabolic substrates in causing these changes has been suggested. Third, intrinsic renal mechanisms including tubuloglomerular feedback and tubular transport mechanisms may be involved. The author then focuses on chronic calorie-protein malnutrition and its effects on renal function. The decrease in GFR and the increased reabsorption of solutes observed in malnourished individuals would tend to minimize the loss of nutrients in the urine. In addition, the fall in the filtered load of sodium would decrease the metabolic requirements for sodium reabsorption in the kidney and hence lower the basal metabolic requirement in patients with chronic protein energy malnutrition. 2 figures. 1 table. 68 references. (AA-M).

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CHAPTER 7. MULTIMEDIA ON MALNUTRITION Overview In this chapter, we show you how to keep current on multimedia sources of information on malnutrition. 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 malnutrition is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “malnutrition” 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 “malnutrition” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on malnutrition: •

Nutritional Findings and Interventions in the AIDS Patient Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1992, 60 minutes. Contact: WIN, 1 WIN WAY, Bethesda, MD 20892-3665. Summary: Dr. Kotler begins his lecture by listing potential adverse effects of malnutrition in AIDS patients. Malnutrition may be an independent risk factor for mortality and may affect immune dysfunction, disease progression, quality of life, response to therapies, and use of health care resources. He notes that although these problems appear self-evident, none have actually been proven. Body weight is a reliable measure of nutritional status in healthy individuals but not in those acutely ill. Dr. Kotler prefers to measure body cell mass (the chief constituent of muscle, organs, and nonadipose tissue) in the laboratory, calculated from a person's potassium levels. He cites his 1985 study showing that a group of men with AIDS had a mean body weight that was 82 percent of ideal body weight (or low-normal), but a mean body cell mass 68

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percent of normal. Thus, someone with AIDS may be normal weight but extremely malnourished. Loss of body cell mass limits patients' performance. Studies of patients with wasting illnesses reveal that death occurs when a patient's body cell mass reaches 54 percent of normal. Treating AIDS patients is not simply a matter of prescribing nutritional supplementation, because not every AIDS patient is malnourished. In addition, malnutrition may be caused by a variety of conditions that require different nutritional strategies. Sometimes the answer is to treat the complication, and the patient will recover on his or her own, as Dr. Kotler found in a study of AIDS patients who suffered from CMV (cytomegalovirus) colitis. Another study of AIDS patients with gastrointestinal disease and AIDS patients with systemic infections found that the patients with GI infections responded to nutritional supplementation, but those with systemic infections did not. Strategies to be tested, in addition to nutritional supplementation, include appetite stimulants, enteral or parenteral nutrition, and anabolic agents such as growth hormone. •

Control of Food Intake Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1992, 60 minutes. Contact: WIN, 1 WIN WAY, Bethesda, MD 20892-3665. Summary: In this lecture Dr. Rolls describes her research on two aspects of the control of food intake: how the variety of food available and restriction of fat intake affect overall food consumption. Dr. Rolls reviews studies conducted with humans in which she and her colleagues identified a phenomenon called "sensory-specific satiety," or the change in the palatability of a food as it is eaten. Because of sensory-specific satiety, people switch from food to food during a meal and thus eat a variety of foods, says Dr. Rolls. This research suggests abnormal sensory-specific satiety may be a factor in eating disorders such as anorexia nervosa and bulimia, as well as in malnutrition among the elderly. Further, since subjects tended to eat more when a greater variety of food was available, apparently appetite reduction could be encouraged by decreasing the variety of foods offered to the minimum necessary for a balanced diet. Dr. Rolls also discusses the results of studies that looked at how human subjects' food intake was affected by controlling fat and carbohydrate intake and by use of "fat substitutes." The researchers found that carbohydrate and fat have similar effects on hunger and satiety. The use of fat substitutes was associated with a decrease in fat intake, but no change in daily energy intake. Studies suggesting that subjects who ate a low-fat diet were able to lose weight even when their total caloric intake was not controlled are also discussed.

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Nutrition and the Injury/Stress Response in the Hospitalized Patient Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1992, 60 minutes. Contact: WIN, 1 WIN WAY, Bethesda, MD 20892-3665. Summary: In this lecture, Dr. Bistrian describes the metabolic "stress response" that occurs in severely ill or injured patients and also reviews the provision of nutritional support to these patients at the New England Deaconess Hospital. Results of studies by Dr. Bistrian and others have established that about 40 percent of hospital patients are malnourished. The most common reason patients require invasive nutritional support is disease-associated malnutrition caused by the metabolic response to injury. The goal of nutritionally supporting an injured patient, according to Dr. Bistrian, is to foster the metabolic response and encourage healing. From clinical experience, Dr. Bistrian and his

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colleagues have concluded that a feeding formula of 30 kcal per kilogram of body weight, plus 1.5 grams of protein per kilogram. will adequately feed 90 percent of patients. They have further concluded that, provided the patient can tolerate it, enteral feeding is always preferable to parenteral feeding. Dr. Bistrian also discusses the risks associated with overfeeding and underfeeding, nutritional support of obese patients, and invasive feeding of patients with anorexia nervosa, cancer, and AIDS. •

Cirrhosis of the Liver Source: Los Angeles, CA: National Health Video, Inc. 1998. (videocassette). Contact: Available from National Health Video, Inc. 12021 Wilshire Blvd., Suite 550, Los Angeles, CA 90025. (800) 543-6803. Fax (310) 477-8198. E-mail: [email protected]. PRICE: $89.00 plus shipping and handling. Summary: This health education videotape is designed to convince viewers of the liver damage caused by alcohol intake. Narrated by a registered dietitian, the program first briefly reviews the anatomy of the liver and then describes the liver's functions: making clotting factors, supporting the immune system, filtering out chemical and alcohol toxins (regardless of how they enter the body), maintaining glycogen (stored food energy), aiding digestion of fats, protein and carbohydrates, and making bile for digesting fats and accessing vitamins. The main factor in keeping the liver healthy is the avoidance of alcohol, but the program also discusses the importance of a healthy diet and regular exercise. The program then focuses on cirrhosis, a condition in which normal liver cells are replaced by scar tissue. The program offers mortality statistics and reviews the causes of cirrhosis, including hepatitis, genetic disease, drug effects, and alcohol (which causes 75 percent of cirrhosis cases). There are no adequate warning signs that become apparent before the liver has been damaged. The program discusses the consequences of cirrhosis, including malnutrition, hepatic encephalopathy (ammonia induced mental impairment), swollen abdomen (ascites), fatty liver (in which fat cells replace normal liver cells), and reduced ability to manage medications and toxins. A final section discusses liver failure and liver transplantation, emphasizing that there are never enough donor livers available and that people who have alcohol induced liver disease are often not acceptable transplant candidates. The program features interviews and scenes with patients and physicians.

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Aging Brain Source: Sacramento, CA: Department of Aging. 1987. (videocassette, 6 handouts and 6 page training manual.). Contact: California Department of Aging, Training and Education Section. 1600 K Street, Sacramento, CA 95814. (916) 322-3110. PRICE: $10.00. Summary: This tape contains seven training segments designed for administrators and staff working in residential facilities for the aged. It reviews commonly held beliefs about aging that may negatively influence the care given to aging residents and how these myths developed. According to the tape, many believe that aged people are naturally "senile". Aged people can either accept this belief and act accordingly, creating a self-fulfilling prophecy in which they relinquish their independence to those caring for them, or they can rebel against their caregivers. Several studies related to aging are reviewed that suggest that there are only minor differences between the mental capacities of the young and aged. Treatable diseases that can affect the aged person's mental abilities are described including drug overdoses, malnutrition, dehydration, blood clots, brain tumors, depression, alcoholism, liver failure, kidney failure, drastic

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environmental changes, thyroid problems, heart failure, infections, diabetes, constipation, and emphysema. Organic brain syndromes, incurable diseases that affect mental capability, also are reviewed, including multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Korsakoff's syndrome, Parkinson's disease, and Alzheimer's disease. Specific attention is given to changes in the brain that occur as the disease progresses, the symptoms, and possible risk factors and causes of the disease. Contact points for the Alzheimer's Association are provided for further information. •

Nutrition Strategies in HIV Management Teleconference Contact: TKN - TV, 2000 5th Ave R-101, River Grove, IL, 60171. Summary: This videorecording documents a teleconference on the subject of nutrition and Human immunodeficiency virus (HIV) infection. Hosted by Novella Dudley, it features a panel of four experts from various areas of the field who discuss aspects of HIV and nutrition; they then field questions from both the studio audience and over the telephone. Short video segments introduce each new topic. The panel includes Dr. Donald Kotler, of St. Luke's - Roosevelt Hospital; Joyce Fitzpatrick, a nursing consultant; Frank San Miguel, coordinator of HIV services for travelers and immigrants in Chicago; and Annette Smerko of Caremark. The teleconference opens by considering nutrition as part of the psychosocial needs of a Person with AIDS (PWA). The symptoms of malnutrition are discussed, such as weight loss, anorexia, diarrhea, fever, and painful chewing or swallowing. It addresses financial issues of the cost of medication being so great that some patients cannot afford food. It looks at the different nutritional needs of PWA's, who must avoid weight loss by eating extra calories. The panel addresses the philosophy behind providing nutritional care for someone who is dying, and looks at the effect of alcohol use on nutrition. Case studies are examined; they say that the lack of ability to eat may be due to neurologic disease, drugs, or local pathology. PWA's are encouraged to consult with a dietitian, a physican, and a social worker. The connection between depression and malnutrition is established. The panel looks at specific opportunistic infections that may affect the appetite, such as hepatitis, thrush, and candida. A demonstration is given on safe handling of food to prevent salmonella and other foodborne diseases. The videorecording examines the devastating effects of weight loss on a patient, and looks at the barriers to motivating a patient to eat. It studies ethical concerns in treatment and legal issues involved in refusal to treat. The concluding segment studies the diagnosis and management of gastrointestinal disorders. It touches on steroid use and the use of nutritional supplements. At the end of the videorecording, viewers are urged to complete an evaluation.

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Nutrition and Inflammatory Bowel Disease Source: Bethesda, MD: Weight-Control Information Network. 1995. (videocassette). Contact: Available from Weight-Control Information Network. 1 WIN Way, Bethesda, MD 20892-3665. (202) 828-1025 or (877) 946-4627. Fax (202) 828-1028. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: $5.00. Summary: This videotape program presents coverage of a slide lecture presentation given by Dr. Michael Sitrin, the Director of the Clinical Nutrition Research Center at the University of Chicago. Dr. Sitrin discusses the nutritional therapy of inflammatory bowel disease (IBD), including enteral and parenteral nutrition therapies. He first covers the pathogenesis of malnutrition in patients with these types of disorders. Factors that contribute to malnutrition in IBD include decreased food intake (often to avoid symptoms), malabsorption (especially in patients with resections), excessive secretion of

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nutrients across the diseased mucosa, and increased nutrient requirements. Dr. Sitrin describes the prevalence of malnutrition in patients with IBD, particularly various vitamin deficiencies. The remainder of Dr. Sitrin's lecture discusses the five reasons that nutritional therapy might be utilized in a patient with IBD: as primary therapy for the disease itself, as preoperative nutritional support, to manage Crohn's disease and intestinal fistulas, to prevent growth retardation in children with IBD, and to maintain survival in patients with gut failure (accomplished predominantly through home total parenteral nutrition, or TPN). The videotape focuses primarily on Dr. Sitrin as he lectures, with shots of each slide as he shows them.

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 “malnutrition” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on malnutrition: •

Introductory Remarks: Causes and Treatment of Malnutrition in Chronic Renal Failure Source: Bethlehem, PA: St. Luke's Hospital. 1991. Contact: Available from St. Luke's Hospital. Nutrition Services-Renal, 801 Ostrum Street, Bethlehem, PA 18015. (215)954-4000. ATTN: Emilia Johns. PRICE: contact directly for information. Summary: This audiocassette presents a program from a one-day symposium, held in October 1991, that focuses on the nutritional assessment and nutritional intervention in the treatment of patients with chronic renal failure (CRF). The speaker, Joel D. Kopple, discusses the causes and treatment of malnutrition in CRF. The symposium was designed for dietitians and for students studying to become dietitians.

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CHAPTER 8. PERIODICALS AND NEWS ON MALNUTRITION Overview In this chapter, we suggest a number of news sources and present various periodicals that cover malnutrition.

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

Child malnutrition rising in Iraq, experts say Source: Reuters Health eLine Date: June 26, 2003

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U.N.: Iraqi children face death from malnutrition Source: Reuters Health eLine Date: May 14, 2003

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Depression may be an independent risk factor for malnutrition in dialysis patients Source: Reuters Medical News Date: May 09, 2003

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Outpatient care deemed reasonable for severe malnutrition Source: Reuters Industry Breifing Date: December 06, 2002

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Global initiative launched to combat malnutrition Source: Reuters Health eLine Date: May 09, 2002

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150 million children suffer malnutrition: UNICEF Source: Reuters Health eLine Date: March 13, 2002

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Drought creates malnutrition crisis in Guatemalan children Source: Reuters Medical News Date: February 15, 2002

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UN: Malnutrition threat to Afghan children growing Source: Reuters Health eLine Date: February 01, 2002

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Afghan children face increasing threat of malnutrition Source: Reuters Medical News Date: February 01, 2002

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UN official urges attention to malnutrition in Africa as a way to fight HIV/AIDS Source: Reuters Medical News Date: July 19, 2001

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Malnutrition compounds AIDS disaster in Africa Source: Reuters Health eLine Date: July 19, 2001

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Fetal malnutrition linked to adult schizophrenia Source: Reuters Health eLine Date: February 19, 2001

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Malnutrition stunting Tibetan children's growth Source: Reuters Health eLine Date: February 01, 2001

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Malnutrition levels high in children living in Indian slums Source: Reuters Medical News Date: January 25, 2001

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Survey finds chronic malnutrition in Afghan children Source: Reuters Health eLine Date: January 23, 2001

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Cardiac disease in offspring linked to maternal malnutrition in early gestation Source: Reuters Medical News Date: December 27, 2000

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Malnutrition linked to heart problems in HIV patients Source: Reuters Health eLine Date: November 27, 2000

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Malnutrition, anemia widespread among women and children in India Source: Reuters Medical News Date: November 17, 2000

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Less breast-feeding causing malnutrition in India Source: Reuters Health eLine Date: October 24, 2000

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UN says child malnutrition in Iraq very serious Source: Reuters Health eLine Date: September 14, 2000

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WHO to wage obesity war, vows to stem malnutrition Source: Reuters Health eLine Date: September 13, 2000

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Maternal malnutrition may increase airway disease in offspring Source: Reuters Medical News Date: July 14, 2000

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Malnutrition, sepsis, shigella are risk factors for fatal pediatric diarrhea Source: Reuters Medical News Date: June 27, 2000

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Malnutrition, dehydration in US nursing homes pinned on staffing problems Source: Reuters Medical News Date: June 09, 2000

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Malnutrition widespread in US nursing homes Source: Reuters Health eLine Date: June 09, 2000

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to

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Market Wire’s home page at http://www.marketwire.com/mw/home, type “malnutrition” (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 “malnutrition” (or synonyms). If you know the name of a company that is relevant to malnutrition, 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 “malnutrition” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “malnutrition” (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 malnutrition: •

Malnutrition in the Hemodialysis Patient Source: Renal Nutrition Forum. 14(4): 1-4. Fall 1995. Contact: Available from Renal Nutrition Forum. 2246 Poinciana Road, Winter Park, FL 32792. (407) 774-0631. Summary: This article presents a brief overview of research addressing nutritional status in the hemodialysis (HD) patient and the relationship between malnutrition, morbidity, and mortality. The article is also intended to help the dietitian in preventing malnutrition in the HD patient by offering suggestions for therapy. Dialysis factors which may contribute to malnutrition include an increase in muscle protein degradation caused by blood contact with the dialyzer membrane; inadequate dialysis resulting in a uremic state which leads to nausea, vomiting, and loss of appetite; and loss of amino acids and peptides in dialysate. Hormonal disturbances include insulin resistance, increased circulating levels of catabolic hormones such as insulin and parathyroid hormone, and decreased levels of anabolic hormones such as growth factor and erythropoietin caused by deterioration of kidney function. Gastrointestinal factors

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include gastroparesis, malabsorption, gastritis, esophagitis, and constipation. The author reports on studies documenting that malnutrition greatly increases morbidity and mortality in the HD patient. HD patients should ingest 1.2 grams of protein per kilogram of actual body weight, where 50 percent is high biological value protein. An adequate energy intake is vital for the efficient utilization of dietary protein. The most important factor in improving malnutrition in this population is to assure adequate dialysis. The author concludes with a section on interventions for patients who continue to have poor appetites, even if dialysis delivery is optimal. 1 table. 15 references.

Academic Periodicals covering Malnutrition Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to malnutrition. In addition to these sources, you can search for articles covering malnutrition 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.”

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CHAPTER 9. 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 malnutrition. 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 malnutrition. 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

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to malnutrition: 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

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 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 malnutrition 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 “malnutrition” (or synonyms)

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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 malnutrition: •

Oxandrolone (trade name: Hepandrin) http://www.rarediseases.org/nord/search/nodd_full?code=328

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

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

11

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 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:13 •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

12

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). 13 See http://www.nlm.nih.gov/databases/databases.html.

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•

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

•

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

The NLM Gateway14 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.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “malnutrition” (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 68127 2492 919 235 137 71910

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “malnutrition” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

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

15

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). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

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

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

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Coffee Break: Tutorials for Biologists19 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.20 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.21 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/.

19 Adapted 20

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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

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Anemia http://www.nlm.nih.gov/medlineplus/anemia.html Child Nutrition http://www.nlm.nih.gov/medlineplus/childnutrition.html Coronary Disease http://www.nlm.nih.gov/medlineplus/coronarydisease.html Crohn's Disease http://www.nlm.nih.gov/medlineplus/crohnsdisease.html Eating Disorders http://www.nlm.nih.gov/medlineplus/eatingdisorders.html Metabolic Disorders http://www.nlm.nih.gov/medlineplus/metabolicdisorders.html Osteoporosis http://www.nlm.nih.gov/medlineplus/osteoporosis.html Ulcerative Colitis http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.html Vitamins and Minerals http://www.nlm.nih.gov/medlineplus/vitaminsandminerals.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on malnutrition. 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: •

AAKP Advisory: Inadequate Peritoneal Dialysis May Increase the Risk of Malnutrition, Hospitalization and Premature Death Source: Tampa, FL: American Association of Kidney Patients (AAKP). 199x. [10 p.]. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. PRICE: $0.30 per copy. Summary: Research has shown that many peritoneal dialysis patients may not be receiving enough dialysis to prevent uremic symptoms (such as weight loss, poor

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appetite, and nausea), serious medical complications, hospitalizations and, in some cases, premature death. This brochure from the American Association of Kidney Patients (AAKP) provides a special advisory to inform and advise patients that inadequate peritoneal dialysis may increase their risk of malnutrition, hospitalization, and premature death. Topics include how to determine if dialysis is adequate, how the adequacy of peritoneal dialysis (PD) is measured, how important maintaining proper nutrition is, how to monitor the peritoneal access, and what to ask the doctor and PD staff. The brochure recommends that residual renal function (RRF) be measured every 2 months during the first year of dialysis and every 4 months after that; peritoneal membrane function (PET) should be measured during the first month after beginning PD and when the patient notices decreased drain volumes or longer drain times; the weekly KT over V and creatinine clearance levels should be measured at least every 4 months; and a routine clinic visit should be undertaken monthly or at least every 2 months. This routine clinic visit should be used to check for symptoms of inadequate dialysis, to determine that the peritoneal exchanges are going smoothly, to confirm that the patient's blood chemistries are stable, and to evaluate general health and nutrition. The brochure includes a tear out section of those questions for patients to carry with them to their health care provider. It concludes with a section describing the American Association of Kidney Patients (AAKP) and a membership form. 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 “malnutrition” (or synonyms). The following was recently posted: •

(1) Part I. Guidelines for the management of severe traumatic brain injury. In: Management and prognosis of severe traumatic brain injury. (2) Update notice. Guidelines for the management of severe traumatic brain injury: cerebral perfusion pressure Source: American Association of Neurological Surgeons - Medical Specialty Society; 2000 (revised 2003); 165 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3794&nbr=3020&a mp;string=inadequate+AND+nutrition

•

ACR Appropriateness Criteriatm for growth disturbances: risk of intrauterine growth restriction Source: American College of Radiology - Medical Specialty Society; 1996 (revised 2001); 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3253&nbr=2479&a mp;string=malnutrition

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Altered mental states Source: American Health Care Association - Professional Association; 1998 (reviewed 2003); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1804&nbr=1030&a mp;string=malnutrition

•

Altered nutritional status Source: American Medical Directors Association - Professional Association; 2001; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3304&nbr=2530&a mp;string=malnutrition

•

American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children--2003 update Source: American Association of Clinical Endocrinologists - Medical Specialty Society; 1998 (revised 2003); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3726&nbr=2952&a mp;string=malnutrition

•

American Gastroenterological Association management of oropharyngeal dysphagia

medical

position

statement

on

Source: American Gastroenterological Association - Medical Specialty Society; 1998 July 24 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3067&nbr=2293&a mp;string=malnutrition •

American Gastroenterological Association medical position statement: celiac sprue Source: American Gastroenterological Association - Medical Specialty Society; 2000 November 12 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3058&nbr=2284&a mp;string=malnutrition

•

American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3065&nbr=2291&a mp;string=malnutrition

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American Gastroenterological Association medical position statement: guidelines for the evaluation of food allergies Source: American Gastroenterological Association - Medical Specialty Society; 2000 November 12 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3059&nbr=2285&a mp;string=malnutrition

•

American Gastroenterological Association medical position statement: guidelines for the management of malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease in patients with human immunodeficiency virus infection Source: American Gastroenterological Association - Medical Specialty Society; 1996 December (reviewed 2001); 31 pages http://www.guideline.gov/summary/summary.aspx?doc_id=837&nbr=41& string=malnutrition

•

American Gastroenterological Association medical position statement: guidelines on osteoporosis in gastrointestinal diseases Source: American Gastroenterological Association - Medical Specialty Society; 2003 March; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3697&nbr=2923&a mp;string=malnutrition

•

American Gastroenterological Association medical position statement: irritable bowel syndrome Source: American Gastroenterological Association - Medical Specialty Society; 1996 November 10 (revised 2002 Dec); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3685&nbr=2911&a mp;string=malnutrition

•

American Gastroenterological Association medical position statement: parenteral nutrition Source: American Gastroenterological Association - Medical Specialty Society; 2001 May 18; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3056&nbr=2282&a mp;string=malnutrition

•

American Gastroenterological Association medical position statement: short bowel syndrome and intestinal transplantation Source: American Gastroenterological Association - Medical Specialty Society; 2003 April; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3795&nbr=3021&a mp;string=malnutrition

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Appropriate patient preparation for renal replacement therapy Source: Renal Physicians Association - Medical Specialty Society; 2002 October; 78 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3591&nbr=2817&a mp;string=malnutrition

•

ASHP therapeutic guidelines for nonsurgical antimicrobial prophylaxis Source: American Society of Health-System Pharmacists - Professional Association; 1999 June 15; 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1959&nbr=1185&a mp;string=malnutrition

•

Assessment and management of stage I to IV pressure ulcers Source: Registered Nurses Association of Ontario - Professional Association; 2002 August; 104 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3719&nbr=2945&a mp;string=malnutrition

•

Care of the neonate requiring parenteral nutrition Source: National Association of Neonatal Nurses - Professional Association; 1999; 34 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2144&nbr=1370&a mp;string=malnutrition

•

Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=malnutrition

•

Chronic kidney disease (non-dialysis) medical nutrition therapy protocol Source: American Dietetic Association - Professional Association; 2002 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3293&nbr=2519&a mp;string=malnutrition

•

Clinical practice guidelines for nutrition in chronic renal failure Source: National Kidney Foundation - Disease Specific Society; 2000 June; 121 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2545&nbr=1771&a mp;string=malnutrition

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Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult Source: American College of Critical Care Medicine - Professional Association; 1995 (revised 2002); 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3171&nbr=2397&a mp;string=malnutrition

•

Dehydration and fluid maintenance Source: American Medical Directors Association - Professional Association; 2001; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3305&nbr=2531&a mp;string=inadequate+AND+nutrition

•

Discharge guidelines for the technology dependent infant Source: National Association of Neonatal Nurses - Professional Association; 1999; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2145&nbr=1371&a mp;string=malnutrition

•

Evidence based clinical practice guideline for children with hypertrophic pyloric stenosis Source: Cincinnati Children's Hospital Medical Center - Hospital/Medical Center; 2001 August 8; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3119&nbr=2345&a mp;string=malnutrition

•

General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) Source: American Academy of Family Physicians - Medical Specialty Society; 2002 February 8; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3180&nbr=2406&a mp;string=malnutrition

•

Glomerulonephritis Source: National Committee on Renal Care (Singapore); 2001 October; 132 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2971&nbr=2197&a mp;string=malnutrition

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Guideline for prevention and management of pressure ulcers Source: Wound, Ostomy, and Continence Nurses Society - Professional Association; 2003; 52 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3860&nbr=3071&a mp;string=malnutrition

•

Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients Source: American Society for Blood and Marrow Transplantation - Professional Association; 2000 October 20; 126 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2573&nbr=1799&a mp;string=malnutrition

•

Hyperlipidemia medical nutrition therapy protocol Source: American Dietetic Association - Professional Association; 2001 June; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3295&nbr=2521&a mp;string=inadequate+AND+nutrition

•

Identifying and treating eating disorders Source: American Academy of Pediatrics - Medical Specialty Society; 2003 January; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3589&nbr=2815&a mp;string=malnutrition

•

K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification Source: National Kidney Foundation - Disease Specific Society; 2002 February; 246 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3192&nbr=2418&a mp;string=malnutrition

•

Liver transplantation Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2000 January; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3449&nbr=2675&a mp;string=malnutrition

Patient Resources

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Management of breastfeeding for healthy full-term infants Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2002 December; 89 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3624&nbr=2850&a mp;string=malnutrition

•

Management of chronic kidney disease and pre-ESRD in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 2000 November; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3099&nbr=2325&a mp;string=malnutrition

•

Management of postmenopausal osteoporosis: position statement of The North American Menopause Society Source: The North American Menopause Society - Private Nonprofit Organization; 2002 March; 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3179&nbr=2405&a mp;string=inadequate+AND+nutrition

•

Mealtime difficulties for older persons: assessment and management Source: The John A. Hartford Foundation Institute for Geriatric Nursing - Academic Institution; 2003; 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3506&nbr=2732&a mp;string=malnutrition

•

NKF-K/DOQI clinical practice guidelines for anemia of chronic kidney disease: update 2000 Source: National Kidney Foundation - Disease Specific Society; 1997 (updated 2000); 67 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2784&nbr=2010&a mp;string=malnutrition

•

NKF-K/DOQI clinical practice guidelines for peritoneal dialysis adequacy: update 2000 Source: National Kidney Foundation - Disease Specific Society; 1997 (updated 2000); 72 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2782&nbr=2008&a mp;string=malnutrition

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Nutrition practice guidelines for gestational diabetes mellitus Source: American Dietetic Association - Professional Association; 2001 September; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3294&nbr=2520&a mp;string=inadequate+AND+nutrition

•

Nutrition practice guidelines for type 1 and type 2 diabetes mellitus Source: American Dietetic Association - Professional Association; 2001 December; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3296&nbr=2522&a mp;string=inadequate+AND+nutrition

•

Oral hygiene care for functionally dependent and cognitively impaired older adults Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2002 November; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3611&nbr=2837&a mp;string=inadequate+AND+nutrition

•

Osteoporosis. Guide to prevention, diagnosis, and treatment Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 1999 (revised 2001); 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3430&nbr=2656&a mp;string=inadequate+AND+nutrition

•

Pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis Source: American Pain Society - Professional Association; 2002; 179 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3691&nbr=2917&a mp;string=inadequate+AND+nutrition

•

Practice guideline for the treatment of patients with eating disorders Source: American Psychiatric Association - Medical Specialty Society; 1993 (updated 2000 Jan); 51 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2194&nbr=1420&a mp;string=malnutrition

•

Practice guidelines for the management of infectious diarrhea Source: Infectious Diseases Society of America - Medical Specialty Society; 2001 February; 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2791&nbr=2017&a mp;string=malnutrition

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Practice guidelines for the management of patients with histoplasmosis Source: Infectious Diseases Society of America - Medical Specialty Society; 2000 April; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2668&nbr=1894&a mp;string=inadequate+AND+nutrition

•

Practice management guidelines for nutritional support of the trauma patient Source: Eastern Association for the Surgery of Trauma - Professional Association; 2001; 112 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2961&nbr=2187&a mp;string=malnutrition

•

Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint Source: American Academy of Child and Adolescent Psychiatry - Medical Specialty Society; 2001 May 13; 81 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3020&nbr=2246&a mp;string=inadequate+AND+nutrition

•

Prediction and prevention of pressure ulcers in adults Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2001 March; 51 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3277&nbr=2503&a mp;string=inadequate+AND+nutrition

•

Pressure ulcer prevention and treatment following spinal cord injury Source: Consortium for Spinal Cord Medicine - Private Nonprofit Organization; 2000 August; 80 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2589&nbr=1815&a mp;string=inadequate+AND+nutrition

•

Pressure ulcer risk assessment and prevention Source: Royal College of Nursing - Professional Association; 2001 April; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2953&nbr=2179&a mp;string=malnutrition

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Pressure ulcers Source: American Medical Directors Association - Professional Association; 1996 (reviewed January 2001, 2002, and 2003); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1811&nbr=1037&a mp;string=malnutrition

•

Pressure ulcers in adults: prediction and prevention Source: Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]; 1992 (reviewed 2000); 63 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2601&nbr=1827&a mp;string=inadequate+AND+nutrition

•

Preventing falls in acute care Source: The John A. Hartford Foundation Institute for Geriatric Nursing - Academic Institution; 2003; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3510&nbr=2736&a mp;string=malnutrition

•

Preventing pressure ulcers and skin tears Source: The John A. Hartford Foundation Institute for Geriatric Nursing - Academic Institution; 2003; 37 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3511&nbr=2737&a mp;string=malnutrition

•

Prevention of pressure ulcers Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1997 (revised 2002 May); 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3458&nbr=2684&a mp;string=malnutrition

•

Recommendations for blood lead screening of young children enrolled in Medicaid: targeting a group at high risk Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2000 December 8; 25 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2738&nbr=1964&a mp;string=inadequate+AND+nutrition

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Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2002 July; 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3287&nbr=2513&a mp;string=inadequate+AND+nutrition

•

Risk assessment and prevention of pressure ulcers Source: Registered Nurses Association of Ontario - Professional Association; 2002 January; 56 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3713&nbr=2939&a mp;string=inadequate+AND+nutrition

•

Routine prenatal care Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 August (revised 2002 Aug); 64 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3442&nbr=2668&a mp;string=inadequate+AND+nutrition

•

Screening and assessing adolescents for substance use disorders Source: Substance Abuse and Mental Health Services Administration (U.S.) - Federal Government Agency [U.S.]; 1993 (updated 1999) http://www.guideline.gov/summary/summary.aspx?doc_id=1816&nbr=1042&a mp;string=inadequate+AND+nutrition

•

Tests of glycemia in diabetes Source: American Diabetes Association - Professional Association; 1996 November (revised 2000; republished 2003 Jan); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3581&nbr=2807&a mp;string=inadequate+AND+nutrition

•

The management of diabetes mellitus in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 December; 147 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2583&nbr=1809&a mp;string=malnutrition

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Thrombocytopenia Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3393&nbr=2619&a mp;string=malnutrition

•

Translation of the diabetes nutrition recommendations for health care institutions Source: American Diabetes Association - Professional Association; 1996 August (reviewed 1997; republished 2003 Jan); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3570&nbr=2796&a mp;string=malnutrition

•

Treatment of pressure ulcers Source: Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]; 1994 December (reviewed 2000); 154 pages http://www.guideline.gov/summary/summary.aspx?doc_id=810&nbr=8&st ring=malnutrition

•

Treatment of pressure ulcers Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1997 (revised 2002 Aug); 30 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3457&nbr=2683&a mp;string=malnutrition

•

VHA/DOD clinical practice guideline for the management of chronic obstructive pulmonary disease. Source: Department of Defense - Federal Government Agency [U.S.]; 1999 August; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2584&nbr=1810&a mp;string=inadequate+AND+nutrition

•

VHA/DoD clinical practice guideline for the management of dyslipidemia in primary care Source: Department of Defense - Federal Government Agency [U.S.]; 2001 December; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3187&nbr=2413&a mp;string=inadequate+AND+nutrition

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VHA/DOD clinical practice guideline for the management of major depressive disorder in adults Source: Department of Defense - Federal Government Agency [U.S.]; 1997 (updated 2000); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2585&nbr=1811&a mp;string=malnutrition 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 malnutrition. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

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

•

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

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

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

•

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

•

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

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

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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 “malnutrition” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “malnutrition”. 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 “malnutrition” (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 “malnutrition” (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.22

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

22

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)23: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

23

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

Finding Medical Libraries 185

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Medical Libraries 187

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

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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

•

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

•

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

•

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

•

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

•

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

•

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

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

Basic Guidelines for Malnutrition Malnutrition Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000404.htm

•

Signs & Symptoms for Malnutrition Binge eating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003265.htm Hunger Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003134.htm

•

Nutrition for Malnutrition Deficiency - vitamin A Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002400.htm Deficiency - vitamin B1 (thiamine) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002401.htm

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Deficiency - vitamin B2 (riboflavin) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002411.htm Deficiency - vitamin B6 (pyridoxine) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002402.htm Deficiency - vitamin B9 (folacin) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002408.htm Deficiency - vitamin E Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002406.htm Deficiency - vitamin K Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002407.htm Diet and iodine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002421.htm Scurvy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000355.htm Vitamins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002399.htm Well-balanced diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002449.htm •

Background Topics for Malnutrition Food guide pyramid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002093.htm

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

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

•

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

•

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

•

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

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MALNUTRITION DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] 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] 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] 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] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] 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] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte 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] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyl: Chemical signal used by bacteria to communicate. [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

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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] Adduct: Complex formed when a carcinogen combines with DNA or a protein. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant 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] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] 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] 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 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 Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [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] Aetiology: Study of the causes of disease. [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] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH] Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is

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produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [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 stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkylating Agents: Highly reactive chemicals that introduce alkyl radicals into biologically active molecules and thereby prevent their proper functioning. Many are used as antineoplastic agents, but most are very toxic, with carcinogenic, mutagenic, teratogenic, and immunosuppressant actions. They have also been used as components in poison gases. [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] 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] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [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] 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

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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] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [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] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

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] Anergy: Absence of immune response to particular substances. [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]

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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] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anomalies: Birth defects; abnormalities. [NIH] 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] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Anosmia: Absence of the sense of smell; called also anosphrasia and olfactory anaesthesia. [EU]

Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [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] 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] 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] Anticonvulsants: Drugs used to prevent seizures or reduce their severity. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with

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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] 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] 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] Antiviral: Destroying viruses or suppressing their replication. [EU] 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] Apathy: Lack of feeling or emotion; indifference. [EU] 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] Appetite Stimulants: Agents that are used to stimulate appetite. These drugs are frequently used to treat anorexia associated with cancer and AIDS. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] 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,

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euryarchaeota, and korarchaeota. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspartate: A synthetic amino acid. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] 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] Auditory: Pertaining to the sense of hearing. [EU] 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] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH]

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Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Autoreceptors: Transmitter receptors on or near presynaptic terminals (or varicosities) which are sensitive to the transmitter(s) released by the terminal itself. Receptors for the hormones released by hormone-releasing cells are also included. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] 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] Barbiturates: A class of chemicals derived from barbituric acid or thiobarbituric acid. Many of these are medically important as sedatives and hypnotics (sedatives, barbiturate), as anesthetics, or as anticonvulsants. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [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] Base Sequence: The sequence of purines and pyrimidines in nucleic acids and polynucleotides. It is also called nucleotide or nucleoside sequence. [NIH] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] 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] Behavioral Symptoms: Observable manifestions of impaired psychological functioning. [NIH]

Beta carotene: A vitamin A precursor. Beta carotene belongs to the family of fat-soluble vitamins called carotenoids. [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

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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 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] 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] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biochemical reactions: In living cells, chemical reactions that help sustain life and allow cells to grow. [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] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] 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

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embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood 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 vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [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 Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Development: Gross development of bones from fetus to adult. It includes osteogenesis, which is restricted to formation and development of bone from the undifferentiated cells of the germ layers of the embryo. It does not include osseointegration. [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 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] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain 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]

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Breakdown: A physical, metal, or nervous collapse. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] 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] 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] Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [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] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened.

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[NIH]

Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] 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] Cardiac arrest: A sudden stop of heart function. [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] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [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] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] 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,

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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] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] 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] 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 Count: A count of the number of cells of a specific kind, usually measured per unit volume of sample. [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 motility: The ability of a cell to move. [NIH] Cell Physiology: Characteristics and physiological processes of cells from cell division to cell death. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH]

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Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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] 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] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [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 the passage of blood vessels and a nerve. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [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] 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] Chorda Tympani Nerve: A branch of the facial (7th cranial) nerve which passes through the middle ear and continues through the petrotympanic fissure. The chorda tympani nerve carries taste sensation from the anterior two-thirds of the tongue and conveys parasympathetic efferents to the salivary glands. [NIH] Chorioretinitis: Inflammation of the choroid in which the sensory retina becomes edematous and opaque. The inflammatory cells and exudate may burst through the sensory retina to cloud the vitreous body. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye

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between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [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] 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] 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] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all

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codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] 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] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] 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] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the

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alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] 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] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] 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] 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] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [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] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [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]

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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]

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] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried 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] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Coxsackievirus Infections: A heterogeneous group of infections produced by coxsackieviruses, including herpangina, aseptic meningitis, a common-cold-like syndrome, a non-paralytic poliomyelitis-like syndrome, epidemic pleurodynia, and a serious myocarditis. [NIH] Coxsackieviruses: A heterogeneous group of the genus enterovirus found in association with various diseases in man and other animals. Two groups (A and B) have been identified with a number of serotypes in each. The name is derived from a village in New York State

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where the virus was first identified. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Crete: A rotary prism, especially one designed with a sliding indicator on a long, radially protruding handle. [NIH] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [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] Cysteinyl: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cystitis: Inflammation of the urinary bladder. [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] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [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]

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Dark Adaptation: Adjustment of the eyes under conditions of low light. The sensitivity of the eye to light is increased during dark adaptation. [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] Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] 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] 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] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [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] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three

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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] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] Deoxyguanosine: A nucleoside consisting of the base guanine and the sugar deoxyribose. [NIH]

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] DES: Diethylstilbestrol. 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] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Dialysis Solutions: Solutions prepared for exchange across a semipermeable membrane of solutes below a molecular size determined by the cutoff threshold of the membrane material. [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] 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]

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Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] 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]

Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [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] 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] Dihydrotestosterone: Anabolic agent. [NIH] Dihydroxy: AMPA/Kainate antagonist. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] 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] 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] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU]

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Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [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] 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] 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] Duke: A lamp which produces ultraviolet radiations for certain ophthalmologic therapy. [NIH]

Duodenum: The first part of the small intestine. [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]

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] Dyspareunia: Painful sexual intercourse. [NIH]

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Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dystrophin: A muscle protein localized in surface membranes which is the product of the Duchenne/Becker muscular dystrophy gene. Individuals with Duchenne muscular dystrophy usually lack dystrophin completely while those with Becker muscular dystrophy have dystrophin of an altered size. It shares features with other cytoskeletal proteins such as spectrin and alpha-actinin but the precise function of dystrophin is not clear. One possible role might be to preserve the integrity and alignment of the plasma membrane to the myofibrils during muscle contraction and relaxation. MW 400 kDa. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [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] 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] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] 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] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] 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] 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 replacement in the same or a new environment. The embryo is usually phase, i.e., a blastocyst. The process includes embryo or blastocyst transfer after in vitro fertilization and transfer of the inner cell mass of

environment and in the pre-nidation transplantation or the blastocyst. It is

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not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [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]

Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [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] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [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] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] 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

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routes. [NIH] Enhancer: Transcriptional element in the virus genome. [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] Enterocytes: Terminally differentiated cells comprising the majority of the external surface of the intestinal epithelium (see intestinal mucosa). Unlike goblet cells, they do not produce or secrete mucins, nor do they secrete cryptdins as do the paneth cells. [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]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach.

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[NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] 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] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] 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] Excitatory Amino Acid Agonists: Drugs that bind to and activate excitatory amino acid receptors. [NIH] Excitatory Amino Acids: Endogenous amino acids released by neurons as excitatory neurotransmitters. Glutamic acid is the most common excitatory neurotransmitter in the brain. Aspartic acid has been regarded as an excitatory transmitter for many years, but the extent of its role as a transmitter is unclear. [NIH] Excitotoxicity: Excessive exposure to glutamate or related compounds can kill brain neurons, presumably by overstimulating them. [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] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and 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

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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] Extracorporeal: Situated or occurring outside the body. [EU] Extrapyramidal: Outside of the pyramidal tracts. [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] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Faecal: Pertaining to or of the nature of feces. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [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] Fat Substitutes: Compounds used in food or in food preparation to replace dietary fats. They may be carbohydrate-, protein-, or fat-based. Fat substitutes are usually lower in calories but provide the same texture as fats. [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] Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Feeding Behavior: Behavioral responses or sequences associated with eating including modes of feeding, rhythmic patterns of eating, and time intervals. [NIH] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH]

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Fenfluramine: A centrally active drug that apparently both blocks serotonin uptake and provokes transport-mediated serotonin release. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [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] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] 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] 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] Fibronectins: Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [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] Food Preferences: The selection of one food over another. [NIH]

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Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Frameshift: A type of mutation which causes out-of-phase transcription of the base sequence; such mutations arise from the addition or delection of nucleotide(s) in numbers other than 3 or multiples of 3. [NIH] Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] 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] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating

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food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [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] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Expression Profiling: The determination of the pattern of genes expressed i.e., transcribed, under specific circumstances or in a specific cell. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Germ Layers: The three layers of cells comprising the early embryo. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] 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] 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] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

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Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [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] 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] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] 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] 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] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH]

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Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Goblet Cells: Cells of the epithelial lining that produce and secrete mucins. [NIH] Goiter: Enlargement of the thyroid gland. [NIH] Gonadal: Pertaining to a gonad. [EU] 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] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [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 replace diseased or injured tissue removed from another part of the body. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanine: One of the four DNA bases. [NIH] Guanosine Tetraphosphate: Guanosine 5'-diphosphate 2'(3')-diphosphate. A guanine nucleotide containing four phosphate groups. Two phosphate groups are esterified to the sugar moiety in the 5' position and the other two in the 2' or 3' position. This nucleotide serves as a messenger to turn off the synthesis of ribosomal RNA when amino acids are not

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available for protein synthesis. Synonym: magic spot I. [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] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [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 Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [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] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematogenous: Originating in the blood or spread through the bloodstream. [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] Hemodialysis Solutions: Solutions prepared for hemodialysis. The composition of the predialysis solution may be varied in order to determine the effect of solvated metabolites on anoxia, malnutrition, acid-base balance, etc. Of principal interest are the effect of the choice of buffers (e.g., acetate or carbonate), the addition of cations (Na+, K+, Ca2+), and addition of carbohydrates (glucose). [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or

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regional blood circulation. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoperfusion: Removal of toxins or metabolites from the circulation by the passing of blood, within a suitable extracorporeal circuit, over semipermeable microcapsules containing adsorbents (e.g., activated charcoal) or enzymes, other enzyme preparations (e.g., gel-entrapped microsomes, membrane-free enzymes bound to artificial carriers), or other adsorbents (e.g., various resins, albumin-conjugated agarose). [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatic Encephalopathy: A condition that may cause loss of consciousness and coma. It is usually the result of advanced liver disease. Also called hepatic coma. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Hepatocyte Growth Factor: Multifunctional growth factor which regulates both cell growth and cell motility. It exerts a strong mitogenic effect on hepatocytes and primary epithelial cells. Its receptor is proto-oncogene protein C-met. [NIH] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [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] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH] Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach

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to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Hip Fractures: Fractures of the femur head, the femur neck, the trochanters, or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region. For the fractures of the femur neck the specific term femoral neck fractures is available. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] 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] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] 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 therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human growth hormone: A protein hormone, secreted by the anterior lobe of the pituitary, which promotes growth of the whole body by stimulating protein synthesis. The human gene has already been cloned and successfully expressed in bacteria. [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 hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H,

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atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperammonemia: Metabolic disorder characterized by elevated level of ammonia in blood. [NIH] 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] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypergravity: Condition wherein the force of gravity is greater than or is increased above that on the surface of the earth. This is expressed as being greater than 1 g. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] 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] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypokalaemia: Abnormally low potassium concentration in the blood; it may result from potassium loss by renal secretion or by the gastrointestinal route, as by vomiting or diarrhoea. It may be manifested clinically by neuromuscular disorders ranging from weakness to paralysis, by electrocardiographic abnormalities (depression of the T wave and elevation of the U wave), by renal disease, and by gastrointestinal disorders. [EU] 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] 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

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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] Hypoxanthine: A purine and a reaction intermediate in the metabolism of adenosine and in the formation of nucleic acids by the salvage pathway. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [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] 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] 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] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] 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] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to

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prevent graft 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] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In 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] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [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 Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infant Nutrition: Nutrition of children from birth to 2 years of age. [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 Diarrhea: Diarrhea caused by infection from bacteria, viruses, or parasites. [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] 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

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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] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in 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] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] 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] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [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] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] 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

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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-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] International Agencies: International organizations which provide health-related or other cooperative services. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Fistula: Abnormal passage communicating with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [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] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] 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]

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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 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] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-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 from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoleucine: An essential branched-chain amino acid found in many proteins. It is an isomer of LEUCINE. It is important in hemoglobin synthesis and regulation of blood sugar and energy levels. [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] Kainic Acid: (2S-(2 alpha,3 beta,4 beta))-2-Carboxy-4-(1-methylethenyl)-3-pyrrolidineacetic acid. Ascaricide obtained from the red alga Digenea simplex. It is a potent excitatory amino acid agonist at some types of excitatory amino acid receptors and has been used to discriminate among receptor types. Like many excitatory amino acid agonists it can cause neurotoxicity and has been used experimentally for that purpose. [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] Keratinocyte growth factor: A substance that stimulates the growth of epithelial cells that

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line the surface of the mouth and intestinal tract. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Kidney Cortex: The outer zone of the kidney, beneath the capsule, consisting of kidney glomerulus; kidney tubules, distal; and kidney tubules, proximal. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] 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] Lactate Dehydrogenase: A tetrameric enzyme that, along with the coenzyme NAD+, catalyzes the interconversion of lactate and pyruvate. In vertebrates, genes for three different subunits (LDH-A, LDH-B and LDH-C) exist. [NIH] Lactation: The period of the secretion of milk. [EU] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

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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] 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] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [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] Library Services: Services offered to the library user. They include reference and circulation. [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] Ligases: A class of enzymes that catalyze the formation of a bond between two substrate molecules, coupled with the hydrolysis of a pyrophosphate bond in ATP or a similar energy donor. (Dorland, 28th ed) EC 6. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipid Peroxides: Peroxides produced in the presence of a free radical by the oxidation of unsaturated fatty acids in the cell in the presence of molecular oxygen. The formation of lipid peroxides results in the destruction of the original lipid leading to the loss of integrity

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of the membranes. They therefore cause a variety of toxic effects in vivo and their formation is considered a pathological process in biological systems. Their formation can be inhibited by antioxidants, such as vitamin E, structural separation or low oxygen tension. [NIH] Lipolysis: The hydrolysis of lipids. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [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] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [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] 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] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Luciferase: Any one of several enzymes that catalyze the bioluminescent reaction in certain marine crustaceans, fish, bacteria, and insects. The enzyme is a flavoprotein; it oxidizes luciferins to an electronically excited compound that emits energy in the form of light. The color of light emitted varies with the organism. The firefly enzyme is a valuable reagent for measurement of ATP concentration. (Dorland, 27th ed) EC 1.13.12.-. [NIH] 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

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involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] 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] 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] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with 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] 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]

Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked

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by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [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 with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Megestrol Acetate: A drug that belongs to the group of hormones called progestins, used as hormone therapy to block estrogen and to suppress the effects of estrogen and androgens. [NIH]

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] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those

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persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [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] Metabotropic: A glutamate receptor which triggers an increase in production of 2 intracellular messengers: diacylglycerol and inositol 1, 4, 5-triphosphate. [NIH] Metallothionein: A low-molecular-weight (approx. 10 kD) protein occurring in the cytoplasm of kidney cortex and liver. It is rich in cysteinyl residues and contains no aromatic amino acids. Metallothionein shows high affinity for bivalent heavy metals. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [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] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] 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] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milligram: A measure of weight. A milligram is approximately 450,000-times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] 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] 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]

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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]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] 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] 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] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter Studies: Controlled studies which are planned and carried out by several cooperating institutions to assess certain variables and outcomes in specific patient populations, for example, a multicenter study of congenital anomalies in children. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple Trauma: Physical insults or injuries occurring simultaneously in several parts of the body. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Proteins: The protein constituents of muscle, the major ones being ACTINS and

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MYOSIN. More than a dozen accessary proteins exist including troponin, tropomyosin, and dystrophin. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mycotoxins: Toxins derived from bacteria or fungi. [NIH] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myoclonus: Involuntary shock-like contractions, irregular in rhythm and amplitude, followed by relaxation, of a muscle or a group of muscles. This condition may be a feature of some central nervous systems diseases (e.g., epilepsy, myoclonic). Nocturnal myoclonus may represent a normal physiologic event or occur as the principal feature of the nocturnal myoclonus syndrome. (From Adams et al., Principles of Neurology, 6th ed, pp102-3). [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] 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 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] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neonatal Screening: The identification of selected parameters in newborn infants by various tests, examinations, or other procedures. Screening may be performed by clinical or laboratory measures. A screening test is designed to sort out healthy neonates from those not well, but the screening test is not intended as a diagnostic device, rather instead as epidemiologic. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH]

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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] Nephrologist: A doctor who treats patients with kidney problems or hypertension. [NIH] 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] Nervous System Diseases: Diseases of the central and peripheral nervous system. This includes disorders of the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscle. [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 Pathways: Neural tracts connecting one part of the nervous system with another. [NIH]

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] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] 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]

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Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neuroretinitis: Inflammation of the optic nerve head and adjacent retina. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] 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] Night Blindness: Anomaly of vision in which there is a pronounced inadequacy or complete absence of dark-adaptation. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] 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] 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] 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]

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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] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [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] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Olfaction: Function of the olfactory apparatus to perceive and discriminate between the molecules that reach it, in gas form from an external environment, directly or indirectly via the nose. [NIH] Olfactory Bulb: Ovoid body resting on the cribriform plate of the ethmoid bone where the olfactory nerve terminates. The olfactory bulb contains several types of nerve cells including the mitral cells, on whose dendrites the olfactory nerve synapses, forming the olfactory glomeruli. The accessory olfactory bulb, which receives the projection from the vomeronasal organ via the vomeronasal nerve, is also included here. [NIH] Olfactory Nerve: The 1st cranial nerve. The olfactory nerve conveys the sense of smell. It is formed by the axons of olfactory receptor neurons which project from the olfactory epithelium (in the nasal epithelium) to the olfactory bulb. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Oligopeptides: Peptides composed of between two and twelve amino acids. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [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] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [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] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU]

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Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [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 Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Organ 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] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [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] Osseointegration: The growth action of bone tissue, as it assimilates surgically implanted devices or prostheses to be used as either replacement parts (e.g., hip) or as anchors (e.g., endosseous dental implants). [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] 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] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment

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in a clinic or dispensary connected with the hospital. [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] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [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 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] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] 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] 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] 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

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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] Paneth Cells: Epithelial cells found in the basal part of the intestinal glands (crypts of Lieberkuhn). Paneth cells synthesize and secrete lysozyme and cryptdins. [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] 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] 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] Pathogen: Any disease-producing microorganism. [EU] 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] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)-

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L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [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] Performance status: A measure of how well a patient is able to perform ordinary tasks and carry out daily activities. [NIH] 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] 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] 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] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [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,

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constipation, vomiting, and moderate fever. [EU] Pesticides: Chemicals used to destroy pests of any sort. The concept includes fungicides (industrial fungicides), insecticides, rodenticides, etc. [NIH] 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] 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] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phlebotomy: The letting of blood from a vein. Although it is one of the techniques used in drawing blood to be used in diagnostic procedures, in modern medicine, it is used commonly in the treatment of erythrocytosis, hemochromocytosis, polycythemia vera, and porphyria cutanea tarda. Its historical counterpart is bloodletting. (From Cecil Textbook of Medicine, 19th ed & Wintrobe's Clinical Hematology, 9th ed) Venipuncture is not only for the letting of blood from a vein but also for the injecting of a drug into the vein for diagnostic analysis. [NIH] 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 the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylating: 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] Photoreceptor: Receptor capable of being activated by light stimuli, as a rod or cone cell of the eye. [NIH] Phototransduction: The transducing of light energy to afferent nerve impulses, such as takes place in the retinal rods and cones. After light photons are absorbed by the photopigments, the signal is transmitted to the outer segment membrane by the cyclic GMP second messenger system, where it closes the sodium channels. This channel gating ultimately

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generates an action potential in the inner retina. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [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] 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] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] 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] 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]

Pneumonia: Inflammation of the lungs. [NIH] Point Mutation: A mutation caused by the substitution of one nucleotide for another. This results in the DNA molecule having a change in a single base pair. [NIH]

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Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Poliomyelitis: An acute viral disease, occurring sporadically and in epidemics, and characterized clinically by fever, sore throat, headache, and vomiting, often with stiffness of the neck and back. In the minor illness these may be the only symptoms. The major illness, which may or may not be preceded by the minor illness, is characterized by involvement of the central nervous system, stiff neck, pleocytosis in the spinal fluid, and perhaps paralysis. There may be subsequent atrophy of groups of muscles, ending in contraction and permanent deformity. The major illness is called acute anterior p., infantile paralysis and Heine-Medin disease. The disease is now largely controlled by vaccines. [EU] 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] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Postural: Pertaining to posture or position. [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] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH]

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Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] 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] 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] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] 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] 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] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Program Development: The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development). [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

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severity. [EU] Promoter: A chemical substance that increases the activity of a carcinogenic process. [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] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [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] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] 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] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protein-Energy Malnutrition: The lack of sufficient energy or protein to meet the body's metabolic demands, as a result of either an inadequate dietary intake of protein, intake of poor quality dietary protein, increased demands due to disease, or increased nutrient losses. [NIH]

Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to

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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] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] 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] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] 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] 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] 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]

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] Pyloric Stenosis: Obstruction of the pyloric canal. [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

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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] 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] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] 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] Raphe Nuclei: Collections of small neurons centrally scattered among many fibers from the level of the trochlear nucleus in the midbrain to the hypoglossal area in the medulla oblongata. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and

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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, produce, etc., other substances. [EU] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] 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] Recessive gene: A gene that is phenotypically expressed only when homozygous. [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] Rectum: The last 8 to 10 inches of the large intestine. [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] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

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] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Rehydration Solutions: Fluids restored to the body in order to maintain normal waterelectrolyte balance. [NIH] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH]

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Renal Osteodystrophy: Decalcification of bone due to hyperparathyroidism secondary to chronic kidney 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] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residential Facilities: Long-term care facilities which provide supervision and assistance in activities of daily living with medical and nursing services when required. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [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] Retinitis: Inflammation of the retina. It is rarely limited to the retina, but is commonly associated with diseases of the choroid (chorioretinitis) and of the optic nerve (neuroretinitis). The disease may be confined to one eye, but since it is generally dependent on a constitutional factor, it is almost always bilateral. It may be acute in course, but as a rule it lasts many weeks or even several months. [NIH] Retinitis Pigmentosa: Hereditary, progressive degeneration of the neuroepithelium of the retina characterized by night blindness and progressive contraction of the visual field. [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] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] 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]

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Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] 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] 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] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rodenticides: Substances used to destroy or inhibit the action of rats, mice, or other rodents. [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] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Salmonellosis: Infection by salmonellae. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoplasmic Reticulum: A network of tubules and sacs in the cytoplasm of skeletal muscles that assist with muscle contraction and relaxation by releasing and storing calcium ions. [NIH]

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Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [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] Schistosome: Dermatitis caused by the snail parasite, Schistosoma cercariae. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] 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] Selenocysteine: A naturally occurring amino acid in both eukaryotic and prokaryotic organisms. It is found in tRNAs and in the catalytic site of some enzymes. The genes for glutathione peroxidase and formate dehydrogenase contain the TGA codon, which codes for this amino acid. [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]

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Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequela: Any lesion or affection following or caused by an attack of disease. [EU] 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] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [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] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] 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] Shigella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that ferments sugar without gas production. Its organisms are intestinal pathogens of man and other primates and cause bacillary dysentery. [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]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [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

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differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] 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] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [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 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] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic

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system. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [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] 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] 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]

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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] Sprue: A non febrile tropical disease of uncertain origin. [NIH] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [NIH] 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]

Standardize: To compare with or conform to a standard; to establish standards. [EU] Status Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Steatosis: Fatty degeneration. [EU] 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] 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] 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] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] 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

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disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] 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] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] 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 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] 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] 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] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [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]

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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] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tapeworm: A flatworm that is an endoparasite and belongs to the class Cestoda. [NIH] Taste Buds: Small sensory organs which contain gustatory receptor cells, basal cells, and supporting cells. Taste buds in humans are found in the epithelia of the tongue, palate, and pharynx. They are innervated by the chorda tympani nerve (a branch of the facial nerve) and the glossopharyngeal nerve. [NIH] Temperament: Predisposition to react to one's environment in a certain way; usually refers to mood changes. [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] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] 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] Thiamine:

3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2-

hydroxyethyl)-4-

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methylthiazolium chloride. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thioredoxin: A hydrogen-carrying protein that participates in a variety of biochemical reactions including ribonucleotide reduction. Thioredoxin is oxidized from a dithiol to a disulfide during ribonucleotide reduction. The disulfide form is then reduced by NADPH in a reaction catalyzed by thioredoxin reductase. [NIH] 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] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] 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] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] 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] Tic: An involuntary compulsive, repetitive, stereotyped movement, resembling a purposeful movement because it is coordinated and involves muscles in their normal synergistic relationships; tics usually involve the face and shoulders. [EU] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH]

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Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] 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] 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] 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] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] 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] 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] Transaminases: A subclass of enzymes of the transferase class that catalyze the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally a 2-keto acid). Most of these enzymes are pyridoxyl phosphate proteins. (Dorland, 28th ed) EC 2.6.1. [NIH]

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

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both local and systemic cellular immunity to nonimmune recipients. [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] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor 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] 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] Ultrasonography: The visualization of deep structures of the body by recording the

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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] Ultraviolet radiation: Invisible rays that are part of the energy that comes from the sun. UV radiation can damage the skin and cause melanoma and other types of skin cancer. UV radiation that reaches the earth's surface is made up of two types of rays, called UVA and UVB rays. UVB rays are more likely than UVA rays to cause sunburn, but UVA rays pass deeper into the skin. Scientists have long thought that UVB radiation can cause melanoma and other types of skin cancer. They now think that UVA radiation also may add to skin damage that can lead to skin cancer and cause premature aging. For this reason, skin specialists recommend that people use sunscreens that reflect, absorb, or scatter both kinds of UV radiation. [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] Uracil: An anticancer drug that belongs to the family of drugs called alkylating agents. [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]

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] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] 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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also

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called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [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]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vegetarianism: Dietary practice of consuming only vegetables, grains, and nuts. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [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] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vibrio: A genus of Vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Vibrio cholerae: The etiologic agent of cholera. [NIH] 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] 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] 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

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tissues of the host. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] 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] Volition: Voluntary activity without external compulsion. [NIH] War: Hostile conflict between organized groups of people. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xanthine: An urinary calculus. [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] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or

Dictionary 271

brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [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] Zebrafish: A species of North American fishes of the family Cyprinidae. They are used in embryological studies and to study the effects of certain chemicals on development. [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] 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]

273

INDEX A Abdomen, 145, 191, 200, 213, 216, 231, 235, 245, 246, 247, 261, 262, 265 Abdominal, 56, 72, 126, 191, 192, 211, 220, 231, 232, 236, 245, 246, 247 Abdominal Pain, 126, 191, 220, 236, 247 Abortion, 191, 251, 269 Acceptor, 191, 234, 245, 266 Acetylcholine, 32, 191, 204, 242 Acidity, 191, 248 Acidosis, 78, 108, 191 Acquired Immunodeficiency Syndrome, 9, 191 Actin, 191, 239, 240, 267 Activities of Daily Living, 191, 256 Acuity, 16, 191 Acute renal, 129, 191 Acyl, 13, 191 Adaptation, 24, 73, 129, 191, 210, 230, 242 Adduct, 61, 192 Adenine, 121, 192, 253 Adenocarcinoma, 192, 225 Adenosine, 192, 201, 228, 248, 264 Adenovirus, 41, 192 Adipocytes, 192, 234 Adipose Tissue, 112, 192 Adjustment, 45, 132, 135, 191, 192, 210 Adolescence, 192, 204, 246 Adolescent Nutrition, 130, 192 Adrenal Cortex, 192, 208, 217, 251 Adrenal Glands, 192, 194 Adrenergic, 56, 192, 213, 216, 263 Adverse Effect, 7, 15, 143, 192, 259 Aetiology, 63, 192 Afferent, 56, 192, 209, 218, 234, 248 Affinity, 43, 192, 193, 238, 260 Affinity Chromatography, 43, 192 Agarose, 192, 225 Age of Onset, 193, 267 Agonist, 46, 117, 122, 193, 213, 232 Airway, 151, 193 Albumin, 193, 225, 249 Alertness, 193, 201 Algorithms, 193, 199 Alimentary, 193, 212, 216, 246 Alkaline, 191, 193, 194, 201, 264 Alkylating Agents, 193, 268 Alleles, 193, 225

Allergen, 193, 211 Alternative medicine, 151, 193 Aluminum, 64, 193 Alveoli, 193, 211 Ameliorating, 116, 117, 121, 122, 193 Amenorrhea, 37, 193, 195, 250 Amino Acid Sequence, 194, 195 Ammonia, 145, 194, 222, 227, 268 Amniotic Fluid, 194, 221 Amyloidosis, 127, 194 Anabolic, 40, 53, 115, 144, 152, 194, 212 Anaemia, 82, 194, 237 Anaerobic, 194, 257, 259 Anaesthesia, 194, 195, 229 Analgesics, 173, 194 Analogous, 194, 266 Analytes, 9, 194 Anatomical, 194, 197, 204, 212, 215, 229, 258 Androgens, 192, 194, 208, 237 Anemia, 29, 48, 57, 71, 127, 151, 168, 175, 194, 201, 219, 236, 271 Anergy, 62, 194 Anesthesia, 116, 121, 193, 194 Aneurysm, 195, 269 Angiogenesis, 54, 195 Angiotensinogen, 195, 256 Animal model, 8, 9, 16, 19, 26, 27, 37, 50, 54, 119, 195 Anions, 193, 195, 232, 259 Anomalies, 195, 239 Anorexia, 19, 36, 46, 47, 53, 66, 78, 104, 130, 139, 140, 144, 145, 146, 195, 196, 220, 268 Anorexia Nervosa, 36, 47, 78, 130, 139, 144, 145, 195 Anosmia, 127, 195 Anovulation, 37, 195, 250 Anoxia, 117, 122, 195, 224 Antagonism, 195, 201, 264 Anthropometry, 17, 30, 66, 195 Antibacterial, 195, 261 Antibiotic, 195, 246, 261, 264 Antibodies, 26, 63, 195, 224, 226, 228, 236, 249 Antibody, 25, 192, 195, 196, 206, 224, 226, 228, 229, 232, 233, 237, 239, 254, 261, 271 Anticoagulant, 195, 252

274

Malnutrition

Anticonvulsants, 122, 195, 198 Antigen, 25, 192, 195, 206, 226, 227, 228, 229, 230, 237, 254 Anti-infective, 196, 227, 231 Anti-inflammatory, 38, 54, 100, 196, 208, 222 Anti-Inflammatory Agents, 196, 208 Antimicrobial, 172, 196 Antineoplastic, 48, 193, 196, 208 Antioxidant, 18, 23, 29, 55, 79, 118, 119, 196, 197, 245 Antiviral, 196, 231, 247 Anuria, 196, 233 Anus, 196, 200, 206 Anxiety, 19, 33, 116, 121, 196 Apathy, 118, 196 Apolipoproteins, 196, 235 Apoptosis, 13, 27, 54, 55, 196, 209 Appetite Stimulants, 144, 196 Applicability, 24, 112, 196 Aqueous, 113, 196, 198, 209, 227 Arachidonic Acid, 196, 214, 234, 252 Archaea, 196, 238 Arginine, 10, 114, 197, 242, 244 Aromatic, 24, 197, 238, 248 Arterial, 197, 204, 227, 252, 264 Arteries, 197, 200, 208, 235, 238, 265 Arterioles, 197, 200, 202, 238 Arteriovenous, 197, 238 Artery, 49, 127, 195, 197, 208, 253 Articular, 197, 244 Ascorbic Acid, 95, 197, 227 Aseptic, 197, 208, 244, 262 Aspartate, 117, 122, 197 Aspiration, 27, 28, 197 Assay, 28, 36, 62, 111, 112, 197, 228, 254 Asymptomatic, 30, 197, 245 Atrial, 33, 197 Atrial Fibrillation, 33, 197 Atrium, 197, 269 Atrophy, 6, 9, 116, 117, 118, 119, 122, 197, 241, 250 Attenuation, 9, 197 Auditory, 93, 197, 217 Autodigestion, 197, 245 Autoimmune disease, 115, 197 Autonomic, 12, 19, 27, 54, 127, 191, 197, 198, 209, 222, 241, 242, 247, 261, 263 Autonomic Nervous System, 19, 197, 241, 247, 261, 263 Autonomic Neuropathy, 27, 54, 198 Autoreceptors, 47, 198

Axons, 198, 211, 243, 244, 251 B Bacteremia, 198, 257 Bacterial Physiology, 192, 198 Bactericidal, 198, 217 Bacteriophage, 198, 257, 266, 270 Barbiturates, 198, 254 Basal cells, 198, 264 Base, 3, 6, 121, 192, 198, 209, 210, 211, 220, 224, 232, 233, 249, 264, 268 Base Sequence, 198, 220 Basement Membrane, 198, 217, 233 Basophils, 198, 223, 234 Behavioral Symptoms, 47, 198 Beta carotene, 93, 198 Bilateral, 198, 250, 256 Bile, 119, 145, 198, 199, 220, 226, 232, 235, 262 Bile Acids, 199, 262 Bile Acids and Salts, 199 Bile Pigments, 199, 232 Biliary, 199, 201, 246 Biliary Tract, 199, 201, 246 Bioassay, 18, 111, 199 Biochemical, 19, 42, 51, 55, 115, 120, 121, 193, 199, 233, 244, 259, 265 Biochemical reactions, 199, 265 Biological response modifier, 199, 230 Biological therapy, 199, 223 Biomarkers, 46, 199 Biotechnology, 63, 64, 93, 151, 163, 199 Biotransformation, 199 Bivalent, 199, 238 Bladder, 9, 198, 199, 207, 209, 229, 241, 252, 268 Blastocyst, 199, 207, 214, 249 Bloating, 56, 200, 221, 229, 236 Blood Coagulation, 200, 201, 219, 265 Blood Glucose, 200, 225, 230 Blood Platelets, 200, 259 Blood pressure, 12, 19, 128, 200, 202, 227, 239, 247, 250, 260 Blood vessel, 195, 200, 202, 204, 215, 222, 232, 235, 236, 238, 247, 260, 262, 264, 265, 269 Body Composition, 7, 17, 40, 43, 61, 112, 114, 200 Body Fluids, 199, 200, 219, 243, 260, 267 Body Mass Index, 40, 200 Bone Development, 52, 200 Bone Marrow, 200, 216, 221, 228, 236, 239, 260, 271

Index 275

Bone scan, 200, 258 Bowel, 57, 116, 126, 130, 146, 171, 200, 212, 230, 231, 233, 241, 247, 259, 262 Bowel Movement, 200, 212, 262 Brachytherapy, 200, 231, 232, 254, 271 Bradykinin, 200, 242, 249 Brain Stem, 200, 203 Branch, 187, 200, 204, 236, 243, 246, 253, 261, 264 Breakdown, 10, 109, 116, 201, 212, 220, 244 Breeding, 4, 61, 201 Bronchitis, 201, 205 Buccal, 201, 236 Buffers, 201, 224 Bulimia, 47, 139, 144, 201 Burns, 115, 120, 123, 201 Burns, Electric, 201 C Cachexia, 50, 53, 76, 104, 115, 171, 201 Cadmium, 28, 201 Cadmium Poisoning, 201 Caffeine, 130, 201, 253 Calcium, 62, 119, 120, 201, 206, 246, 257, 260, 264, 267, 270 Calculi, 201, 223 Caloric intake, 5, 12, 42, 110, 111, 128, 144, 201 Candidiasis, 4, 85, 201 Candidosis, 201 Capillary, 200, 202, 222, 269 Capsules, 202, 221, 222 Carbohydrate, 52, 111, 117, 129, 144, 202, 208, 218, 222, 250, 259 Carbon Dioxide, 110, 202, 249, 256, 268 Carcinogen, 120, 192, 202 Carcinogenic, 193, 202, 230, 243, 252, 262 Carcinoma, 202 Cardiac, 14, 93, 117, 122, 150, 197, 201, 202, 215, 216, 240, 245, 262 Cardiac arrest, 117, 122, 202 Cardiovascular, 9, 12, 18, 19, 34, 35, 44, 49, 71, 83, 115, 131, 198, 202, 234, 259, 261 Cardiovascular disease, 9, 35, 49, 71, 115, 131, 202 Cardiovascular System, 198, 202 Carnitine, 48, 119, 129, 202 Carotene, 198, 202, 256 Carotenoids, 198, 202 Carrier Proteins, 202, 249, 254 Carrier State, 128, 202 Catabolism, 32, 141, 202, 268 Catecholamine, 202, 213

Catheter, 202, 231 Catheterization, 202, 231 Cathode, 203 Cations, 31, 203, 224, 232 Caudal, 203, 212, 227, 250 Causal, 47, 59, 203 Cause of Death, 60, 76, 203 Celiac Disease, 130, 203 Cell, 9, 18, 23, 25, 27, 31, 33, 39, 41, 42, 54, 61, 62, 69, 111, 112, 113, 115, 117, 118, 120, 122, 126, 143, 174, 191, 193, 196, 197, 198, 199, 202, 203, 205, 206, 209, 210, 211, 212, 214, 215, 217, 220, 221, 223, 225, 226, 228, 230, 231, 232, 233, 234, 237, 238, 239, 240, 242, 243, 245, 248, 249, 252, 253, 255, 256, 258, 259, 260, 264, 265, 266, 267, 270 Cell Adhesion, 203, 230 Cell Count, 41, 203 Cell Death, 196, 203 Cell Differentiation, 33, 111, 203, 260 Cell Division, 198, 203, 223, 237, 238, 249, 252 Cell membrane, 115, 117, 122, 202, 203, 211, 220, 232, 248, 260 Cell motility, 203, 225 Cell Physiology, 42, 203 Cell proliferation, 203, 260 Cell Survival, 203, 223 Centrifugation, 15, 203 Cerebellar, 15, 203 Cerebellum, 15, 203 Cerebral, 21, 117, 122, 169, 200, 204, 208, 215, 216, 236, 265 Cerebral Palsy, 21, 204 Cerebrospinal, 39, 204 Cerebrospinal fluid, 39, 204 Cerebrovascular, 14, 202, 204 Cerebrum, 204 Character, 204, 210, 222 Chemotherapeutic agent, 126, 204 Chemotherapy, 83, 118, 172, 204 Child Development, 127, 204 Child Nutrition, 44, 58, 67, 102, 168, 204 Chin, 72, 78, 204, 237 Cholecystokinin, 46, 204 Cholera, 24, 116, 204, 269 Cholesterol, 18, 66, 68, 79, 130, 199, 204, 205, 208, 213, 227, 235, 258, 262 Cholesterol Esters, 204, 235 Cholinergic, 95, 204 Chondrocytes, 204, 219

276

Malnutrition

Chorda Tympani Nerve, 204, 264 Chorioretinitis, 204, 256 Choroid, 204, 256 Chromatin, 196, 205, 216 Chromosome, 205, 234 Chronic Disease, 35, 46, 49, 89, 201, 205 Chronic Obstructive Pulmonary Disease, 93, 110, 180, 205 Chronic renal, 14, 53, 57, 129, 140, 147, 172, 205, 250, 268 Chylomicrons, 205, 235 Cirrhosis, 23, 34, 63, 145, 205, 250 CIS, 43, 205, 256 Citrus, 197, 205 Clear cell carcinoma, 205, 211 Clinical Medicine, 205, 251 Clinical study, 205, 208 Clinical trial, 8, 21, 29, 38, 40, 57, 103, 104, 163, 205, 208, 213, 239, 252, 254 Clone, 43, 205 Cloning, 199, 205 Coagulation, 200, 205, 225, 249 Codon, 56, 205, 258 Coenzyme, 197, 206, 233 Cofactor, 31, 206, 252, 265 Cognition, 28, 116, 121, 206 Cohort Studies, 15, 206 Colitis, 144, 168, 206, 230 Collagen, 194, 198, 206, 218, 219, 221, 249 Collapse, 201, 206 Colloidal, 193, 206, 259 Colon, 119, 206, 213, 230, 233 Combination Therapy, 206, 217 Communicable disease, 206, 268 Complement, 206, 230, 249 Compliance, 29, 42, 59, 129, 207 Computational Biology, 163, 207 Computed tomography, 207, 258 Computer Simulation, 42, 207 Computerized tomography, 51, 207 Conception, 191, 207, 219, 251, 262 Concomitant, 22, 119, 207 Cone, 207, 248 Confounding, 34, 49, 207 Conjugated, 10, 199, 207, 225 Conjunctiva, 207, 230, 267 Connective Tissue, 197, 200, 206, 207, 219, 220, 221, 238, 256, 264 Consciousness, 194, 207, 210, 212, 213, 225, 262 Constipation, 130, 146, 153, 207, 248 Constitutional, 21, 207, 240, 256

Constriction, 207, 232 Consultation, 128, 207 Consumption, 20, 55, 70, 81, 109, 144, 207, 211, 220, 243, 245 Contamination, 126, 207 Contraindications, ii, 208 Control group, 23, 45, 54, 59, 208, 251 Controlled clinical trial, 80, 208 Controlled study, 38, 48, 65, 208 Convulsions, 116, 121, 208 Coordination, 15, 203, 208 Coronary, 49, 127, 168, 202, 208, 238 Coronary heart disease, 202, 208 Coronary Thrombosis, 208, 238 Cortex, 208, 216, 217 Cortical, 100, 208, 217, 258 Corticosteroid, 10, 208 Cortisol, 59, 193, 208 Coxsackievirus Infections, 39, 208 Coxsackieviruses, 208 Cranial, 203, 204, 209, 218, 222, 224, 241, 243, 244, 247, 267 Cranial Nerves, 209, 241 Creatinine, 169, 209, 233, 268 Creatinine clearance, 169, 209 Crete, 109, 209 Crowns, 209, 211 Curative, 209, 242, 257, 264 Cutaneous, 201, 209, 235 Cyanide, 117, 122, 209 Cyclic, 201, 209, 224, 242, 248, 258, 264 Cysteinyl, 119, 209, 238 Cystine, 24, 61, 114, 209 Cystitis, 117, 122, 209 Cytokine, 28, 41, 42, 50, 59, 209 Cytomegalovirus, 144, 209 Cytoplasm, 196, 198, 203, 209, 216, 223, 238, 239, 257 Cytosine, 121, 209, 253 Cytoskeleton, 209, 230 Cytotoxic, 209, 254, 260 Cytotoxicity, 54, 209, 233 D Dairy Products, 209, 258 Dark Adaptation, 17, 210 Data Collection, 18, 57, 58, 210 Day Care, 126, 210 De novo, 121, 210 Deamination, 210, 268 Decidua, 210, 249 Defense Mechanisms, 210, 230

Index 277

Degenerative, 117, 119, 120, 122, 210, 225, 244 Dehydration, 38, 76, 78, 116, 118, 145, 151, 173, 204, 210 Dehydroepiandrosterone, 50, 210 Deletion, 52, 61, 196, 210 Delivery of Health Care, 210, 224 Delusions, 210, 253 Dementia, 14, 33, 117, 122, 130, 146, 191, 210 Dendrites, 210, 211, 241, 243 Density, 110, 111, 200, 203, 210, 213, 235, 243 Dental Abutments, 210, 211 Dental Care, 128, 210 Dental Caries, 179, 210 Dentate Gyrus, 210, 226 Dentists, 128, 211 Dentition, 33, 137, 211 Dentures, 5, 211 Deoxyguanosine, 23, 211 Depolarization, 211, 260 Depressive Disorder, 181, 211 Deprivation, 9, 42, 60, 211 DES, 9, 211 Desensitization, 17, 211 Detoxification, 78, 119, 211 Deuterium, 211, 227 Developing Countries, 58, 67, 101, 119, 120, 131, 132, 133, 136, 138, 211 Diabetes Mellitus, 9, 49, 71, 90, 115, 141, 176, 179, 211, 222, 225 Diagnostic procedure, 107, 152, 211, 248 Dialysate, 4, 5, 17, 29, 127, 152, 211 Dialysis Solutions, 29, 211 Dialyzer, 152, 211, 224 Diaphragm, 9, 211, 225 Diarrhoea, 72, 132, 212, 220, 227 Diastolic, 212, 227 Diencephalon, 212, 227, 265 Dietary Fats, 212, 218 Dietary Fiber, 128, 212 Dietitian, 5, 145, 146, 152, 212 Digestion, 56, 140, 145, 193, 199, 200, 212, 214, 221, 229, 231, 235, 262 Digestive system, 105, 126, 212 Digestive tract, 198, 212, 260 Dihydrotestosterone, 212, 255 Dihydroxy, 121, 212 Dilatation, 191, 195, 212, 251, 269 Dilatation, Pathologic, 212, 269 Dilation, 200, 212, 269

Dilution, 112, 212 Direct, iii, 15, 29, 47, 52, 109, 113, 119, 155, 205, 212, 213, 255, 263 Discrete, 21, 212, 235 Disease Progression, 5, 43, 55, 72, 130, 143, 212, 269 Disinfectant, 212, 217 Dissociation, 29, 46, 192, 212, 232 Dissociative Disorders, 212, 213 Distal, 27, 56, 213, 233, 247, 251, 253 Diuresis, 118, 201, 213, 264 Diverticula, 213 Diverticulitis, 130, 213 Diverticulum, 213 Dopamine, 141, 213, 242, 248 Dose-dependent, 213, 271 Double-blind, 29, 48, 213 Double-blinded, 29, 213 Drive, ii, vi, 32, 39, 87, 114, 168, 213, 232 Drug Interactions, 156, 213 Drug Tolerance, 213, 266 Duke, 4, 13, 20, 213 Duodenum, 198, 213, 220, 262 Dysentery, 213, 259 Dyslipidemia, 180, 213 Dyspareunia, 213, 217 Dyspepsia, 214, 229 Dysphagia, 170, 214 Dysphoric, 47, 211, 214 Dystrophin, 214, 240 Dystrophy, 79, 110, 214 E Eating Disorders, 18, 37, 46, 139, 144, 168, 174, 176, 214 Edema, 118, 214, 241, 268 Effector, 13, 191, 206, 214, 233 Effector cell, 214, 233 Efficacy, 12, 19, 29, 42, 54, 55, 59, 214 Eicosanoids, 141, 214 Elastic, 214, 222, 263 Elastin, 206, 214, 218 Elective, 128, 214 Electrolysis, 195, 203, 214 Electrolyte, 6, 27, 115, 128, 208, 214, 219, 233, 238, 243, 250, 255, 260, 268 Electroretinogram, 16, 214 Emaciation, 191, 214 Embryo, 26, 191, 199, 200, 203, 214, 219, 221, 229, 244, 251, 262 Embryo Transfer, 214, 251 Embryology, 126, 215 Emphysema, 146, 205, 215

278

Malnutrition

Empiric, 113, 215 Enamel, 210, 215 Encephalocele, 215, 241 Encephalopathy, 114, 215 Endemic, 25, 50, 59, 69, 204, 215, 236, 262 Endocarditis, 201, 215 Endogenous, 10, 28, 36, 53, 59, 60, 90, 109, 213, 214, 215, 217, 245, 252, 266 Endothelial cell, 54, 215, 219, 265 Endothelium, 30, 215, 242 Endothelium, Lymphatic, 215 Endothelium, Vascular, 215 Endothelium-derived, 215, 242 Endotoxin, 41, 215, 267 End-stage renal, 14, 29, 34, 53, 57, 66, 75, 79, 82, 89, 127, 140, 205, 215, 250 Energy balance, 11, 38, 215, 234 Energy Intake, 144, 153, 215 Enhancer, 62, 216 Enteral Nutrition, 85, 129, 216 Enterocytes, 119, 216 Entorhinal Cortex, 216, 226 Environmental Exposure, 118, 216, 243 Environmental Health, 14, 162, 164, 216 Enzymatic, 31, 194, 201, 202, 206, 210, 216, 226, 256 Enzyme Inhibitors, 216, 249 Eosinophils, 216, 223, 234 Epidemic, 39, 44, 139, 208, 216, 262 Epidemiological, 26, 42, 216 Epigastric, 216, 245 Epinephrine, 192, 213, 216, 242, 267 Epithelial, 60, 116, 119, 192, 210, 216, 223, 225, 232, 233, 246 Epithelial Cells, 60, 116, 119, 216, 225, 232, 233 Epithelium, 123, 198, 215, 216, 243 Erythrocytes, 194, 200, 216 Erythropoietin, 7, 29, 44, 152, 216 Esophagitis, 153, 216 Esophagus, 212, 216, 224, 248, 262 Estradiol, 49, 217 Estrogen, 48, 217, 237 Estrogen Replacement Therapy, 48, 217 Ethanol, 23, 55, 109, 217, 219 Eukaryotic Cells, 217, 229, 244, 267 Evacuation, 207, 217, 220, 233 Evoked Potentials, 93, 217 Excitatory, 116, 117, 121, 122, 217, 222, 232 Excitatory Amino Acid Agonists, 217, 232 Excitatory Amino Acids, 116, 117, 121, 122, 217

Excitotoxicity, 117, 122, 217 Excrete, 114, 196, 217, 233 Exhaustion, 195, 217, 236 Exocrine, 204, 217, 245 Exogenous, 36, 64, 199, 215, 217, 252, 267 External-beam radiation, 217, 232, 254, 270 Extracellular, 47, 54, 112, 207, 217, 218, 219, 230, 260, 264 Extracellular Matrix, 54, 207, 217, 219, 230 Extracellular Matrix Proteins, 54, 217 Extracellular Space, 217, 218 Extracorporeal, 108, 218, 225 Extrapyramidal, 213, 218 Eye Infections, 192, 218 F Facial, 204, 218, 261, 264 Facial Nerve, 218, 264 Faecal, 212, 218 Failure to Thrive, 139, 218 Family Planning, 163, 218 Fat Substitutes, 144, 218 Fatigue, 48, 126, 218, 224 Fatty acids, 16, 60, 193, 214, 218, 234, 252, 265 Fatty Liver, 145, 218 Febrile, 218, 236, 262 Feces, 27, 207, 218, 262 Feeding Behavior, 19, 37, 132, 218 Femoral, 93, 218, 226 Femoral Neck Fractures, 93, 218, 226 Femur, 93, 218, 226 Fenfluramine, 46, 219 Fermentation, 219, 257 Ferritin, 29, 219 Fertilization in Vitro, 219, 251 Fetal Development, 219, 241 Fetus, 25, 49, 191, 200, 216, 219, 249, 251, 262 Fibrin, 54, 200, 219, 247, 265 Fibrinogen, 219, 249, 265 Fibroblast Growth Factor, 118, 219 Fibroblasts, 219, 231 Fibronectins, 218, 219 Fibrosis, 12, 34, 50, 110, 120, 219, 258 Fistula, 219, 220 Flatus, 219, 220 Fluid Therapy, 219, 243 Folate, 55, 62, 219 Folic Acid, 55, 120, 219 Follicles, 25, 219 Food Preferences, 20, 219

Index 279

Foramen, 204, 220, 247 Forearm, 200, 220 Fossa, 203, 220 Frameshift, 56, 220 Fraud, 129, 220 Free Radicals, 119, 196, 212, 220 Fungi, 218, 220, 223, 238, 240, 265, 271 Fungus, 201, 220 G Gallbladder, 191, 199, 204, 212, 220 Ganglia, 191, 220, 241, 247, 263 Gap Junctions, 220, 264 Gas, 49, 194, 202, 219, 220, 227, 229, 236, 242, 243, 259 Gastric, 27, 140, 197, 202, 220, 221, 224, 226 Gastric Emptying, 27, 140, 220, 221 Gastrin, 220, 226 Gastritis, 130, 153, 220 Gastroduodenal, 28, 220 Gastroenteritis, 77, 130, 220, 257 Gastrointestinal tract, 6, 28, 217, 221, 234, 259, 261, 267 Gastroparesis, 27, 141, 153, 221 Gastrostomy, 216, 221 Gelatin, 221, 222, 265 Gene Expression, 6, 14, 16, 25, 28, 31, 42, 56, 62, 221 Gene Expression Profiling, 14, 32, 221 Gene Therapy, 192, 221 Genetics, 13, 14, 221 Genital, 198, 205, 221 Genomics, 14, 221 Genotype, 35, 39, 221, 248 Germ Cells, 221, 237, 243, 245, 261, 264 Germ Layers, 200, 221 Gestation, 15, 19, 32, 49, 150, 221, 247, 249, 262 Gestational, 20, 61, 176, 221 Gestational Age, 61, 221 Gland, 192, 221, 245, 246, 249, 252, 258, 262, 265 Glomerular, 141, 221, 222, 231, 233, 255 Glomerular Filtration Rate, 141, 222, 233 Glomerulus, 221, 222, 233 Glossopharyngeal Nerve, 222, 264 Glucocorticoid, 36, 59, 92, 222 Glucose, 11, 12, 32, 37, 42, 69, 115, 116, 131, 140, 197, 200, 211, 222, 223, 224, 225, 230, 257, 261 Glucose Intolerance, 211, 222 Glucose tolerance, 32, 69, 222 Glucose Tolerance Test, 32, 222

Glutamate, 64, 123, 217, 222, 238 Glutamic Acid, 123, 219, 222, 242 Glutamine, 10, 31, 115, 116, 119, 120, 222 Glutathione Peroxidase, 23, 55, 61, 222, 258 Gluten, 203, 222 Glycine, 119, 194, 199, 222, 242 Glycogen, 145, 222 Glycolysis, 13, 223 Glycoprotein, 115, 216, 219, 223, 233, 265, 267 Glycosaminoglycans, 218, 223 Glycosidic, 121, 223 Goblet Cells, 216, 223 Goiter, 51, 223 Gonadal, 223, 262 Gout, 130, 223 Governing Board, 223, 251 Gp120, 223, 247 Grade, 20, 223 Graft, 68, 223, 226, 229 Gram-negative, 223, 257, 259, 269 Granule, 15, 211, 223, 257 Granulocytes, 223, 260, 270 Grasses, 219, 223 Gravis, 111, 112, 223 Growth factors, 54, 118, 129, 223 Guanine, 121, 211, 223, 253 Guanosine Tetraphosphate, 16, 223 Guanylate Cyclase, 224, 242 H Habitual, 28, 204, 224 Haptens, 192, 224, 254 Headache, 201, 224, 230, 250 Health Care Costs, 45, 53, 224 Health Education, 145, 224 Health Expenditures, 224 Health Policy, 59, 224 Health Services, 57, 94, 210, 224 Health Status, 22, 44, 224 Heart attack, 202, 224 Heart failure, 76, 83, 93, 146, 224 Heartburn, 130, 224, 226, 229 Hematogenous, 85, 224 Hemodialysis Solutions, 29, 224 Hemodynamics, 141, 224 Hemoglobin, 28, 41, 194, 216, 225, 232, 234 Hemoglobin A, 28, 225 Hemoperfusion, 127, 225 Hemorrhage, 224, 225, 262 Hemostasis, 127, 225, 230, 259

280

Malnutrition

Hepatic, 52, 113, 117, 122, 128, 145, 193, 222, 225, 235, 250 Hepatic Encephalopathy, 117, 122, 145, 225 Hepatitis, 23, 34, 89, 128, 145, 146, 225, 269 Hepatocellular, 23, 72, 225 Hepatocellular carcinoma, 23, 72, 225 Hepatocyte, 118, 225 Hepatocyte Growth Factor, 118, 225 Hepatotoxicity, 23, 225 Hereditary, 131, 223, 225, 241, 256 Heredity, 221, 225 Heterodimers, 225, 230 Heterogeneity, 192, 225 Heterozygotes, 61, 225 Hiatal Hernia, 130, 225 Hip Fractures, 218, 226 Hippocampus, 28, 211, 226, 263 Histamine, 226 Histidine, 113, 120, 226 Homeostasis, 24, 27, 31, 52, 60, 119, 131, 226, 261 Homologous, 193, 199, 221, 225, 226, 263 Hormonal, 5, 6, 16, 41, 50, 53, 152, 197, 208, 217, 226, 270 Hormonal therapy, 16, 226 Hormone therapy, 226, 237 Host, 11, 23, 28, 39, 46, 50, 54, 123, 198, 201, 202, 226, 228, 234, 268, 270 Human growth hormone, 38, 226, 261 Humoral, 141, 226 Humour, 226 Hybrid, 43, 205, 226 Hybridization, 25, 32, 226 Hybridomas, 226, 231 Hydrogen, 119, 191, 198, 201, 202, 211, 217, 222, 226, 227, 234, 239, 242, 243, 245, 248, 252, 265 Hydrogen Peroxide, 222, 227, 234 Hydrolysis, 117, 122, 199, 227, 232, 234, 235, 248 Hydrophobic, 227, 235 Hydroxyproline, 194, 206, 227 Hyperammonemia, 114, 227 Hyperbilirubinemia, 227, 232 Hypercholesterolemia, 213, 227 Hyperglycemia, 27, 227 Hypergravity, 15, 227 Hyperlipidemia, 174, 213, 227 Hypersensitivity, 193, 211, 227, 234, 257 Hypertension, 12, 31, 33, 49, 115, 127, 129, 131, 202, 224, 227, 241, 250, 268

Hypertriglyceridemia, 213, 227 Hyperuricemia, 115, 223, 227 Hypoglycemia, 116, 117, 121, 122, 227 Hypokalaemia, 72, 227 Hypotension, 208, 227 Hypothalamic, 12, 15, 36, 227 Hypothalamus, 12, 20, 53, 197, 212, 227, 249, 261, 265 Hypothyroidism, 15, 227 Hypoxanthine, 121, 228 Hypoxia, 117, 122, 228 I Id, 96, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181, 186, 188, 228 Ileal, 56, 228 Ileum, 228 Immune function, 5, 7, 35, 41, 61, 62, 104, 120, 228 Immune response, 24, 39, 41, 50, 194, 195, 197, 208, 224, 228, 260, 263, 268, 270 Immune Sera, 228 Immune system, 7, 11, 126, 130, 145, 199, 214, 228, 234, 236, 248, 268, 270 Immunity, 14, 24, 54, 60, 83, 90, 127, 191, 228, 267 Immunization, 68, 128, 173, 228 Immunoassay, 28, 111, 228 Immunocompromised, 128, 228 Immunodeficiency, 85, 112, 113, 130, 146, 171, 191, 228 Immunogenic, 228, 254 Immunoglobulins, 228, 249 Immunohistochemistry, 54, 56, 228 Immunologic, 30, 34, 43, 50, 221, 228, 254, 271 Immunology, 22, 26, 41, 192, 228 Immunosuppressive, 54, 222, 228 Immunotherapy, 199, 211, 228 Impairment, 14, 33, 54, 89, 118, 145, 218, 229, 237, 253 Implant radiation, 229, 231, 232, 254, 270 In situ, 36, 54, 229 In Situ Hybridization, 36, 54, 229 In vitro, 17, 25, 36, 52, 56, 60, 63, 214, 221, 229, 266 In vivo, 41, 43, 52, 54, 60, 63, 112, 221, 229, 235, 245, 265 Incision, 229, 231 Incontinence, 116, 117, 121, 122, 229 Indicative, 131, 229, 246, 269 Indigestion, 130, 229 Induction, 41, 61, 194, 229

Index 281

Infancy, 18, 32, 51, 62, 109, 130, 229, 257 Infant Mortality, 51, 89, 229 Infant Nutrition, 120, 229 Infarction, 208, 229, 238 Infection Control, 128, 229 Infectious Diarrhea, 176, 229 Infertility, 25, 37, 229 Inflammatory bowel disease, 146, 230 Influenza, 130, 230 Infusion, 10, 30, 38, 53, 230 Ingestion, 53, 114, 119, 120, 201, 222, 230, 250, 264 Inhalation, 230, 250 Initiation, 9, 16, 50, 57, 71, 140, 230, 266 Innervation, 127, 218, 230 Inositol, 230, 238, 258 Inotropic, 213, 230 Insecticides, 230, 248 Institutionalization, 20, 230 Insulin, 7, 27, 32, 37, 42, 49, 52, 69, 72, 73, 115, 118, 131, 152, 222, 230, 267 Insulin-dependent diabetes mellitus, 27, 230 Insulin-like, 7, 73, 118, 230 Integrins, 13, 230 Interferon, 28, 230, 231 Interferon-alpha, 230, 231 Interleukin-6, 54, 231 Intermittent, 219, 231, 235, 247 Internal Medicine, 8, 11, 29, 30, 55, 59, 62, 74, 231, 241 Internal radiation, 231, 232, 254, 270 International Agencies, 26, 231 Interstitial, 27, 110, 200, 218, 231, 232, 255, 270 Intestinal Fistula, 147, 231 Intestinal Mucosa, 119, 123, 203, 204, 216, 231 Intestine, 6, 27, 56, 199, 200, 231, 233 Intoxication, 120, 231 Intracellular, 31, 112, 201, 229, 230, 231, 238, 242, 250, 255, 258, 259 Intrahepatic, 55, 231 Intramuscular, 231, 246 Intraperitoneal, 6, 231 Intravenous, 29, 92, 115, 116, 230, 231, 246 Intrinsic, 56, 141, 192, 198, 231 Intubation, 28, 203, 231 Inulin, 222, 231 Invasive, 17, 144, 228, 231, 236 Involuntary, 6, 81, 231, 240, 255, 261, 265 Iodine, 4, 51, 127, 190, 231

Ion Channels, 232, 264 Ion Transport, 31, 232, 238 Ionization, 9, 232 Ionizing, 216, 232, 254 Ions, 6, 9, 191, 198, 201, 212, 214, 227, 232, 257, 260 Irradiation, 118, 130, 232, 271 Ischemia, 116, 121, 122, 197, 232 Isoleucine, 113, 232 J Jaundice, 66, 227, 232 Jejunostomy, 216, 232 Joint, 120, 126, 197, 232, 244, 263, 264 K Kainic Acid, 117, 122, 232 Kb, 162, 232 Keratinocyte growth factor, 118, 232 Keratolytic, 210, 233 Keto, 113, 233, 266 Kidney Cortex, 233, 238 Kidney Disease, 7, 53, 67, 69, 70, 71, 103, 105, 127, 128, 143, 144, 162, 172, 174, 175, 233, 256 Kidney Failure, 53, 145, 215, 233 Kidney Failure, Acute, 233 Kidney Failure, Chronic, 233 Kidney stone, 233, 268 Killer Cells, 233 Kinetic, 7, 17, 232, 233 L Labile, 52, 206, 233 Lactate Dehydrogenase, 54, 233 Lactation, 91, 93, 120, 233 Lag, 29, 62, 233 Laminin, 198, 218, 233 Large Intestine, 212, 231, 233, 255, 260 Laxative, 233, 261 Least-Squares Analysis, 234, 255 Leptin, 12, 36, 37, 53, 73, 234 Lethal, 198, 209, 234 Lethargy, 62, 114, 227, 234 Leucine, 16, 17, 24, 32, 113, 234 Leukocytes, 13, 30, 198, 200, 216, 223, 231, 234, 239, 267 Leukopenia, 234, 271 Leukotrienes, 196, 214, 234 Library Services, 186, 234 Life Expectancy, 34, 234 Ligament, 234, 252 Ligands, 47, 230, 234 Ligases, 10, 234 Likelihood Functions, 234, 255

282

Malnutrition

Linear Models, 234, 255 Linkage, 33, 234 Lipid, 23, 55, 74, 115, 129, 196, 230, 233, 234, 235, 245 Lipid Peroxidation, 23, 55, 234, 245 Lipid Peroxides, 23, 234 Lipolysis, 36, 235 Lipoprotein, 60, 213, 223, 235 Liver cancer, 23, 120, 235 Liver Cirrhosis, 23, 235 Liver scan, 235, 258 Liver Transplantation, 145, 235 Lobe, 226, 235 Localization, 228, 235 Localized, 194, 210, 214, 229, 233, 235, 249, 267 Logistic Models, 235, 255 Long-Term Care, 20, 46, 235 Loop, 10, 26, 41, 235 Low-density lipoprotein, 213, 235 Luciferase, 62, 235 Lumen, 119, 215, 235 Lupus, 115, 235, 264 Lymph, 215, 226, 236 Lymphatic, 215, 229, 236, 238, 260, 261, 265 Lymphatic system, 236, 261, 265 Lymphocyte, 41, 191, 196, 233, 236, 237 Lymphocyte Count, 191, 236 Lymphoid, 195, 236 Lysine, 24, 113, 236 Lytic, 62, 236, 259, 270 M Macrophage, 13, 236 Magnetic Resonance Imaging, 236, 258 Malabsorption, 43, 74, 93, 111, 126, 130, 146, 153, 203, 236, 259 Malabsorption syndrome, 236, 259 Malaria, 82, 83, 120, 236 Malaria, Falciparum, 236 Malaria, Vivax, 236 Malignant, 9, 62, 191, 192, 196, 235, 236, 241, 254 Manic, 236, 253 Manic-depressive psychosis, 236, 253 Manifest, 140, 237 Mastication, 237, 267 Meat, 212, 237, 258 Medial, 46, 237, 244 Mediate, 26, 36, 43, 117, 122, 213, 233, 237 Mediator, 50, 90, 204, 237, 259 Medical Staff, 213, 237

MEDLINE, 163, 237 Megaloblastic, 219, 237 Megestrol Acetate, 104, 237 Meiosis, 199, 237, 263 Melanin, 12, 237, 248, 267 Memory, 28, 33, 195, 210, 237 Meninges, 203, 237 Meningitis, 208, 237 Menopause, 175, 237, 250 Menstruation, 193, 210, 237, 243 Mental, iv, 7, 33, 51, 89, 94, 100, 105, 114, 118, 126, 145, 162, 164, 170, 179, 204, 206, 210, 212, 218, 228, 237, 253, 258, 268 Mental Disorders, 105, 237, 253 Mental Health, iv, 7, 105, 162, 164, 179, 237, 253 Mental Processes, 33, 212, 237, 253 Mentors, 26, 58, 237 Mesenchymal, 27, 238 Metabolic disorder, 53, 115, 223, 227, 238 Metabolite, 115, 120, 199, 238 Metabotropic, 117, 122, 238 Metallothionein, 28, 238 Methionine, 24, 55, 113, 238, 263 MI, 84, 190, 238 Microbe, 238, 266 Microbiology, 26, 31, 192, 238 Microcirculation, 30, 235, 238 Micronutrients, 4, 40, 59, 62, 238 Microorganism, 206, 238, 246, 270 Micro-organism, 210, 238, 249 Migration, 54, 123, 238 Milligram, 115, 238 Mineralocorticoids, 192, 208, 238 Mitosis, 196, 238 Mobilization, 10, 30, 238 Modeling, 7, 42, 62, 112, 127, 239 Modification, 17, 93, 131, 194, 239, 254, 271 Modulator, 28, 141, 239 Molecule, 62, 192, 196, 198, 206, 212, 214, 215, 223, 227, 239, 243, 245, 249, 254, 255, 259, 266, 269 Monitor, 93, 111, 140, 169, 209, 239, 242 Monoclonal, 226, 232, 239, 254, 271 Monocytes, 231, 234, 239 Mononuclear, 63, 69, 239, 267 Morphogenesis, 33, 239 Morphological, 49, 214, 220, 239 Morphology, 54, 95, 196, 239 Motility, 56, 239, 259 Motion Sickness, 239, 240

Index 283

Motivations, 4, 239 Motor Activity, 48, 208, 239 Mucins, 216, 223, 239, 257 Mucosa, 118, 123, 147, 236, 239 Multicenter Studies, 11, 239 Multicenter study, 239 Multiple Trauma, 123, 239 Muscle Contraction, 120, 214, 239, 257 Muscle Proteins, 9, 239 Muscular Dystrophies, 214, 240 Myalgia, 230, 240 Myasthenia, 111, 112, 240 Mycotoxins, 120, 240 Myenteric, 27, 56, 240 Myocarditis, 208, 240 Myocardium, 238, 240 Myoclonus, 116, 121, 122, 240 Myosin, 239, 240, 267 N Nasal Mucosa, 230, 240 Nasogastric, 216, 240 Natural killer cells, 18, 240 Nausea, 56, 110, 125, 152, 169, 220, 221, 229, 240, 268 NCI, 1, 104, 161, 205, 240 Neonatal, 15, 50, 78, 92, 172, 173, 229, 240 Neonatal period, 15, 240 Neonatal Screening, 51, 240 Neoplasia, 127, 240, 241 Neoplasm, 241 Neoplastic, 9, 226, 241 Nephrologist, 57, 241 Nephrology, 4, 38, 57, 68, 73, 76, 78, 79, 84, 89, 94, 95, 241 Nephropathy, 131, 233, 241 Nephrosis, 241 Nephrotic, 129, 241 Nephrotic Syndrome, 129, 241 Nervous System, 4, 39, 90, 117, 122, 126, 128, 191, 192, 197, 201, 203, 204, 217, 220, 222, 224, 234, 237, 240, 241, 242, 244, 247, 250, 259, 263, 264 Nervous System Diseases, 90, 241 Networks, 27, 45, 241 Neural, 14, 28, 57, 116, 121, 192, 215, 226, 241, 260 Neural Pathways, 57, 241 Neural tube defects, 14, 241 Neurodegenerative Diseases, 116, 121, 241 Neurologic, 117, 122, 138, 146, 215, 241 Neuromuscular, 110, 111, 191, 227, 241, 268

Neuromuscular Junction, 191, 241 Neuronal, 47, 116, 121, 122, 241 Neurons, 12, 29, 36, 52, 56, 92, 117, 122, 210, 211, 217, 220, 241, 243, 254, 263 Neuropathy, 39, 117, 122, 131, 198, 241, 247 Neuropeptide, 36, 241 Neurophysiology, 126, 211, 242 Neuroretinitis, 242, 256 Neurotoxicity, 232, 242 Neurotoxin, 49, 242 Neutrons, 232, 242, 254 Neutrophil, 30, 242 Nevirapine, 22, 242 Niacin, 120, 242, 267 Night Blindness, 242, 256 Nitric Oxide, 13, 72, 242 Nitrogen, 10, 17, 59, 109, 113, 116, 192, 194, 217, 222, 233, 242, 267 Non-nucleoside, 242 Norepinephrine, 192, 213, 242 Nuclear, 36, 62, 217, 242 Nucleic acid, 198, 209, 226, 228, 229, 242, 243, 253, 271 Nucleic Acid Hybridization, 226, 243 Nucleus, 46, 62, 196, 198, 205, 209, 211, 216, 217, 237, 239, 242, 243, 252, 254, 261 Nutrition Assessment, 67, 243 Nutritional Support, 20, 129, 139, 144, 147, 177, 221, 243 O Odour, 197, 243, 268 Olfaction, 49, 126, 243 Olfactory Bulb, 243 Olfactory Nerve, 126, 243 Oligomenorrhea, 243, 250 Oligopeptides, 116, 243 Oliguria, 233, 243 Oncogene, 225, 243 Oncogenic, 230, 243 Oocytes, 25, 243 Opacity, 210, 243 Operon, 16, 243, 256 Ophthalmologic, 213, 243 Opportunistic Infections, 146, 174, 191, 244 Opsin, 244, 256, 257 Optic Chiasm, 227, 244 Optic Nerve, 242, 244, 256 Organ Culture, 244, 266 Organelles, 203, 209, 239, 244 Ornithine, 114, 244

284

Malnutrition

Osmolality, 111, 244 Osmoles, 244 Osmosis, 244 Osmotic, 6, 193, 244, 259 Osseointegration, 200, 244 Osteoarthritis, 117, 122, 176, 244 Osteogenesis, 200, 244 Osteoporosis, 78, 130, 168, 171, 175, 176, 217, 244 Outpatient, 11, 150, 244 Ovariectomy, 92, 245 Ovaries, 245, 250, 259 Ovary, 217, 245 Ovulation, 195, 245 Ovum, 210, 221, 245, 251 Oxidants, 103, 119, 245 Oxidation, 13, 17, 32, 55, 191, 196, 199, 209, 222, 234, 245 Oxidation-Reduction, 199, 245 Oxidative Stress, 23, 29, 39, 55, 61, 245 Oxygen Consumption, 12, 245, 256 P Pacemaker, 245 Palate, 222, 245, 264 Palliative, 245, 264 Pancreas, 28, 52, 56, 120, 191, 199, 212, 230, 245, 261, 267 Pancreatic, 53, 70, 89, 131, 202, 204, 245 Pancreatic cancer, 53, 245 Pancreatitis, 81, 245 Paneth Cells, 216, 246 Paralysis, 227, 246, 250 Parasite, 246, 258 Parasitic, 126, 213, 246 Parathyroid, 152, 246, 257, 264 Parathyroid Glands, 246, 257 Parathyroid hormone, 152, 246 Parenteral, 4, 5, 28, 29, 34, 84, 85, 123, 127, 129, 140, 144, 145, 146, 171, 172, 215, 246 Parenteral Nutrition, 4, 84, 85, 123, 127, 129, 140, 144, 146, 171, 172, 246 Pathogen, 25, 39, 246 Pathogenesis, 33, 35, 39, 46, 55, 85, 131, 146, 246 Pathologic, 191, 196, 201, 208, 227, 246 Pathologic Processes, 196, 246 Pathophysiology, 8, 36, 246 Patient Education, 168, 184, 186, 190, 246 Pediatrics, 21, 27, 32, 39, 50, 58, 61, 65, 72, 74, 92, 94, 139, 174, 246 Pelvic, 246, 252 Pelvis, 191, 233, 245, 246

Penicillin, 195, 246, 269 Peptide, 9, 26, 36, 46, 52, 118, 194, 204, 219, 234, 246, 252, 265 Peptide T, 52, 246 Perception, 104, 207, 247 Perennial, 247, 267 Performance status, 48, 247 Perfusion, 169, 228, 247 Pericardium, 247, 264 Perinatal, 19, 22, 68, 79, 91, 229, 247 Peripheral blood, 69, 231, 247 Peripheral Nervous System, 241, 242, 247, 251, 261, 263 Peripheral Neuropathy, 39, 247 Peripheral Vascular Disease, 54, 247 Peritoneal, 4, 5, 6, 70, 73, 75, 77, 94, 95, 108, 127, 140, 168, 175, 211, 231, 247 Peritoneal Cavity, 140, 231, 247 Peritoneal Dialysis, 4, 5, 6, 70, 73, 75, 77, 94, 95, 108, 128, 168, 175, 211, 247 Peritoneum, 247 Peritonitis, 5, 247 Pesticides, 130, 230, 248 PH, 17, 74, 112, 248 Phagocyte, 245, 248 Pharmacokinetic, 248 Pharmacologic, 5, 37, 56, 194, 248, 266 Pharynx, 230, 248, 264 Phenotype, 27, 248 Phenylalanine, 24, 32, 113, 248, 267 Phlebotomy, 140, 248 Phospholipases, 248, 260 Phospholipids, 218, 230, 235, 248 Phosphorus, 62, 128, 201, 246, 248 Phosphorylated, 62, 121, 206, 248 Phosphorylating, 115, 248 Phosphorylation, 9, 41, 73, 121, 248 Photoreceptor, 16, 248, 257 Phototransduction, 16, 248, 258 Physical Examination, 139, 221, 249 Physiologic, 18, 19, 37, 56, 193, 219, 231, 237, 238, 240, 249, 255 Physiology, 4, 19, 27, 28, 53, 91, 126, 137, 241, 242, 249 Pigments, 199, 202, 249, 256 Pilot study, 45, 92, 249 Pituitary Gland, 208, 219, 249 Placenta, 20, 217, 249, 251 Plants, 201, 202, 205, 222, 231, 239, 242, 249, 257, 266, 267 Plasma, 7, 15, 17, 22, 46, 52, 53, 55, 69, 73, 79, 90, 108, 110, 112, 114, 115, 141, 193,

Index 285

195, 203, 204, 214, 215, 219, 221, 222, 225, 233, 238, 249, 256, 258, 259, 269 Plasma cells, 195, 249 Plasma protein, 114, 193, 215, 249, 259 Platelet Activation, 249, 260 Platelet Aggregation, 242, 249, 265 Platelets, 242, 249 Platinum, 235, 249 Pneumonia, 60, 64, 208, 249 Point Mutation, 16, 249 Poisoning, 117, 122, 125, 127, 130, 201, 220, 231, 240, 250, 257 Poliomyelitis, 208, 250 Polycystic, 115, 250 Polycystic Ovary Syndrome, 115, 250 Polysaccharide, 192, 196, 250, 252 Porphyria, 248, 250 Porphyria Cutanea Tarda, 248, 250 Portal Hypertension, 128, 250 Portal Vein, 250 Posterior, 203, 204, 222, 245, 250 Postmenopausal, 48, 175, 217, 244, 250 Postnatal, 20, 28, 52, 58, 79, 95, 250, 262 Postprandial, 56, 250 Postsynaptic, 46, 47, 117, 122, 250, 260, 264 Postural, 19, 250 Potassium, 72, 95, 113, 118, 128, 143, 227, 238, 250 Potentiating, 91, 250 Potentiation, 251, 260 Practice Guidelines, 164, 169, 172, 173, 174, 175, 176, 251 Precursor, 123, 195, 196, 198, 213, 214, 216, 242, 248, 251, 267, 269, 270 Pregnancy Outcome, 88, 251 Pregnancy Tests, 221, 251 Prenatal, 49, 58, 92, 179, 214, 251 Prenatal Care, 179, 251 Preoperative, 67, 147, 251 Presynaptic, 198, 242, 251, 264 Presynaptic Terminals, 198, 251 Prevalence, 5, 14, 23, 33, 38, 40, 49, 57, 78, 80, 89, 90, 94, 135, 140, 147, 251 Primary endpoint, 34, 48, 251 Probe, 15, 251 Problem Solving, 137, 251 Progesterone, 251, 262 Program Development, 44, 251 Progression, 5, 18, 34, 42, 46, 56, 129, 195, 251

Progressive, 35, 43, 53, 55, 203, 205, 210, 213, 217, 223, 233, 240, 241, 244, 249, 251, 255, 256 Promoter, 43, 60, 62, 252 Prophase, 199, 243, 252, 263 Prophylaxis, 22, 172, 252, 256, 268 Proportional, 244, 252 Prospective Studies, 34, 252 Prostaglandins, 196, 214, 252 Prostate, 35, 199, 252, 267 Protease, 56, 206, 252 Protein Binding, 43, 252 Protein S, 5, 10, 17, 31, 32, 36, 199, 224, 226, 252, 257, 264 Protein-Energy Malnutrition, 17, 59, 65, 68, 81, 83, 91, 93, 94, 103, 120, 138, 252 Proteinuria, 241, 252 Proteoglycans, 198, 218, 252 Protocol, 172, 174, 252 Protons, 227, 232, 252, 254 Protozoa, 126, 213, 238, 252, 253 Protozoal, 253 Protozoan, 125, 236, 253 Proximal, 21, 43, 56, 213, 233, 251, 253 Psychiatric, 19, 176, 177, 237, 253 Psychiatry, 47, 177, 253, 262 Psychic, 237, 253, 258 Psychology, 45, 58, 93, 212, 253 Psychosis, 116, 121, 221, 253 Puberty, 37, 50, 253 Public Health, 4, 22, 23, 27, 33, 38, 41, 58, 62, 69, 75, 90, 92, 131, 164, 253 Public Policy, 163, 253 Pulmonary, 51, 64, 110, 200, 207, 233, 234, 253, 263, 269 Pulmonary Artery, 200, 253, 269 Pulmonary Edema, 233, 253 Pulse, 214, 239, 253 Purines, 121, 198, 253 Pyloric Stenosis, 173, 253 Pyridoxal, 40, 253 Pyrimidines, 121, 198, 253 Q Quality of Life, 4, 12, 21, 27, 33, 43, 45, 48, 49, 51, 53, 71, 84, 140, 143, 254 R Race, 112, 113, 238, 254 Radiation, 216, 217, 220, 231, 232, 254, 258, 268, 270 Radiation therapy, 217, 231, 232, 254, 271 Radioactive, 200, 227, 229, 231, 232, 235, 242, 243, 254, 258, 271

286

Malnutrition

Radiography, 221, 254 Radioimmunoassay, 111, 254 Radioisotope, 254, 266 Radiolabeled, 232, 254, 271 Radiology, 51, 169, 254 Radiotherapy, 200, 232, 254, 271 Randomized, 11, 12, 22, 29, 34, 38, 40, 41, 45, 48, 51, 60, 65, 77, 214, 254 Randomized clinical trial, 12, 22, 51, 254 Raphe Nuclei, 92, 254 Reactive Oxygen Species, 23, 254 Reagent, 51, 235, 255 Reality Testing, 253, 255 Receptors, Serotonin, 255, 259 Recessive gene, 50, 255 Recombinant, 4, 38, 41, 255, 269 Rectum, 196, 200, 206, 212, 219, 220, 229, 230, 233, 252, 255 Reductase, 56, 255, 265 Refer, 1, 201, 206, 220, 235, 242, 253, 255, 266 Reflex, 56, 255 Refraction, 255, 261 Regeneration, 17, 219, 255 Regimen, 22, 42, 214, 255 Regression Analysis, 113, 255 Regurgitation, 224, 255 Rehydration, 31, 115, 116, 255 Rehydration Solutions, 116, 255 Reinfection, 50, 64, 255 Renal failure, 38, 53, 129, 140, 141, 255 Renal Osteodystrophy, 127, 256 Renin, 141, 195, 256 Repressor, 243, 256 Reproduction Techniques, 251, 256 Resection, 256, 259 Residential Facilities, 145, 256 Respiration, 202, 239, 256 Restoration, 209, 255, 256, 270 Retina, 17, 95, 204, 205, 242, 244, 249, 256, 257, 270 Retinal, 16, 207, 244, 248, 256, 257, 270 Retinitis, 16, 116, 121, 256 Retinitis Pigmentosa, 16, 256 Retinoids, 256, 270 Retinol, 40, 86, 256, 257 Rheumatism, 256 Rheumatoid, 111, 176, 245, 256, 257 Rheumatoid arthritis, 111, 176, 257 Rhodopsin, 17, 244, 256, 257 Riboflavin, 61, 190, 257 Ribonuclease, 36, 257

Ribose, 120, 192, 257 Ribosome, 257, 267 Rickets, 137, 257, 270 Risk factor, 10, 14, 23, 34, 35, 44, 47, 49, 51, 66, 69, 75, 82, 140, 143, 146, 150, 151, 235, 257 Rod, 16, 40, 248, 257, 259 Rodenticides, 248, 257 S Saliva, 127, 257 Salivary, 204, 209, 212, 218, 245, 257 Salivary glands, 204, 209, 212, 218, 257 Salmonella, 146, 220, 257 Salmonellosis, 63, 257 Saponins, 257, 262 Sarcoplasmic Reticulum, 120, 257 Saturated fat, 33, 258 Scans, 33, 258 Schistosome, 50, 258 Schizophrenia, 66, 116, 121, 122, 150, 258 Sclerosis, 116, 117, 121, 122, 258 Screening, 40, 43, 47, 50, 65, 88, 134, 178, 179, 205, 240, 258 Second Messenger Systems, 258 Secretion, 6, 27, 37, 119, 131, 141, 146, 208, 226, 227, 228, 230, 233, 238, 239, 258 Secretory, 6, 25, 56, 258, 264 Sedimentation, 203, 258 Seizures, 117, 122, 195, 258, 262 Selenium, 23, 39, 55, 61, 95, 258 Selenocysteine, 55, 61, 258 Semen, 252, 258 Senile, 145, 244, 259 Sepsis, 52, 76, 115, 120, 123, 151, 259 Sequela, 22, 259 Sequence Analysis, 39, 259 Sequence Homology, 247, 259 Serologic, 228, 259 Serotonin, 46, 47, 219, 242, 255, 259, 267 Serous, 215, 259 Serum Albumin, 34, 54, 254, 259 Sex Characteristics, 192, 194, 253, 259, 264 Sexually Transmitted Diseases, 130, 259 Sharpness, 259, 270 Shigella, 151, 259 Shock, 240, 259, 267 Short Bowel Syndrome, 111, 171, 259 Side effect, 4, 111, 117, 155, 157, 192, 199, 227, 259, 266 Signal Transduction, 9, 31, 42, 43, 230, 259 Skeletal, 41, 52, 95, 119, 120, 194, 240, 257, 260, 261, 267

Index 287

Skeleton, 191, 218, 232, 260 Skin test, 104, 260 Skull, 215, 241, 260, 264 Small intestine, 6, 56, 116, 119, 205, 213, 226, 228, 231, 240, 260, 269 Smooth muscle, 27, 201, 226, 260, 261, 263 Social Class, 49, 260 Social Environment, 254, 260 Social Isolation, 62, 260 Social Support, 58, 260 Social Work, 146, 260 Socioeconomic Factors, 7, 101, 118, 260 Sodium, 78, 95, 116, 128, 141, 223, 238, 248, 260 Sodium Channels, 248, 260 Solid tumor, 195, 260 Solitary Nucleus, 197, 261 Solvent, 217, 244, 261 Soma, 261 Somatic, 73, 192, 209, 222, 226, 237, 238, 247, 261 Somatostatin, 36, 261 Sorbitol, 109, 261 Spasm, 116, 121, 261, 264 Specialist, 182, 212, 261 Specificity, 41, 49, 192, 261 Spectrometer, 9, 261 Spectrum, 8, 11, 19, 46, 51, 261 Spina bifida, 241, 261 Spinal cord, 117, 122, 177, 200, 203, 204, 237, 241, 247, 255, 261, 263 Spleen, 194, 209, 236, 261 Spontaneous Abortion, 251, 262 Sporadic, 241, 250, 262 Sprue, 170, 262 Sputum, 42, 262 Staging, 258, 262 Standardize, 111, 262 Status Epilepticus, 73, 262 Steatosis, 218, 262 Stem Cells, 61, 216, 262 Sterile, 197, 246, 262 Sterility, 229, 262 Steroid, 146, 199, 208, 257, 262 Stillbirth, 251, 262 Stimulant, 201, 226, 262, 269 Stimulus, 213, 214, 217, 230, 232, 233, 255, 262, 265 Stomach, 27, 36, 191, 197, 212, 216, 220, 221, 222, 225, 226, 240, 247, 248, 260, 261, 262 Stool, 111, 206, 229, 233, 262

Stroke, 14, 105, 116, 117, 121, 122, 162, 202, 262 Stupor, 234, 262 Subacute, 229, 262 Subclinical, 14, 229, 258, 262 Subcutaneous, 118, 120, 192, 214, 246, 263 Subiculum, 226, 263 Subspecies, 261, 263 Substance P, 238, 258, 263 Substrate, 13, 216, 234, 263 Sulfur, 24, 217, 238, 263 Supplementation, 4, 5, 10, 28, 29, 38, 40, 48, 51, 56, 58, 60, 61, 62, 65, 73, 94, 95, 110, 144, 263 Suppression, 10, 25, 32, 34, 37, 56, 208, 263, 271 Surfactant, 60, 263 Survival Rate, 32, 263 Sympathetic Nervous System, 197, 263 Sympathomimetic, 213, 216, 242, 263 Symphysis, 204, 252, 263 Symptomatic, 245, 263 Synapse, 192, 241, 251, 263, 264, 267 Synapsis, 263 Synaptic, 29, 47, 117, 122, 242, 260, 263, 264 Synaptic Transmission, 117, 122, 264 Synergistic, 23, 41, 53, 264, 265 Systemic lupus erythematosus, 111, 264 Systolic, 227, 264 T Tapeworm, 125, 264 Taste Buds, 127, 264 Temperament, 19, 62, 264 Temporal, 28, 226, 264 Terminator, 205, 264, 271 Testis, 217, 264 Testosterone, 255, 264 Tetany, 246, 264 Tetracycline, 64, 264 Theophylline, 253, 264 Therapeutics, 156, 264 Thermal, 212, 242, 264 Thiamine, 189, 264 Thigh, 218, 265 Thioredoxin, 56, 265 Third Ventricle, 227, 265 Thoracic, 211, 265, 270 Thorax, 191, 265 Threonine, 24, 113, 247, 265 Threshold, 211, 227, 265 Thrombin, 219, 249, 252, 265

288

Malnutrition

Thrombomodulin, 252, 265 Thrombosis, 230, 252, 262, 265 Thromboxanes, 196, 214, 265 Thrush, 146, 201, 265 Thymus, 111, 228, 236, 265 Thyroid, 15, 51, 93, 146, 223, 227, 231, 246, 265, 267 Thyroid Gland, 223, 246, 265 Thyrotropin, 228, 265 Thyroxine, 193, 248, 265 Tic, 50, 265 Tin, 247, 249, 265 Tissue Culture, 61, 266 Tolerance, 48, 117, 222, 266 Tomography, 207, 258, 266 Tooth Preparation, 192, 266 Topical, 217, 227, 266 Toxic, iv, 118, 120, 193, 209, 216, 223, 228, 235, 241, 258, 266, 271 Toxicity, 14, 29, 118, 120, 129, 213, 266 Toxicokinetics, 266 Toxicology, 14, 61, 164, 266 Toxin, 64, 215, 266 Trace element, 5, 7, 95, 117, 129, 265, 266 Tracer, 24, 266 Trachea, 248, 265, 266 Transaminases, 64, 266 Transcriptase, 242, 266 Transcription Factors, 43, 266 Transduction, 9, 127, 259, 266 Transfection, 43, 62, 199, 221, 266 Transfer Factor, 228, 266 Translation, 9, 180, 194, 267 Translational, 57, 267 Translocation, 62, 85, 123, 267 Transmitter, 191, 198, 213, 217, 232, 237, 242, 267 Transplantation, 53, 68, 73, 76, 78, 84, 129, 171, 174, 205, 214, 228, 233, 267 Trauma, 10, 40, 115, 116, 117, 120, 121, 122, 126, 177, 216, 224, 246, 267 Trees, 108, 109, 267 Trigeminal, 126, 267 Trophic, 118, 267 Tropomyosin, 240, 267 Troponin, 240, 267 Tryptophan, 59, 113, 206, 259, 267 Tumor marker, 199, 267 Tumor Necrosis Factor, 72, 267 Tunica, 239, 267 Type 2 diabetes, 49, 131, 176, 267 Tyrosine, 24, 41, 114, 115, 213, 267

U Ubiquitin, 10, 267 Ulcer, 177, 267 Ultrasonography, 221, 267 Ultraviolet radiation, 213, 268 Unconscious, 210, 228, 268 Universal Precautions, 130, 268 Uracil, 121, 254, 268 Uraemia, 246, 268 Urea, 7, 17, 32, 109, 114, 127, 233, 244, 268 Urease, 109, 268 Uremia, 7, 77, 114, 126, 233, 255, 268 Urethra, 252, 268 Uric, 18, 223, 227, 253, 268 Urinary, 51, 116, 117, 121, 122, 201, 209, 229, 243, 268, 270 Urine, 51, 141, 196, 199, 209, 213, 229, 233, 243, 252, 257, 268 V Vaccination, 25, 268 Vaccine, 25, 26, 50, 252, 268 Vagina, 201, 211, 237, 268, 269 Vaginitis, 201, 269 Valine, 24, 113, 269 Vascular, 13, 14, 57, 120, 127, 204, 215, 229, 235, 238, 242, 249, 265, 269 Vasculitis, 246, 269 Vasodilation, 32, 141, 269 Vasodilator, 200, 213, 226, 269 Vasomotor, 217, 269 Vector, 61, 62, 266, 269 Vegetarianism, 130, 269 Vein, 54, 111, 195, 197, 231, 242, 248, 250, 269 Venous, 128, 197, 252, 269 Ventricle, 226, 253, 264, 265, 269 Ventricular, 127, 269 Ventricular Dysfunction, 127, 269 Venules, 200, 202, 215, 238, 269 Vertebrae, 261, 269 Veterinary Medicine, 163, 269 Vibrio, 24, 204, 269 Vibrio cholerae, 24, 204, 269 Villi, 269 Villous, 116, 203, 269 Viral, 23, 39, 56, 83, 120, 128, 219, 230, 243, 250, 266, 269, 271 Viral Hepatitis, 128, 269 Viral Load, 23, 269 Virulence, 266, 269 Virulent, 39, 270

Index 289

Virus, 23, 39, 45, 55, 64, 85, 112, 113, 130, 146, 171, 191, 198, 209, 216, 223, 231, 266, 269, 270 Visceral, 46, 52, 84, 197, 198, 209, 222, 247, 270 Visceral Afferents, 197, 222, 270 Visual Acuity, 16, 270 Visual field, 244, 256, 270 Vitamin A, 59, 60, 93, 230, 256, 270 Vitamin D, 41, 147, 257, 270 Vitreous, 204, 256, 270 Vitreous Body, 204, 256, 270 Vitro, 54, 56, 60, 270 Vivo, 41, 54, 60, 270 Volition, 231, 270 W War, 68, 75, 76, 90, 134, 151, 270

Weight Gain, 13, 104, 218, 270 White blood cell, 195, 234, 236, 240, 242, 249, 270 Windpipe, 248, 265, 270 Wound Healing, 13, 54, 81, 219, 230, 270 X Xanthine, 121, 270 Xenograft, 195, 270 X-ray, 17, 203, 207, 232, 242, 254, 258, 270 X-ray therapy, 232, 270 Y Yeasts, 201, 220, 248, 271 Z Zebrafish, 14, 271 Zidovudine, 22, 271 Zymogen, 252, 271

290

Malnutrition

Index 291

292

Malnutrition

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